BY

ABU BAKAR TARIQ

UNIVERSITY OF SARGHODHA

1• Mucous Membrane & Organs.

• Anatomy, Physiology & Pathology

2• Pharmacology of Oral Mucosa

• Pharmacology of Esophageal Mucosa

3• Pharmacology of Gastric Mucosa.

• Pharmacology of Intestinal Mucosa.

‘‘Mucous Memberane’’Mucous Memberane is:

The Linning of certain organs.

Passages that communicate with the Surface of organ.

“Anatomy of Mucosa Membrane’’ What is Composition of Mucous Memberane?

Consists of:

• Epithelium-layer of epithelial cells.

• Lamina Propria-Loose Connective Tissue.

‘‘Epithelium’’ A single or stratified layer of cells underlines:

• Cavities

• Blood vessels

• Organs

GIT

Oral

Ear

Lungs

Urinary Tract

‘‘Lamina Propria’’ Underlines Epithelium.

Provide Nutrition to it.

Contains:

o Lymphocytes

o Plasma cells

o Mast Cells

o Glands(Mucus)

o Leucocytes etc.

“Some Examples of Mucous Membrane”

Oral Mucosa(mouth)

Esophageal Mucosa(esophagus)

Gastric Mucosa(Stomach)

Intestinal Mucosa(Intestine)

“Physiology of GIT ”Mucous Membrane Involve in:

Protection:

Physical Barrier

(Mucus)

Immune Barrier

(Lymph nodes)

‘‘Physiology’’

Secretions:

HCL

Enzymes

Mucous

Serotonin

Histamine

‘‘Physiology’’Absorption:

• Proteins

• Carbohydrates

• Fats

• Vitamins

• Water

• Electrolytes

• DRUGS

“Physiology’’Regulation:

“Pathology”Oral Mucosa:

Candidiasis

Amphthous ulcer

Mouth Cancer

Smoker’s palate

Smoker’s Melanosis

‘‘Pathology’’Esophageal Mucosa:

Esophagitis(Inflammation of Esophagus)

GERD

Tumors

‘‘Pathology’’Gastric Mucosa:

Acute Gastritis

Chronic gastritis

Gastric Ulcer

Gastric Cancer etc.

‘‘Pathology’’ Intestinal Mucosa:

Duodenal Ulcer

Enterocolitis

Diarrhea

Constipation

IBD

Celiac Sprue etc.

“Pharmacology of Oral Mucosa”Fungal Infection:

Candidiasis

(Oral Thrush)

Agent:

Candida albicans

Appearance:

White plague

“Drugs Used”

AZOLES:

Fluconazole

(Fungicure)

Miconazole

Itraconazole

Ketoconazole

Clotrimazole

“Mechanism of Action” Fluconazole acts by inhibiting the synthesis of

Ergosterol, a major component of the cell membrane of yeast and fungi.

Inhibition of Ergosterol synthesis leads to some structural and functional impairment of cytoplasmic membrane.

Side Effects:

Nausea

Abdominal Discomfort

Diarrhea

“Aphthous Ulcer” Also Known as Canker Sores.

Appeared as:

Small, Shallow

lesions.

Drug used:

Amlexanox

(Apthasol)

“Mechanism of Action”Amlexanox :

Inhibit inflammation by inhibiting release of histamine and leukotrienes.

Side effects:

Nausea

Diarrhea

“Squamous cell carcinoma” Also known as Oral Cancer.

Agent:1. Smoking

2. Tobacco

3. Alcohol

Appeared as:

1. Erythroplakia

2. Leukoplakia

“Leukoplakia & Treatment”

NO DRUG IS AVAILABLE

Chemotherapy

“Smokers palate ” Also known as ‘‘Stomatitis nicotinia’’.

Agent:

Cigar

Cigarette

Appeared as:

White opaque dots on

Palate

Treatment:

Stop Smoking

“Smokers Melanosis” Agents:

Smoking

Appeared as:

Melanin

Pigmentation in gums

Treatment:

Quit smoking

“Duodenal Ulcer” Gasrtic Acid cause

Errosive damage to

Duodenal part of

Small intestine if

The mucous barrier

is damaged.

Agents:

H.pylori.

Anti-Inflammatory Drugs.

