RES & GIT

Cholinergic Anticholinergic Asthma TB drugs Peptic Ulcer Peptic ulcer 2 Emetics

drugs drugs (Atropine) is airway obstruction c/b
• release of mediator adenosine, LKT, IL 3,5,8 (spasm) >
Bronchodilators
Isoniazid PO or IV use In all type of TB
Aim:
1. Relieve pain (acid neutralization)
2. Heal ulcer (promote mucosal defense and suppress acid
PPI
Local:
- Mustard water
MOA: MOA:
• (edema)- Ifm > Anti-Ifm secretion) - Ipecac
CVS: transient bradycardia f/b tachycardia d/t vagal tone Static for resting bacteria and Cidal for rapid dividing ones - reversibly inhibit H+,K+ ATPase of gastric parietal cell and inhibit
CVS: decrease HR, FOC, conduction; Vd (M3) • (mucus) - mucolytics 3. Prevent recurrent (eradication of H. pylori) - Warm salt solution
inhibition Penetrate into macrophages and active for extra and Carbonic anhydrase
RES: Bs, BC, RR (M3) - Warfarin
RES: decrease Bs, decrease BC caused by mediators intracellular organisms - Decrease both basal and meal induced acid secretion, NSAID
GLN: Peristalsis, increase secretory activity Chemical mediator Antacids - Cupric sulphate (not use d/t toxicity)
GLN: inhibit GI motility & gastric acid secretion (high dose) induced acid secretion
URT: Urethral peristalsis, contract detrusor m/s, Is inhibited by cAMP and stimulated by cGMP MOA:
URT: uterine smm relaxation, decrease peristalsis of urethra SE:
decrease bladder capacity Neutralize acid and reduce acidity Central
EXO: block all secretion Xpt milk Peripheral neuropathy (promote excretion of B6) Use:
EXO: Stimulate secretion of glands cAMP Relive pain - Apomorphine (on CTZ)
EYE: Mydriasis, IOP increase Isoniazid induce hepatitis (loss appetite, NV, Jaundice) - GERD, reduce recurrence DU assc with H. pylori,
EYE: Miosis, IOP decrease Is inhibited by phosphodiesterase - Ipecacuanha (on CTZ, on gut)
CNS: excitatory effect, antiemetic, anti-Parkinsonism Hypersensitivity - Erosive gastric and esophagitis
Is stimulated by methylxanthine, β +, PGE, Na cromoglycate Use: in suspension form, tablet (chew)
- DOC for ZE$
Drugs that activate cholinergic receptor • Taken at least 1-3 hours after each meal Use:
Atropine poisoning DI:
cGMP • At bedtimes for uncomplicated ulcer - Acute poisoning by non-corrosive substance
 Diazepam (for excitement) inhibit metabolism of anticonvulsant and increase their Notes: need acidic pH to activate, taken 30 minute before meal
Bethanechol Is inhibited by anticholinergic drugs • Taken every 30 min for severe symptoms - Acute indigestion d/t excessive intake of food
 Charcoal (to adsorb drug) effects
SE:
Anti-Emetics
 Physostigmine (to reverse the effect) β2 + Mg and Al combination (balanced and sustained neutralizing
Use: Rifampicin - Nausea, abd pain, flatulence, constipation or diarrhea
- postop abdominal distention (decrease MOA & Use: action) - Subacute myopathy, arthralgia, headache, skin rash
CVS- Atropine (Tx of MI f/b sinus bradycardia) Use
peristalsis), • Inhibit DNA dependent RNA polymerase Enzyme - Long term : increase risk of bone fracture, infection
EYE- Atropine and Homatropine (to reverse miosis) Acute or non acute asthma NaHCO3 Anticholinergic and antihistamine block VC and Gut
- Gastric atony, Gastroparesis (delay (suppress initiation of RNA synthesis) - Hypergastrinemia
EYE- Tropicamide eye drop and cyclopentolate eye drop - Absorbed in BS D2 receptor antagonist, serotonin receptor antagonist: block CTZ and gut
emptying), • Inhibit growth of [Link], proteus, pseudomonas,
CNS- Hyoscine (motion sickness); SE: - Cause HTN, Na retention in renal insufficiency
- Congenital megacolon, urinary retention, Klebsiella, chlamydia, and pox virus DI: inhibit CYP
