Drugs for hepatic encephalopathy

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PHARMACOLOGY:

PHARMACOLOGY DRUGS FOR PATIENTS HAVING HEPATIC ENCEPHALOPATHY

INTRODUCTION:

INTRODUCTION BY: Dr. Mehak Ali

HEPATIC ENCEPHALOPATHY:

HEPATIC ENCEPHALOPATHY WHAT IS HEPATIC ENCEPHALOPATHY ? Hepatic means "of the liver" Encephalopathy means "a disorder of the brain” Hepatic encephalopathy (HE) is a brain disorder that is caused by liver damage. HE can be an acute (short-term) or chronic (long-term) condition and can be mild, moderate, or severe.

CAUSES OF HE:

CAUSES OF HE Disorders that affect the liver. Disorders that reduce liver function (such as cirrhosis or hepatitis ) Conditions in which blood circulation does not enter the liver. Dehydration Eating too much protein Electrolyte abnormalities (especially a decrease in potassium ) Bleeding from the intestines, stomach, or esophagus Infections Kidney problems Low oxygen levels in the body

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An important job of the liver is to change toxic substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged, these "poisons" may build up in the bloodstream. Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Many other substances may also build up in the body if the liver is not working well. They can cause damage to the nervous system. Hepatic encephalopathy may occur suddenly in people who previously had no liver problems when damage occurs to the liver. More often, the condition is seen in people with chronic liver disease.

SYMPTOMS:

SYMPTOMS Breath with a musty or sweet odor Change in sleep patterns Changes in thinking Confusion that is mild Forgetfulness Severe symptoms may include: Abnormal movements or shaking of hands or arms Agitation, excitement, or seizures (occur rarely) Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma. Slurred speech Slowed or sluggish movement

STAGES:

STAGES

TREATMENT:

TREATMENT Hospitalization is required. first step is to identify and treat any factors that may have caused hepatic encephalopathy Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Infections, kidney failure, and electrolyte abnormalities (especially potassium ) need to be treated.

DRUGS FOR THE TREATMENT OF HE:

DRUGS FOR THE TREATMENT OF HE Lactulose may be given to prevent intestinal bacteria from creating ammonia, and as a laxative to remove blood from the intestines. Neomycin may also be used to reduce ammonia production by intestinal bacteria. Rifaximin , a new antibiotic, is also effective in hepatic encephalopathy. Metronidazole , an antibiotic used to fight bacteria in your body

AVOID:

AVOID Medications containing ammonium (including certain antacids) should also be avoided. Sedatives, tranquilizers, and any other medications that are broken down by the liver should be avoided

LACTULOSE:

LACTULOSE

LACTULOSE:

LACTULOSE Lactulose /lac·tu·lose/ (lak´tu-lōs) a synthetic disaccharide used as a laxative and to enhance excretion or formation of ammonia in the treatment of hepatic encephalopathy . A synthetic disaccharide used as a cathartic and to enhance the excretion of ammonia in treatment of hepatic encephalopathy . A disaccharide of galactose and fructose formed when milk is heated

STURUCTURE :

STURUCTURE Generic Name: lactulose (LAK too lose) Brand names: Enulose, Generlac, Kristalose

Mechanism Of Action:

Mechanism Of Action >> Lactulose mechanism of action in humans Lactulose has three major effects: • It is prebiotic • It acts as an active laxative • It reduces blood ammonia levels >> Prebiotic >> Osmotically active laxative >> Reducing blood ammonia levels

How does it work?:

How does it work? Lactugal solution contains the active ingredient lactulose, which is a type of medicine called an osmotic laxative. (NB. Lactulose is also available without a brand name, ie as the generic medicine.) Lactulose has two quite different uses: treating constipation and, in higher doses, reducing a complication associated with liver disease called hepatic encephalopathy.

PowerPoint Presentation:

What is it used for? Constipation . Impairment of brain function caused by severe liver disease such as cirrhosis (hepatic encephalopathy and hepatic coma) . Not to be used in People with a blockage in their gut (intestinal obstruction). Inherited inability to metabolise galactose in the diet (galactosaemia). Pregnancy and breastfeeding This medicine is not known to be harmful if used during pregnancy or breastfeeding. However, as with all medicines, you should seek medical advice from your doctor before taking this medicine if you are pregnant or breastfeeding Side effects Excess gas in the stomach and intestines (flatulence). Abdominal cramps and diarrhea.

