GI Agents

Gastrointestinal AgentsGastrointestinal AgentsCourse Title : Inorganic Pharmacy-IICourse Title : Inorganic Pharmacy-IICourse No.: PHR 107Course No.: PHR 107

Course Teacher : Shahana SharminCourse Teacher : Shahana Sharmin

Glands of the StomachGlands of the Stomach

1. Cardiac1. Cardiac2. Pyloric2. Pyloric3. Gastric*3. Gastric*

The stomach is divided into three functional areas, each The stomach is divided into three functional areas, each with specific glands.with specific glands.

• The cardiac zone (cells), the uppermost area of the The cardiac zone (cells), the uppermost area of the stomach by the cardiac sphincter, contains the cardiac stomach by the cardiac sphincter, contains the cardiac glands.glands.

• The pyloric zone is the lowermost part of the stomach The pyloric zone is the lowermost part of the stomach and contains the pyloric glands.and contains the pyloric glands.

• The greater part of the body of the stomach, the The greater part of the body of the stomach, the fundus, contains the gastric glands.fundus, contains the gastric glands.

• The gastric glands play the most significant role in acid-The gastric glands play the most significant role in acid-related disorders.related disorders.

Cells of the Gastric GlandCells of the Gastric Gland

Parietal cellsParietal cells– Produce and secrete HClProduce and secrete HCl– Primary site of action for many acid-controller drugsPrimary site of action for many acid-controller drugs

Hydrochloric AcidHydrochloric Acid• Secreted by the parietal cells when stimulated by Secreted by the parietal cells when stimulated by

foodfood• Maintains stomach at pH of 1 to 4Maintains stomach at pH of 1 to 4• Secretion also stimulated by:Secretion also stimulated by:– Large fatty mealsLarge fatty meals– Excessive amounts of alcoholExcessive amounts of alcohol– Emotional stressEmotional stress

Gastrointestinal AgentsGastrointestinal Agents

Definition:Definition: Agents used to treat gastrointestinal disturbances Agents used to treat gastrointestinal disturbances are known as gastrointestinal agents. Various are known as gastrointestinal agents. Various inorganic agents used to treat GIT disorder.inorganic agents used to treat GIT disorder.

• Products for altering gastric pH i.e. Products for altering gastric pH i.e.

- Acidifying agent- Acidifying agent

- Antacids- Antacids• Protective for intestinal inflammationProtective for intestinal inflammation• Adsorbents for intestinal toxinsAdsorbents for intestinal toxins• Saline cathartics or laxatives for constipationSaline cathartics or laxatives for constipation

Gastrointestinal agentsGastrointestinal agents

Products for Products for altering pHaltering pH Acidifying agentAcidifying agent

Agents used to increase the stomach Agents used to increase the stomach pH is known as Acidifying agents.pH is known as Acidifying agents.e.g. Ammonium chloride, Calcium e.g. Ammonium chloride, Calcium chloride, dilute HCl etc. can be used to chloride, dilute HCl etc. can be used to treat Achlorhydria.treat Achlorhydria.Lack of Hydrochloric acid (HCl) in Lack of Hydrochloric acid (HCl) in stomach is known as Achlorhydria.stomach is known as Achlorhydria.

AntacidsAntacids

Antacids are substances which Antacids are substances which reduce gastric acidity resulting in reduce gastric acidity resulting in an increase in the pH of stomach an increase in the pH of stomach & and duodenum. & and duodenum.

It is itself basic in nature. Weak It is itself basic in nature. Weak bases are used for this purpose.bases are used for this purpose.

e.g. Al(OH)e.g. Al(OH)33, Mg(OH), Mg(OH)22, NaHCO, NaHCO33

AntacidsAntacids

Gastric activity occurs due to Gastric activity occurs due to excessive secretion of HCl in stomach excessive secretion of HCl in stomach due to various reasons.due to various reasons.