RES- Ipratropium and Tiotropium (inhale) - asthma, COPD Headache - CO2 release: belching, abd discomfort Anticholinergic:
inadequate emptying of bladder (postop, • Highly active against S. aureus (endocarditis, nasal
URT- Flavoxate, oxybutynin (relieve m/s spams c/b infection in Palpitation, tachycardia (reflex Vd)
chronic hypotonic, myogenic, neurogenic infection, osteomyelitis) , N. meningitidis, H. Drug promoting healing
cystitis) Fine tremor (beta 2 effect on smm) Al and Ca cause constipation Hyoscine (Scopolamine) SC dermal patch
bladder) influenzae (meningitis)
Other- organophosphorus poisoning and anesthetic pre-med to Mg cause diarrhea - Motion sickness (taken 1 hour before journey, last for 4 h)
Hypokalemia (K entry to skm) • Cidal for both intra and extracellular Mycobacteria Carbenoxolone Na
dry secretion
Pilocarpine, Cevimeline (TB and leprosy)
Aminophylline (theophylline + ethylenediamine) Mg trisilicate Antihistamine
SE: Use: PU, aphthous ulcer (topical)
Use: - SiO2 >> Adsorb pepsin >> gelatinous SiO2 >> demulcent
Dry mouth Note: absorption is impaired with food and PAS. It Promethazine - space motion sickness, morning sickness
- xerostomia (dry mouth), MOA: induces drug metabolizing enzyme or coat the mucosa SE: HTN, heart failure, hypokalemia
Blurred vision By Inhibiting PDE, increase cAMP >> decrease Ca influx >> Bd - Heart burn Diphenhydramine and dimenhydrinate - motion sickness, Meniere's disease
- Sjogren's $ (dry mouth, dry eye),
Dizziness and lightheadedness, fatigue By inhibiting Adenosine >> Bd (SE: drowsiness)
- glaucoma (IOP increase) SE: Bismuth
Urinary retention Anti-Ifm MOM
Constipation Harmless orange coloration of all body secretion D2 receptor antagonists
SE: - Osmotic cathartic Sub-carbonate, Sub-nitrate, Tri-potassium dicitratobismuthate
Cycloplegia (m/s paralysis) Hepatitis
- Cramps Use Flu like $ with Fever, chill
IOP increase Acute or long term asthma Al(OH)3 Phenothiazine, Chlorpromazine
- Urge to urinate or defecate Use:
Prevent nocturnal asthma - Heartburn Prochlorperazine, perphenazine (SE: drowsiness, hypotension (D2 Vc),
- Flushing Dyspepsia
CTR: Glaucoma, BPH Respiration of apneic preterm infants (by stimulating CNS) - Adsorb pepsin and Phosphate extrapyramidal effect)
- Excessive sweating, salivation Ethambutol Acute diarrhea
- Syncope, asthma, heart block - SE: constipation, Phosphate deficiency, OPO, Eradication of H. pylori (antibacterial effect)
Productive cough > cough stimulant SE: encephalopathy and myopathy in renal disease (Al excretion Metoclopramide
Drug cough > cough suppressant MOA: MOA:
CTR: GI: NV, abd pain with increase gastric secretion and enzymes (minimized Inhibit mycobacterial arabinosyl transferase (essential for less >> toxicity and deposition) SE:
by taking with food, antacid, water or milk) 5HT4 agonist
- Asthma polymerization of arabino-glycan component of cell wall) Black coloration of oral cavity and feces
Demulcents CNS: tremor, nervousness, insomnia, convulsion CaCO3 5HT3 antagonist
- HTH Long term use: ataxia, encephalopathy
CVS: palpitation, arrythmia - Cause hypercalcemia, nephrolithiasis, constipation, Milk D2 antagonist (antiemetic + prokinetic)
- Coronary insufficiency SE:
Use: alkali $
- Acid peptic disease No hepatotoxicity Sucralfate
symptom relieve in drug cough, reduce afferent impulse from Ipratropium (aerosol inhalation) - Release CO2 - belching Use: of metoclopramide
- Intestinal and urinary obstruction Visual toxicity (optic neuritis) decrease visual acuity
irritated pharyngeal mucosa 1. GERD (together antisecretory)
