Gastrointestinal tract diarrhoea with

The indications for these agents are in principle identical to those of the non-selective NSAIDs although the substances have not yet received approval for the whole spectrum of indications of the conventional NSAIDs. Because they lack COX-1-inhibiting properties, COX-2-selective inhibitors show fewer side effects than conventional NSAIDs. However, they are not free of side effects because COX-2 has physiological functions that are blocked by the COX-2 inhibitors. The most frequently observed side effects are infections of the upper respiratory tract, diarrhoea, dyspepsia, abdominal discomfort and headache. Peripheral oedema is as frequent as with conventional NSAIDs. The frequency of gastrointestinal complications is approximately half that observed with conventional NSAIDs. 

Lithium salts, generally in the form of the carbonate or bicarbonate, are rapidly absorbed from the gastrointestinal tract and reach a peak plasma concentration after 2- hours. Extreme fluctuations in blood lithium levels, which are associated with side effects such as nausea, diarrhoea and abdominal cramp, are reduced by using sustained release preparations. Lithium is not protein bound and therefore is widely distributed throughout the body water, which accounts for the adverse effects it has on most organ systems should it reach toxic levels. To avoid toxicity, and ensure optimal... 

Polycystic ovary syndrome endocrine disorder characterised by amenorrhoea, hirsutism and infertility Porphyria inherited disorders presenting with increased production of porphyrins in the bone marrow Prostatic hyperplasia enlargement of the prostate Pseudomembranous colitis diarrhoea occurring in patients who received antibacterial agents, caused by the resulting overgrowth of anaerobic bacteria in the gastrointestinal tract... 

Therapy is perfectly adequate with simple iron salts (Table 2). In adults ferrous gluconate, fumarate or sulphate are all of proven equal efficiency. Approximately 50 mg of iron is present in each tablet with the remaining 300 mg made up with an inert filler. These are given on an empty stomach at least twice a day but should nausea prevail they can be taken with food. Absorption of slow release preparations is not recommended since iron is detached from the carrier beyond the main areas of absorption in the duodenum or jejunum. Stools turn black in all cases and this is a useful index of patient compliance. In 25% of individuals gastrointestinal tract side effects are encountered in the form of diarrhoea or constipation and patients will often spontaneously discontinue medication. It is therefore essential that a tablet-count be carried out on a regular basis with a substitute being provided when this first-line medication is intolerable. In children the same preparations are favoured as syrups these are given twice... 

The medical use of opium as a pain-relieving drug dates back to the third century. Arab physicians used extracts of the oriental poppy to treat diarrhoea and probably introduced it to the Far East. However, because of its erratic absorption from the gastrointestinal tract, its use as an effective analgesic only became possible with the introduction of the hypodermic syringe in the middle of the last century. 

The side-effects are associated with vagal effects on the gastrointestinal tract (anorexia, abdominal discomfort/pain, vomiting and diarrhoea), while cardiotoxic effects include premature ventricular depolarizations, nodal rhythms and AV dissociation, Toxicity is enhanced by hypokalaemia, and this may predispose to more complex arrhythmias. 

Oral therapy of infections is usually cheaper and avoids the risks associated with maintenance of intravenous access on the other hand, it may expose the gastrointestinal tract to higher local concentrations of antibiotic with consequently greater risks of antibiotic-associated diarrhoea. Some antimicrobial agents are available only for topical use to skin, anterior nares, eye or mouth in general it is better to avoid antibiotics that are also used for systemic therapy because topical use may be especially likely to select for resistant strains. Topical... 

Terbinafine interferes with ergosterol biosynthesis, and thereby with the formation of the fungal cell membrane. It is absorbed from the gastrointestinal tract and undergoes extensive metabolism in the liver (tj 14 h). Terbinafine is used topically for dermatophyte infections of the skin and orally for infections of hair and nails where the site (e.g. hair), severity or extent of the infection render topical use inappropriate (see p. 315). Treatment (250 mg/d) may need to continue for several weeks. It may cause nausea, diarrhoea, dyspepsia, abdominal pain, headaches and cutaneous reactions. 