  Contraindications/Cautions :

Contraindications/Cautions Hyeres's. To drug/class/common. Galactosemia Caution if diabetes mellitus Caution if colorectal electrocautery procedures

Metronidazole (flagyl):

Metronidazole (flagyl)

What is metronidazole (Flagyl)?:

What is metronidazole (Flagyl)? Metronidazole is an antibiotic,antifungal.Treats bacterial and fungal infection. Brand Names: Flagyl, Flagyl 375, Flagyl ER Generic Name: metronidazole Synonyms: Metronidazole Hydrochloride Available as: Tablets Oral solution Suppositories Injection

Mechanism of Action: :

Mechanism of Action: Unionized metronidazole is readily taken up by anaerobic organisms and cells. Its selectivity for anaerobic bacteria is a result of the ability of these organisms to reduce metronidazole to its active form intracellularly. The electron transport proteins necessary for this reaction are found only in anaerobic bacteria. Reduced metronidazole then disrupts DNA's helical structure, thereby inhibiting bacterial nucleic acid synthesis. This eventually results in bacterial cell death. Metronidazole also has immunosuppressive and antiinflammatory actions, and it has been used in patients with rosacea. The antimicrobial actions of metronidazole alter the bacterial metabolism of bile acids in the GI tract, decreasing pruritus in patients with cholestasis secondary to primary biliary cirrhosis

Use:

Use Medical: Treatment of susceptible anaerobic bacterial and protozoal infections in the following conditions: amebiasis, symptomatic and asymptomatic trichomoniasis; skin and skin structure infections; CNS infections; intra-abdominal infections; systemic anaerobic infections; topically for the treatment of acne rosacea; used in combination with other agents (eg, tetracycline, bismuth subsalicylate, and an H2-antagonist) to treat duodenal ulcer disease due to Helicobacter pylori; also used in Crohn's disease and hepatic encephalopathy

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Overdosage/Toxicology Symptoms of overdose include nausea, vomiting, ataxia, seizures, peripheral neuropathy Treatment is symptomatic Side-effects What can I do if I experience this Feeling or being sick: Eat little and often. Stick to simple foods. Make sure you take your doses after a meal or a snack Changes in the way things taste, furred tongue, sore mouth: Ask your pharmacist to recommend a suitable oral hygiene product such as a mouthwash Lack of appetite: this should soon pass, but in the meantime choose food that you usually enjoy

Contraindications/Cautions :

Contraindications/Cautions Hypersens. To drug/class/compon. Pregnancy (single dose bacterial vaginosis use) Pregnancy 1st trimester (trichomoniasis use) Caution if blood dyscrasia Caution if hepatic impairment, severe Caution if CNS disorder.

NEOMYCIN:

NEOMYCIN

NEOMYCIN:

NEOMYCIN HISTORY: Neomycin was discovered in 1949 by the microbiologist Selman Waksman and his student Hubert Lechevalier at Rutgers University. It is produced naturally by the bacterium Streptomyces fradiae BRAND NAMES: ORAL: Mycifradin®Sulfate, Neo-fradin®, Neo-Tabs® TOPICAL: Mycifradin® Sulfate

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USES: Orally to prepare GI tract for surgery; topically to treat minor skin infections; treat diarrhea caused by E. coli ; adjunct in the treatment of hepatic encephalopathy CONTRAINDICATIONS: Hypersensitivity to neomycin or any component, or other amino glycosides; patients with intestinal obstruction. ANTIMICROBIAL ACTIVITY: Similar to other amino glycosides, neomycin has excellent activity against Gram-negative bacteria , and has partial activity against Gram-positive bacteria . Pseudomonas and streptococci are generally resistant.

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PHARMACOKINETICS: Drugs of neomycin group are poorly absorbed by gastrointestinal tract. After oral administration, the intestinal flora is suppressed or modified, and the drug is excreted in the feces. Excretion of any absorbed drug is mainly through glomerular filtration into urine. ADVERSE REACTIONS: 1% to 10%: Dermatologic: Dermatitis, rash, urticaria, erythema Local: Burning Ocular: Contact conjunctivitis <1%: Nausea, vomiting, diarrhea, neuromuscular blockade, ototoxicity, nephrotoxicity OVERDOSAGE/TOXICOLOGY : Symptoms of overdose (rare due to poor oral bioavailability) include; Ototoxicity Nephrotoxocity Neuromuscular toxicity