Hyperuricemia, peripheral neuritis MOA: 2. Pts with delayed gastric emptying (d/t post gastrectomy, DM
MAO: Simethicone, Dimethicone - Cross link and form a polymer that adhere to epithelial cell and
Expectorant Anticholinergic - Decrease foaming and esophageal reflux gastroparesis)
Notes; mechanical obstruction: tumor, scar Pyrazinamide: bactericidal at acidic pH ulcer for 6 hours at pH 4
Inhibit cGMP >> not release of chemical mediator >> Bd - Relieve flatulence 3. Give it to empty GIT and to do small bowel intubation, ER anesthesia
tissue, foreign tissue; functional obstruction: - Inhibit hydrolysis of mucosal protein
Guaiphenesin or glyceryl guaiacolate: and Labor
defect m/s function (decrease peristalsis); MOA:
Na & K citrate: these salt increase Bs Use DI: 4. Tx of vomiting d/t GI dis, cytotoxic drug, radiation, uremia-d/t toxin
bethanechol not use in constipation! It is converted in pyrazinoic acid by bacterial Use:
KI: increase Bs, irritate mucus membrane (make it to increase As adjunct to β2 + and steroid - decrease absorption of tetra, cipro d/t chelation of Mg, Al accumulation (block D2 receptor in area postrema)
further secretion) pyrazinamidase. It disrupts cell membrane metabolism and - Stress ulcer
ACH esterase inhibitors COPD - Decrease acidity (decrease absorption of ketoconazole, - Condition ass with mucosa inflammation not responding to acid
NH4 salt: reflex increase in Bs transport function SE:
sucralfate) suppression ( radiation oral mucositis, aphthous ulcer, bile reflux
Others: steam inhalation and proper hydration 1. Extrapyramidal $ in children and youth , Gynecomastia and
Neostigmine: reversible inhibitors SE: SE of anticholinergic SE: gastropathy, radiation proctitis, solitary rectal ulcer)
Drugs that decrease gastric secretion galactorrhea (D2 antagonist)
Hepatotoxicity 2. Drowsiness and fatigue
Use: Steroids: beclomethasone, budesonide, fluticasone, mometasone, Hyperuricemia SE: constipation and dry mouth
Bromhexine: mucolytic & muco-kinetic H2 blocker
Myasthenia gravis (autoimmune - Ab to Ach ciclesonide (inhale) Arthralgia
Useful when mucus is present CTR of Metoclopramide
receptor) Anorexia, nausea, fever, malaise DI : Antacid, H2 (-), PPI reduce its action; it inhibits absorption of
Cimetidine 1. Itst obstruction
To reverse action of NMBA MOA: phenytoin, digoxin, cimetidine, ketoconazole, fluoroquinolone
SE: rhinorrhea, lacrimation, nausea, gastric irritation 2. Perforation
Postop urinary retention Inhibit PLA2 >> inhibit eicosanoid synthesis
MOA: 3. Hemorrhage
To stimulate bowel after surgery Increase sensitivity of β receptors to Cat MDR TB Misoprostol
Ambroxol: metabolite of Bromhexine - Reversibly competing with H for binding to H2 receptor on
Acetyl cysteine, Carbocisteine: make sputum more viscid Gp 1: first line oral: P, E, R # EP$ d/t D2 antagonist effect on basal ganglia
Pyridostigmine: reversible inhibitor Use: Gp 2: injectable: kanamycin, Amikacin, Capreomycin, the basolateral membrane Use:
- Reduce volume and acidity, inhibit both basal and meal 1. Akathisia (urge to move constantly)
Crisis asthma (IV hydrocortisone) Streptomycin NSAID induced acid secretion
Codeine: induce acid secretion, decrease pepsin and IF 2. Dystonia (abnormal posture d/t involuntary m/s contraction)
Use: Nonacute asthma (oral prednisolone or other inhale) Gp 3: Fluoroquinolone (L, M, O) Erosive gastritis, mucosal hemorrhage
Standard antitussive 3. Parkinsonism (tremor, rigidity, slow movement)
Myasthenia gravis Gp 4: oral 2nd line: Ethionamide, Prothionamide,
Cough center is suppressed for 6 hours Use: 4. Tardive dyskinesia (repetitive involuntary facial movement)
SE: Cycloserine, PASA, PASS SE:
