Lesson 3. Drugs affecting liver function choleretic, hepatotropic drugs. Drugs
affecting the motility of the gastrointestinal tract: prokinetics, antispasmodics.
Laxatives/ Antidiarrheals. Drugs to restore the normal intestinal microflora.
Dysbacteriosis (2 hours)
Classification:
MoA
Task 1.Explain the mechanism of action of the senna preparation:/Put in the correct
order
1. Strengthening the peristalsis of the large intestine.
2. Absorption of the drug in the small intestine
3. Isolation of the drug from the systemic circulation in the large intestine
4. Irritation of chemoreceptors of the mucous membrane of the large intestine.
Answer:_
Task 2. Explain the mechanism of action of magnesium sulfate:
1. Violation (delay) of water absorption in the intestine.
2. Increase in osmotic pressure.
3. Stimulation of intestinal mechanoreceptors.
4. Dissociation in the intestine with the formation of poorly absorbed ions.
5. Increase in the volume of intestinal contents.
6. Strengthening the peristalsis of the intestine throughout its entire length.
Answer:____ _____________
Task 3. Explain the mechanism of action of lactulose:
1. An increase in the volume of the contents of the large intestine.
2. Increased osmotic pressure in the intestine.
3. Digestion by microorganisms in the large intestine with the formation
low molecular weight organic acids.
4. Increased peristalsis of the large intestine.
5. Stimulation of mechanoreceptors of the mucous membrane of the large intestine.
Answer:___ ______________
Task 4. Explain the mechanism of action of loperamide:
1. Reducing the release of acetylcholine from the endings of cholinergic fibers.
2. Stimulation of opioid μ-receptors at the endings of cholinergic neurons.
3. Decreased intestinal motility.
Answer:____________
Case task:
Task 1.
In a drug store a pharmacist was asked by the visitor suffering from chronic
cholecystitis, the pharmacist offered him a corn silk.
Specify pharmacological properties.
Justify Pharmacotherapeutic application of the medicament material.
Pick analogues of synthetic and plant-derived drugs.
Task 2.
The patient (45 years old) suffering from chronic cholecystitis with symptoms of
biliary dyskinesia. He notes dull, aching pain in the right upper quadrant, the
bitterness in the mouth, mild nausea. Also, he complains of mild stool, diarrhea,
flatulence.
1. Select from the list drugs for the treatment of chronic cholecystitis.
2. Specify their pharmacological origin, mechanism of action and rational ways
of reception.
Mezim forte
Omeprasole
Fluoxetine
Cholensim
Ademetionine
Mirtazpine
No-shpa
Oxafenamide
Allochol
Task 3.
Effective in intralobular cholestasis. The anticholestatic effect is due to an increase
in the mobility and polarization of hepatocyte membranes, due to stimulation of the
synthesis of phosphatidylcholine in them. This improves the function of bile acid
transport systems associated with hepatocyte membranes and promotes the passage
of fatty acids into the biliary system.
Determine the drug.
Task 4.
A client was delighted at the pharmacy, who used Senna for a long time due to
chronic constipation. The last package bought at the pharmacy has no effect, and
therefore the patient complains about the poor quality of the drug.
What can you answer? What to advise?
Task 5.
A derivative of piperidine. Interacts with opiate receptors of the longitudinal and
circular muscles of the intestinal wall and inhibits the release of acetylcholine and
prostaglandins. Slows down intestinal motility and increases the time of passage of
intestinal contents.
Solve the problem by answering the following questions:
A. What drug is it?
B. What are the pharmacological effects of this drug?
C. How is this drug used?
D. When is the drug indicated?
E. List the contraindications to the use of the drug
Task 6. The pharmacy has the following choleretic agents:
allochol, corn silk, immortelle flowers, liv-52, oxafenamide, valerian root,
hydroxymethyl nicotinamide, capsules with calamus oil, sorbitol, Liobil
Solve the problem by answering the following questions:
A. Which group of choleretic drugs do these drugs belong to according to the
classification?
B. What are herbal preparations?
C. What drugs are synthetic drugs?
D. Which drugs are bile drugs?
E. List the indications for the use.
F. When are they contraindicated?
Test:
1. Indicate the remedy increasing bile secretion:
A.Oxaphenamidum
B.Apomorphine
C.Cimetidine
D.Almagel
E. No-Spa (drotaverine)
2.
Indicate a cholagogue agent used for treatment of chronic cholecystitis
A.Allocnolum
B.Absinthium (sagebrush) tincture
C.Metoclopramide
D.Almagel
3.
Specify an agent from the group of hepatoprotectors which restores normal
structure and function of hepatocytes, used in different liver deseases.
A.Essentiale
B.Tetracycline
C.Cholenzymum
D.Tocopherol acetate
E. Allocholum
4.
A.
B.
C.
D.
hepatoprotectors include
Essential phospholipids
Misoprostol
Bismuth subnitrate
Atropine
5.
A.
B.
C.
D.
salt laxatives include
Magnesium sulfate
Sodium picosulfate
Fluconazole
Metoclopramide
6.
A.
B.
C.
D.
Drugs obtained from the Milk Thistle are used as
hepatoprotective
photosensitizing
antispasmodic
diuretic
7. A 40 years old patient was admitted to the hospital with the biliary colic attack.
What agent should be administered in this case?
A. No-spa (drotaverine)
B. Almagel
С Pancreatin
D. Contrycal (aprotinine)
E. Metoclopramide
Distribute medicines according to algorithms:
Drugs used for flatulence: mezim forte, festal, panzinorm, espumizan (simeticone),
plantex (fennel extract), activated charcoal, drotaverine, platifillin.
Drugs that improve the
digestion of food:
Drugs that reduce the pressure of gases on
the walls of the intestine:
Drugs containing bile:
Carminative drugs:
Drugs containing mucosal
extract stomach:
Drugs that reduces the surface tension of
gas bubbles:
Drugs that affect liver function: allochol*, legalon (milk thistle extract),
magnesium sulfate, drotaverine, oxaphenamide (osalmid), phenobarbital, Essentiale
N**, flamin***, phosphogliv****, Essentuki mineral water No. 17*****.
They have a choleretic
effect:
Improve the detoxifying function of the
liver:
Stimulate education
bile:
Inhibit lipid peroxidation:
Combined drug:
Combined drug:
*Allochol contains: Dry cattle bile - 80 mg; dried garlic - 40 mg; activated charcoal -
25 mg; nettle leaves - 5 mg
**phospholipids from soybeans containing 80% phosphatidylcholines
***sum of flavonoids of immortelle sandy flowers 50 mg
**** It has a membrane-stabilizing, hepatoprotective and antiviral effect.
Phosphatidylcholine + Glycyrate (glycyrrhizic acid and salts)
*****medicinal chloride-hydrocarbonate sodium, boron natural drinking mineral
water of high mineralization (10.0–14.0 g/l)