• Gastritis (a general inflammation of Gastritis (a general inflammation of gastric mucosa)gastric mucosa)

• Peptic ulcer or oesophageal ulcer Peptic ulcer or oesophageal ulcer ( lower end of oesophagus)( lower end of oesophagus)

• Gastric ulcer (stomach)Gastric ulcer (stomach)• Duodenum ulcerDuodenum ulcer

AntacidsAntacids

Criteria for antacidsCriteria for antacids• The antacids should not be absorber or cause The antacids should not be absorber or cause

systemic alkalosis*.systemic alkalosis*.• It should not be constipative or laxatives.It should not be constipative or laxatives.• It should exert effect rapidly and over a long It should exert effect rapidly and over a long

period of timeperiod of time• The antacid should buffer in the range of pH 4-The antacid should buffer in the range of pH 4-

6.6.• Reaction of antacid with HCl should not cause Reaction of antacid with HCl should not cause

large evolution of gas.large evolution of gas.• Should probably inhibit pepsin activity.Should probably inhibit pepsin activity.

*Alkalosis : Alkalosis refers to a condition reducing hydrogen ion concentration *Alkalosis : Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma (alkalemia). Generally alkalosis is said to occur when of arterial blood plasma (alkalemia). Generally alkalosis is said to occur when pH of the blood exceeds 7.45. The opposite condition is acidosis. pH of the blood exceeds 7.45. The opposite condition is acidosis.

AntacidsAntacids

Classification Classification ::

There are two types of AntacidsThere are two types of Antacids

- Systemic- Systemic

- Non-systemic- Non-systemic

Systemic antacidsSystemic antacids

It is soluble & systemically absorbed.It is soluble & systemically absorbed. Capable of producing systemic alkalosis.Capable of producing systemic alkalosis.

e.g. NaHCOe.g. NaHCO33

Sodium carbonate is water soluble & potent Sodium carbonate is water soluble & potent neutralizer, but it is not suitable for peptic neutralizer, but it is not suitable for peptic ulcer because of risk of ulcer perforation due ulcer because of risk of ulcer perforation due to production of carbon dioxide in stomach.to production of carbon dioxide in stomach.As it may lead to alkalosis may worsen As it may lead to alkalosis may worsen edema and congestive heart failure because edema and congestive heart failure because of sodium ion load.of sodium ion load.

Systemic antacidsSystemic antacidsNaHCONaHCO33

Preparation of NaHCOPreparation of NaHCO33 : :1. By passing strong brine containing 1. By passing strong brine containing high concentration of ammonia through high concentration of ammonia through a carbonated tower where it is saturated a carbonated tower where it is saturated with carbon dioxide under pressure. The with carbon dioxide under pressure. The ammonia & carbon dioxide reacts to ammonia & carbon dioxide reacts to form ammonia bicarbonate which is form ammonia bicarbonate which is allowed to react with NaCl to precipitate allowed to react with NaCl to precipitate NaHCONaHCO33 which is separated by filtration. which is separated by filtration.NHNH33 + H + H22O + COO + CO22 NH NH44HCOHCO33

NHNH44HCOHCO33 + NaCl + NaCl NaHCO NaHCO33


Preparation of NaHCOPreparation of NaHCO33 ::

2. it can also be prepared by 2. it can also be prepared by covering sodium carbonate covering sodium carbonate crystals with water and passing crystals with water and passing carbon dioxide to saturation.carbon dioxide to saturation.