- PU 5. Bradykinesia (slowness of voluntary movement)
Physostigmine: reversible inhibitor, cross BBB, Oral candidiasis (Immunosuppressive) Gp 5: unclear role: clofazimine, linezolid, Amoxiclav, Diarrhea
SE: constipation, BC, avoid in children - Uncomplicated GERD 6. Tremor (involuntary rhythmic shaking)
decrease IOP Hoarseness of voice (d/t androgenic action) imipenem/ cilastatin, thioacetazone, clarithromycin Abd cramp
- Stress ulcer 7. Oculogyric crisis (uncontrolled upward eye movement)
Others: Abortion
Use: Nedocromil - Pre-anesthetic medication (to prevent acid reflux to lung) Abn vaginal bleeding
ethyl-morphine, - ZE$ (adjunct to PPI) 5HT3 antagonist Ondansetron, tropisetron, granisetron
Glaucoma
Pholcodine, - Systemic mastocytosis, basophilic leukemia
Improve Alzheimer type dementia MOA: CTR
Noscapine, Use:
Inherited ataxia Inhibit mediator release Pregnancy
Dextromethorphan (placebo), SE: - Vomiting d/t cytotoxic, radiation, post-op
Atropine poisoning Prevent BC not cause BD IBD
Chlophedianol (SE: dry mouth, vertigo, irritability) - Gynecomastia, loss of libido, impotency (antiandrogenic)
Reverse NMBA action Inhibit leukocyte trafficking
- Confusion, slurred speech, delirium, hallucination, headache SE:
Antihistamine (H1) - bradycardia and cardiac conduction defection (H2 on - Fatigue, malaise, constipation (serotonin increase peristalsis)
Edrophonium: reversible inhibitors Use
Long term prophylaxis of asthma heart)
Chlorpheniramine - Dae, drowsiness, fatigue, m/s pain, constipation
Use: Nasal spray: allergic rhinitis
Diphenhydramine Cannabinoids
To Dx Myasthenia gravis Eye drops: allergic conjunctivitis
Promethazine DI: inhibit CYPs MOA:
To differentiate between Myasthenia crisis and
- CB1 subtype of cannabinoid receptors on neuron and VC
cholinergic crisis LKT receptor (-) {Zafirlukast not recommend < 12 yrs , montelukast}
Use: Ranitidine: 10 x cimetidine, no antiandrogenic, not inhibit CYP
Relieve cough d/t its sedative action and anticholinergic Famotidine: 30 x cimetidine, Use:
SE Use:
Nizatidine: = Rani, - Vomiting due to cytotoxic
Depolarization block (overstimulation) Exercise induced asthma
Cholinergic crisis( overstimulation) Aspirin induce asthma
B6
CVS and CNS effect (confusion, drowsiness, Adjunct to steroid
- No specific
convulsion, coma) f/b depression Allergic rhinitis
- Placebo
- Use alone or with other in hyperemesis gravidarum (pregnancy)
Notes SE:
Alzheimer's dz Hepatic dys: F (rare)
Dexamethasone
- Donepezil Churg-Strauss $
- Unknown mechanism
- Rivastigmine
- Vomiting d/t cytotoxic
- Galantamine Omalizumab (Ig E (-))
Neurokinin 1 antagonist (aprepitant) - adjunct to Dexamethasone and 5HT4
Irreversible inhibitors (echothiopate) Use:
inhibitor
Moderate to severe persistent asthma
Use: glaucoma Other allergic disorder
Benzodiazepine (lorazepam and alprazolam)
- Vomiting d/t chemo, anxiety
Organophosphorus poisoning SE:
- Atropine 2 mg IV every 5-15 min util Injection site: red, stinging, bruise, induration
atropine toxicity sign appear
1. Vertigo (dizziness)
- Pralidoxime 2 g IV infusion (reactivate or Anti-IL 5
- Anticholinergic, phenothiazine (D2-)
(+P) ACH esterase) given within a few Use: eosinophilic asthma
- Acute attack - cyclizine (H2-), Prochlorperazine (D2-)
minute after poisoning
- Beta-histamine and cinnarizine (improve BF to inner ear in Meniere's
- Diazepam (control convulsion)
dz)
2. Motion sickness
- Hyoscine dermal patch
- Cinnarizine, cyclizine, dimenhydrinate, promethazine
3. d/t cytotoxic drug
- Ondansetron /+ dexamethasone
- Metoclopramide
4. Vomiting a/f GA
- Metoclopramide, haloperidol
5. In pregnancy
- Promethazine, Phenothiazine