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MECHANISM OF ACTION : Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits PHARMACODYNAMICS: Absorption: Oral, percutaneous: Poor (3%) Distribution: V d : 0.36 L/kg Metabolism: Slight hepatic Half-life: 3 hours (age and renal function dependent) Time to peak serum concentration: Oral: 1-4 hours; I.M.: Within 2 hours Elimination: In urine (30% to 50% as unchanged drug); 97% of an oral dose eliminated unchanged in feces

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DOSAGE FORM: Cream, as sulfate: 0.5% (15 g) Injection, as sulfate: 500 mg Ointment, topical, as sulfate: 0.5% (15 g, 30 g, 120 g) Solution, oral, as sulfate: 125 mg/5 mL (480 mL) Tablet, as sulfate: 500 mg [base 300 mg]

RIFAXIMIN:

RIFAXIMIN

What is Rifaximin?:

What is Rifaximin? Rifaximin works differently from other antibiotics because it passes through your stomach and into your intestines without being absorbed into your blood stream. Because rifaximin treats only the intestinal tract, it will not treat infections of other parts of the body.Rifaximin is an antibiotic that fights bacterial infection only in the intestines. Rifaximin is used to treat travelers' diarrhea caused by E. coli in adults and children who are at least 12 years old. Most people get this infection by eating food or drinking fluids that have been contaminated with the bacteria. Rifaximin is also used to lower the risk of worsened brain function, or hepatic encephalopathy (he-PAT-ik en-SEF-a-LOP-ath-ee), in adults with liver failure. Brain function can be affected when the liver stops working and cannot remove toxic substances from the body. Rifaximin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about rifaximin?:

What is the most important information I should know about rifaximin? Rifaximin works differently from other antibiotics because it passes through your stomach and into your intestines without being absorbed into your blood stream. Because rifaximin affects only the intestinal tract, it will not treat infections of other parts of the body. You should not use take this medication if you are allergic to rifaximin or medications such as rifabutin (Mycobutin), rifampin (Rifater, Rifadin, Rifamate), or rifapentine (Priftin). Before you take rifaximin, tell your doctor if you have severe liver disease, diarrhea with fever, or diarrhea that is watery or has blood in it. Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Rifaximin will not treat a viral infection such as the common cold or flu, or any form of diarrhea that is caused by a virus. Call your doctor if your symptoms do not improve after 24 hours, or if they get worse while taking rifaximin. Rifaximin does not treat all bacterial forms of traveler's diarrhea.

What should I discuss with my healthcare provider before taking rifaximin?:

What should I discuss with my healthcare provider before taking rifaximin? You should not use take this medication if you are allergic to rifaximin or medications such as rifabutin (Mycobutin), rifampin (Rifater, Rifadin, Rifamate), or rifapentine (Priftin). If you have any of these other conditions, you may need a rifaximin dose adjustment or special tests: severe liver disease; diarrhea with a fever; or watery or bloody diarrhea. FDA pregnancy category C. It is not known whether rifaximin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether rifaximin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take rifaximin?:

How should I take rifaximin? Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Rifaximin can be taken with or without food. Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Rifaximin will not treat a viral infection such as the common cold or flu, or any form of diarrhea that is caused by a virus. Call your doctor if your symptoms do not improve after 24 hours, or if they get worse while taking rifaximin. Rifaximin does not treat all bacterial forms of traveler's diarrhea. Store at room temperature away from moisture and heat.

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What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 What should I avoid while taking rifaximin? Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking rifaximin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Rifaximin side effects:

Rifaximin side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using rifaximin and call your doctor at once if you have a fever or diarrhea that is watery or bloody. Less serious side effects are more likely, and may include: bloating, gas, stomach pain; feeling like you need to empty your bowel urgently; feeling like your bowel is not completely empty; nausea, vomiting, constipation; headache, dizziness; tired feeling; or swelling in your hands, feet, or torso. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 .

PowerPoint Presentation:

Usual Adult Dose for Traveler's Diarrhea:Rifaximin Dosing Information 200 mg orally 3 times a day for 3 days Usual Adult Dose for Hepatic Encephalopathy: 550 mg orally twice a day Usual Pediatric Dose for Traveler's Diarrhea: 12 years or older: 200 mg orally 3 times a day for 3 days What other drugs will affect rifaximin? There may be other drugs that can interact with rifaximin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

THANK YOU :

THANK YOU

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