NaNa22COCO3 3 + H+ H22O +O + COCO2 2 NaHCONaHCO33


Flow chart of Rebound acidityFlow chart of Rebound acidity : :NaHCO3 + HCl NaHCO3 + HCl pHpH Alkaline mediaAlkaline media Stimulation of Stimulation of oxgentic celloxgentic cell

Secretion of HCl Secretion of HCl to to balance balance the aciditythe acidity

Then again Reaction occurs Need Then again Reaction occurs Need excessexcess rebound acidity & form alkaline media NaHCO3 rebound acidity & form alkaline media NaHCO3 acidity acidity Stimulation of oxgentic cell Stimulation of oxgentic cell Secretion of HCl Secretion of HCl Excess HCl Excess HCl

occurs (Rebound acidity) occurs (Rebound acidity)

UlcerUlcer Infection of stomach Infection of stomach

Non-systemic Non-systemic antacidsantacids They are insoluble & poorly absorbed They are insoluble & poorly absorbed

systemically. systemically.

e.g. Al(OH)e.g. Al(OH)33, Mg(OH), Mg(OH)22, CaCO, CaCO3 3 etc.etc.• In case of Mg(OH)In case of Mg(OH)2 , 2 , it has low water solubility and it has low water solubility and

has the power to absorb and inactive pepsin and has the power to absorb and inactive pepsin and to protect ulcer base. to protect ulcer base.

• In case of Al(OH)In case of Al(OH)33 , it is a weak and slow reacting , it is a weak and slow reacting antacid.antacid.

• In case of CaCOIn case of CaCO33 , it is a potent antacid with rapid , it is a potent antacid with rapid acid neutralizing capacity, but in long term use it acid neutralizing capacity, but in long term use it can cause hypercalciuria, hypercalcemia and can cause hypercalciuria, hypercalcemia and formation of calcium stone in kidney.formation of calcium stone in kidney.

Aluminium containing Aluminium containing AntacidsAntacids

Forms:Forms:• Aluminum Hydroxide Gel (suspension)Aluminum Hydroxide Gel (suspension)

contain aromatics and sweeteningcontain aromatics and sweetening

not more than 0.5% preservativesnot more than 0.5% preservatives• Dried Aluminum Hydroxide Gel Dried Aluminum Hydroxide Gel

(powder)(powder)

colloidial – great adsorptive powerscolloidial – great adsorptive powers

amphoteric charactersamphoteric characters

Magnesium Containing Magnesium Containing AntacidsAntacids

Forms :Forms : MAGNESIUM CARBONATEMAGNESIUM CARBONATE• Carbonate of Magnesia, Heavy Magnesium Carbonate.Carbonate of Magnesia, Heavy Magnesium Carbonate.• Dissolves as carbonate and hydroxide are consumed.Dissolves as carbonate and hydroxide are consumed. MAGNESIUM HYDROXIDEMAGNESIUM HYDROXIDE

Used as laxatives in high doses (salt action).Used as laxatives in high doses (salt action). MILK OF MAGNESIAMILK OF MAGNESIA• Suspension of magnesium hydroxide.Suspension of magnesium hydroxide.

with citric acid to minimize the interaction of glass and magnesium with citric acid to minimize the interaction of glass and magnesium hydroxidehydroxide

• Very popular antacid and laxative.Very popular antacid and laxative. MAGNESIUM HYDROXIDEMAGNESIUM HYDROXIDE• Magnesia.Magnesia.• Light Magnesium Oxide hydrolyzes faster than heavy to Magnesium Light Magnesium Oxide hydrolyzes faster than heavy to Magnesium

hydroxide.hydroxide.• Magnesia added to water to avoid formation of hard lumpMagnesia added to water to avoid formation of hard lump

arsenic antidote.arsenic antidote.

Calcium Containing Calcium Containing AntacidsAntacids

Forms Forms :: CALCIUM CARBONATECALCIUM CARBONATE• Precipitated chalkPrecipitated chalk• Fast actionFast action• Found in combinations with Mg antacidsFound in combinations with Mg antacids• In Lozenges and Oral suspensionIn Lozenges and Oral suspension TRIBASIC CALCIUM PHOSPHATETRIBASIC CALCIUM PHOSPHATE• Precipitated Calcium Phosphate, Tertiary Calcium Precipitated Calcium Phosphate, Tertiary Calcium

Phosphate, Calcium PhospatePhosphate, Calcium Phospate• Found in nature as Found in nature as phosphrite phosphrite (phosphate rock) (phosphate rock)

and and apatiteapatite• No gas produced (no flatulence)No gas produced (no flatulence)• Does not alkalize the systemDoes not alkalize the system

Non-systemic antacidsNon-systemic antacidsAl(OH)Al(OH)33

Aluminum Antacids are Nonsystemic and widely Aluminum Antacids are Nonsystemic and widely used and are buffer in the pH 3-5 region. used and are buffer in the pH 3-5 region.