Diarrhea
Aims: Amebicide Anthelmintics Drugs effecting on
- Correct fluid and electrolyte balance
- Eradicate causal
- Normalize flora
Luminal Tissue
• Diloxanide furoate • Metronidazole
Mechanism of Anthelmintics
1. Paralysis of the worm
2. Damage to surface membrane of worm
GI motility
- Decrease GI motility • Iodoquinol • emetin Domperidone
3. Interfere with metabolism of worms
• Paromomycin • chloroquine MAO:
Specific agent Benzimidazole: Mebendazole, Thiabendazole, - D2 (-) at the CTZ
- Acute Dae (adult) - Oral fluoroquinolone (cipro, o, nor, - Increase LES tone
DF: Albendazole
levo), Azithromycin and rifaximin, Cotrimoxazole
- Children: Azithromycin - Direct amoebicidal action
MOA: Use:
Non-specific agent - DOC for asymptomatic pts with cyst in feces
- Inhibit microtubule synthesis in nematode - Chronic dyspepsia
- Increase viscosity, coating, adsorb toxic substance - - Invasive mild itst amebiasis and extra-itst with
- Irreversibly impaired glucose uptake by - Promote Post partum lactation (D2 >> inhibit PRL)
Adsorbent powder (SE: blacken stool) other drugs
- SE: mild GI symptoms: flatulence, nausea, abd organism
- Decrease GI motility (opiate * anticholinergic) SE:
cramps, diarrhea, skin: pruritus
M: oral (fatty meal increase absorption) - Hyperprolactinemia, galactorrhea, gynecomastia (D2 >>
Opiate (loperamide, Diphenoxylate, Eluxadoline) - CTR: pregnancy and lactation
- Before or after meal, chew inhibit prolactin)
Iodoquinol - Ascariasis, Trichuriasis, hookworm,
- Ach cause GI motility Erythromycin for Constipation
- Direct amoebicidal trichostrongylus
- Loperamide - 2nd and 3rd trimester OK MAO
○ interfere with Ach release, - Topical for trichomonas vaginalis, Balantidiasis
- Hypersensitivity, elevation of liver enzyme - Stimulate motilin receptor in GI,
○ Not cross BBB - SE: iodism, subacute myelooptic neuropathy,
- Caution: pregnancy, lactation - Increase LES tone, stimulate bowel and gastric
○ Increase transit time peripheral polyneuritis with dysesthesia
contractility
- CTR: iodine intolerance
○ Increase anal sphincter tone A: oral (fatty meal increase absorption) >1yr old
○ Anti-secretory against cholera toxin child Use:
Paromomycin
- Diphenoxylate - Hookworm - Diabetic gastroparesis (hyperglycemia >> never damage
- AMG
○ Lomotil (diphenoxylate + atropine) - Cutaneous lava migran in Enteric Nerve plexus
- Asymptomatic and itst infection, eradication
- Eluxadoline - Visceral lava migran - Acute upper GI bleeding (promote gastric emptying of
of cyst
○ IBS + Dae - Hydatid dz blood)
- Hepatic coma and bacterial Dae
- Preparation of bowel before surgery - Strongyloidiasis
Anticholinergic - chronic Dae (not use in acute Dae in children) - SE: transient gastric distress, lassitude Lubiprostone
- SE : anorexia, NV, epigastric pain, abd cramps,
- CTR: cirrhosis, pregnancy MOA:
pruritus, diarrhea, malabsorption, overgrowth
Probiotics - CL channel 2 activator on apical membrane of S itst >>
of flora
- Prevent pathogenic bacteria from adhering T: oral after meal chew; promote Cl and fluid excretion and improve gut motility
- Compete with pathogen for nutrient Metronidazole - alternative to ivermectin for cutaneous lava
- Modify toxin receptor in gut wall migran (strongyloidiasis) Use:
- Its Nitro group accept electron and form
- Strength CD4+ T response - Anti-Ifm properties - Opioid induced Constipation
cytotoxic compound that binds to protein or
- Antipyretic - IBD with constipation
DNA result in cell death of amoeba
Others - Spectrum: - Antifungal
- Scabicide SE:
1. Anaerobic bacteria
Bile salt induced Dae - cholestyramine - SE: GI upset - N, D
2. Urogenital trichomonas
DM with chronic Dae - Clonidine - CTR: pregnancy and lactation - Headache, dyspnea
3. Entamoeba
Severe Dae d/t tumor in GIT and pancreas - Octreotide and SS 4. Giardia lamblia
Alosetron - IBS + Dae Pyrantel Pamoate Anti-spasmodic (Anticholinergic) Atropine, dicyclomine,
5. Balantidium coli
MOA: NMBA for parasite scopolamine
6. Blastocystic hominis
- Other Use
- Pinworm, ascariasis, hookworm Use:
1. Immunosuppressive
- IBD with diarrhea
2. Mutagenic
SE: - Relieve itst cramping and pain
3. Carcinogenic
Laxatives & - Use
1. Use With luminal amebicide
- GI upset