In the normal adult, 7-8 litres of of water and electrolytes are secreted daily into the gastrointestinal tract. This, together with dietary fluid, is absorbed by epithehal cells in the small and large bowel. Water follows the osmotic gradients which result from shifts of electrolytes across the intestinal epithelium, and sodium and chloride transport mechanisms are central to the causation and management of diarrhoea, especially that caused by bacteria and viruses. The energy for the process is provided by the activity of Na /K ATPase. 

Clinical manifestations of PMC classically include watery or bloody diarrhoea (Ros et al. 1996). The patients have moderate fever, abdominal cramps, leukocytosis, and hypoalbuminaemia. Severe forms can cause electrolyte disturbances, dehydratation, hypoalbuminaemia (with anasarca), and even life-threatening conditions such as toxic megacolon and perforation of the colon. Hypoalbuminaemia is due to the rapid loss of protein in the gastrointestinal tract (Merine et al. 1987). 

Niacin requirements are also affected by diseases or conditions interfering with niacin absorption and/or processing, such as prolonged diarrhoea, chronic dialysis treatment, chronic colitis (particularly ulcerative colitis), cirrhosis of the liver, tuberculosis of the gastrointestinal tract, malignant carcinoid tumour and chronic alcoholism (Food and Nutrition Board 1998). Substantial individual differences (about 30%) in the conversion efficiency of tryptophan to niacin have been reported (Horwitt et al. 1981). 

Inhibitors of pancreatic lipase (section 4.3.2) do reduce lipid digestion and absorption, and some have been licensed for pharmaceutical use. The problem with their use is that undigested fat in the gastrointestinal tract can cause discomfort and, if enough is present, foul-smelling fatty diarrhoea (steatorrhoea). 

The pharmacological effects of this complex mixture of alkaloids in opium may, in some respects, be more beneficial than the effects of an individual alkaloid. The effect of opium in the treatment of diarrhoea is better than that of either morphine or codeine given individually. It is possible to calm the gastrointestinal tract with a dose which contains only half of the dose which would be necessary for morphine alone. The combination of the increase in stretch reflex caused by morphine and the inhibition of increased peristaltic action by papaverine leads to a better therapeutic effect. The increase in muscle tone due to morphine is reduced by papaverine, and other benzylisoquinolines also participate in this tranquillisation of the g.i. tract. In the normal 50 mg dosage of opium used for the treatment of diarrhoea there is about 5 mg of morphine, 0.5 mg of papaverine and 3 mg of nos-capine which contrasts markedly with a dose of 100—200 mg of papaverine if this were given alone. The analgaesic activity of opium is due mainly to the morphine present, as the levels of codeine, neopine and papaverine are relatively small. The respiratory depression effect of opium is also due to the morphine content and the antagonistic effects of noscapine and narcotoline are not so pronounced. Thus the main use of opium in medicine is for the treatment of diarrhoea. 

Among the side effects reported from oral treatment with fosfomycin in these doses have been diarrhoea and other disturbances of the gastrointestinal tract, transient increases of serum GOT, GPT and LDH, exanthemata and rash, eosinophilia (in one case) and derangement of vision (59 ). 

Antimuscarinic agents have a remarkable effect on the gastrointestinal tract, and reduced saliva, gastric section, amount of stomach acid, pepsin and mucine are all observed. Motility is affected as well, with the walls of the viscera being relaxed and both the tone and propulsive movements being diminished upon antimuscarinic therapy. Hiese effects make antimuscarinic dmgs potential a nts for the treatment of peptic ulcers, diarrhoea and intestinal cramps. Specific agents have been optimised for each of these three indications. 

There are many issues with oral delivery of nanospheres, such as the efficiency of uptake, reproducibility, and the pathophysiologic condition of the patient (e.g. diarrhoea) that could affect the retention of orally administered nanospheres. To increase the efficacy of uptake of nanospheres by the gastrointestinal tract, investigators have been studying nanospheres which are surface modified with lectins and transferrin The receptors... 

Azithromycin achieves high concentrations in tissues relative to those in plasma. It remains largely unmetabolised and is excreted in the bile and faeces (t) 50h). Azithromycin is used to treat respiratory tract and soft tissue infections, and sexually transmitted diseases, especially genital Chlamydia infections. Gastrointestinal effects (9%) are less than with erythromycin but diarrhoea, nausea and abdominal pain occur. In view of its high hepatic excretion use in patients with liver disease should be avoided. Interactions see erythromycin (above). 

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