“Symptoms”1. Pain Upper tummy

2. Bloating

3. Retching

4. Sickness

5. Vomiting

6. Burning

“Drugs for Duodenal Ulcer” Bismuth Salts

Cimetidine (HCl)

Omeperazole

Pirenzepine (di HCl)

Propantheline (Br)

Ranitidine Omeprazole Sucralfate

“Mechanism of Bismuth Salt” Bismuth Salts are antimicrobial agents,Antacid and

used to treat Duodenal ulcer.

Bismuth salt(Bismuth

Salicylate) retards the

Expulsion of fluids

into the GIT system by

Coating them.

Its anti-inflammatory action

by Prostaglandin Inhibition.

“Celiac Disease” Auto-immune disorder occurs due to indigestion of

Gluten.

Low Absorptive surface of Small Intestine.

“Symptoms” Anemia.

Chronic Diarrhea.

Weight Loss.

Fatigue.

Cramps.

Bloating.

Irritability.

Burning.

“Drugs For celiac Disease” Celecoxib(NSAIDS)

Celiprolol (HCL)

Gluten Free Diet.

Vitamins & Mineral Supplements.

“Mechanism of Celecobix” COX-II Inhibitor.

“Mucosal Abnormalities in AIDS”

In Acute Phase HIV induce cell lysis and killing of infected cell by cytotoxic T-Cells accounts for CD4

T-cell depletion in Small Intestinal Mucosa.

“Agents” Human Immuno-deficiency Virus(HIV)

Pro-inflammatory cytokinins

“Symptoms” Diarrhea

Waitloss

Dysphagia

Abdominal Pain

Gastro-intestinal Bleeding

Lymphoma

Bilary Tract Disorders

“Drugs” NTRI’s(Nucleotide Reverse Transcriptase Inhibitors)

Anti-retro viral Therapy

CCR-5 Receptor Antagonists

Integrase Inhibitor

“Mechanism of NTRI’s”

“Adverse Effects of Stavudine” Numbness

Rash

Diarrhea

Headache

Hand Pain

Feet Pain

“Large Intestinal Mucosa”Introduction:

Large intestine Absorbs mainly Nutrients, Water, Electrolytes and vitamins.

Role of microbiota:

Microflora reduce the capability of pathogenic species to cause damage to mucosa of colon.

The increased use of antibiotics reduce the normal population of the microflora that lead to the damage of intestine and cause high risk of pathogenicity.

“Forms of IBD”Two forms of IBD:

Ulcerative Colitis:

(localized)

Crohn’s Disease:

(Transmural)

“Inflammatory Bowel Disease(IBD)”

MECHANISM OF ACTION

“Drugs Used in IBD”1. Glucocorticoids(Prednisolone & Budesonide)

2. Aminosalycilates(Salfasalazine,Balsalazide)

3. Immunosuppressant(Thiopurine)

4. Antibiotics(Ciprofloxacin)

“Glucocorticoids”Drugs:

Prednisolone(Prelone).

Budesonide(Pulmicort).

Mechanism of action:

Prednisolone act by Inhibiting nuclear factor (NF- Kb)

Adverse Effects:

Acne

Constipation

Nausea.

“Mechanism of Prednisolone”

“Amino-Salicylates”Mechanism of action:

Reduce inflammation by scavenging of free radical.

By inhibition of the production of interleukin-1 andTumor Necrosis Factor(TNF)

And Also by inhibition of NF-kb

Drugs:

Sulfasalazine(Azulfidine)

Olsalazine(Dipentum)

Balsazide(Colazide)

“ADVERSE EFFECTS”

Headache

Fatigue

Rash

Diarrhea

“Immunosuppressants”Mechanism of Action:

Thiopurine impair purine biosynthesis.

Hinders DNA synthesis and thus inhibit the proliferation of cells.

So the two types of lymphocytes(T & B) affected by the inhibition of purine synthesis

“DRUGS & Adverse Effects”Drugs:

Thiopurine derivatives

Azothiopurine(Immuran)

6-Mercaptopurine(Purinethol)

Adverse Effects:

Vomiting

Bone marrow Suppression

Elevation in liver Function.

“Anti-TNF Therapy”Mechanism of Action:

Drugs caused the lysis of TNF alpha cells by cell mediated cytotoxicity.

Drugs:

Infliximab(Remicade)

Adalimumab