CTR:
Cathartics
2. Giardiasis, Balantidiasis, Trichomonas
vaginitis, Gardnerella vaginitis, - Pregnancy and < 2 yrs old
Anaerobic infection
- Promote defecation (soft stool {L}, fluid stool{C}) 3. acute ulcerative gingivitis, cancrum oris, Levamisole
decubitus ulcer, phagedenic leg ulcer MOA:
Bulk forming cathartics 4. Pseudomembrane colitis (C. difficile) - stimulate ganglion like structure in helminths
- Increase bulk by adsorb and retain water -- distension 5. H. pylori infection - Immunomodulating
of itst stimulate peristalsis - SE: - Restore impaired cellular response
- Take with a full glass 1. Metallic, bitter taste Use:
2. Dark urine - Anthelminthics
Use: 3. Minor GI disturbance - Immunomodulator (adjunct to malignancy,
1. Functional Cstp 4. CNS - headache, insomnia, Diz, ataxia, rheumatoid arthritis, Crohn's disease)
2. Meckel's diverticulum vertigo SE:
3. IBD-Cstp - DI - Rash
4. Colostomies 1. Not to use alcohol 1 days before - Influenza like illness
5. Bile salt induced diarrhea! starting and for 2 days after the last - mouth ulcer
6. Suppress appetite (fill the stomach) dose
SE: 2. Increase coumarin effect Ivermectin
1. Lazy bowel 3. Increase lithium toxicity - DOC for Onchocerciasis, strongyloidiasis
2. Obstruction (if less water) - Caution - Ascariasis, enterobiasis, trichuriasis
1. Hepatic impairment and encephalopathy - Potentiate GABA and cause paralysis,
Osmotic cathartics (MOM, Mg sulphate, Mg citrate, Na 2. Pregnancy and lactating hyperpolarization
phosphate) 3. Pediatric - CTR :pts with co-infected with Loasis
- Draw fluid (increase stool liquidity) increase peristalsis 4. Active dz of CNS

Use: Tx of acute Cstp, Prevent chronic Cstp Diethylcarbamazine

- Hyperpolarization
SE: fluid loss; toxicity in renal failure - DOC for microfilariae, Loa loa, Wuchereria
- SE: NV, encephalopathy

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SE: 2. Increase coumarin effect Ivermectin
1. Lazy bowel 3. Increase lithium toxicity - DOC for Onchocerciasis, strongyloidiasis
2. Obstruction (if less water) - Caution - Ascariasis, enterobiasis, trichuriasis
1. Hepatic impairment and encephalopathy - Potentiate GABA and cause paralysis,
Osmotic cathartics (MOM, Mg sulphate, Mg citrate, Na 2. Pregnancy and lactating hyperpolarization
phosphate) 3. Pediatric - CTR :pts with co-infected with Loasis
- Draw fluid (increase stool liquidity) increase peristalsis 4. Active dz of CNS

Use: Tx of acute Cstp, Prevent chronic Cstp Diethylcarbamazine

- Hyperpolarization
SE: fluid loss; toxicity in renal failure - DOC for microfilariae, Loa loa, Wuchereria
- SE: NV, encephalopathy
Non-absorbable sugar (Sorbitol, lactulose)
Niclosamide
Use: chronic Cstp - Tapeworm infection
- Inhibit anaerobic + P of ADP, decrease energy
Lactulose (metabolized in colon into acid which react with production
NH3 = NH4) - Taenia solium after a light meal
- Reduction of blood NH3 in portal systemic
encephalopathy Praziquantel
- Prevention and Tx of liver failure - Increase cell membrane permeability of Ca,
- SE: flatulence, belching, abd discomfort paralysis
- Swallowed without chew
PEG (polyethene glycol) - for complete colon cleansing - Tapeworm
begore GI endoscopic procedure
Oxamniquine
Stool wetting (surfactant), emollients - S. mansoni
- Penetrate and soften stool, not increase peristalsis
- Docusate Metrifonate
- Liquid paraffin - S. haematobium
○ to prevent painful defecation a/f surgery; prevent Bithionol
straining of stool in elder and pts with hernia (SE: - Fascioliasis
impaired lipophilic vitamin absorption, lipid - Paragonimiasis
pneumonitis with aspiration, increase risk of CA
GI) Orlistat - inhibit gastric acid and pancreatic lipase
- Glycerin - rectal only secretion
Sibutramine - reduce food intake through Beta 1 ,
Stimulants (castor oil, bisacodyl) 5HT 2A/2C receptor agonist
- Castor oil Leptin
○ Stimulate uterine contraction -- facilitate delivery
at term
○ Decrease water and electrolyte absorption in itst
○ Stimulate colonic smooth m/s -- bowel
preparation of surgery, radio examination
○ SE: griping pain (not recommended- d/t its toxic
effect on itst epithelium)
- Bisacodyl - stimulate itst mucosa's sensory nerve (avoid
milk and antacid with 1 h a/f drug)

Anthraquinone
- Bowel preparation

Prokinetic - chronic cstp

Opioid antagonist - methylnaltrexone, alvimopan - opioid

induced Cstp

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