Aluminum hydroxide is recognized in two forms Aluminum hydroxide is recognized in two forms in USP in USP

1. Gel USP XVIII:1. Gel USP XVIII: White viscose suspension, White viscose suspension, small amount of clear liquid may separate small amount of clear liquid may separate constantly pH 5.5-8.0 USP permits inclusion of constantly pH 5.5-8.0 USP permits inclusion of flavoring and antimicrobial agent.flavoring and antimicrobial agent.

2. Dried Gel USP XVIII:2. Dried Gel USP XVIII: White, colorless, White, colorless, tasteless, amorphous powder, insoluble in water tasteless, amorphous powder, insoluble in water and alcohol.and alcohol.


Al(OH)Al(OH)33 : :

Aluminium containing antacids are widely used which Aluminium containing antacids are widely used which are buffer in the pH 3-5 region. It is recognised in two are buffer in the pH 3-5 region. It is recognised in two forms in USP.forms in USP.

1. Al(OH)3 gel : White viscous suspension, small 1. Al(OH)3 gel : White viscous suspension, small amount of clear liquid may separate constantly pH amount of clear liquid may separate constantly pH 5.5-8.0 USP permits inclusion of flavoring & 5.5-8.0 USP permits inclusion of flavoring & antimicrobial agent.antimicrobial agent.

2. Dried Al(OH)3 gel : White colorless, testless, 2. Dried Al(OH)3 gel : White colorless, testless, amorphous powder, insoluble in water & alcohol.amorphous powder, insoluble in water & alcohol.


Therapeutic uses of Al(OH)Therapeutic uses of Al(OH)33 : :1. Al(OH)1. Al(OH)3 3 gel is used for the treatment of gel is used for the treatment of

- Peptic ulcer- Peptic ulcer- Peptic esophegitis- Peptic esophegitis- Gastric hyperacidity- Gastric hyperacidity- Phosphate nephrotithiasis- Phosphate nephrotithiasis

2. It is infrequently used in the treatment of diarrhaea 2. It is infrequently used in the treatment of diarrhaea & cholera.& cholera.3.It is also used against the hyperachlorhydria of ulcer 3.It is also used against the hyperachlorhydria of ulcer patient.patient.4.It is also used as4.It is also used as

- Antiseptic & antidiarrhoeal agent- Antiseptic & antidiarrhoeal agent- Anticholera [Al(OH)- Anticholera [Al(OH)33 dried] dried]- Desicant [Al(OH)- Desicant [Al(OH)33 dried)] dried)]


Acid neutralization by Al(OH)Acid neutralization by Al(OH)33 : :

Al(OH)Al(OH)33 is considered as ideal antacid. It is soluble in is considered as ideal antacid. It is soluble in acidic media. The overall mode of action of an Al-base acidic media. The overall mode of action of an Al-base antacid proceeds in a series of steps depending on the antacid proceeds in a series of steps depending on the amount of antacid & the pH.amount of antacid & the pH.

Antacid reacts with water to form a complex.Antacid reacts with water to form a complex.

Al(OH)Al(OH)33 + 3H + 3H22O O [Al(H [Al(H22O)O)33. (OH). (OH)33]]00

Complex (Base)Complex (Base)


Acid neutralization by Al(OH)Acid neutralization by Al(OH)3 3 cont….cont….

The complex is soluble in acid media.The complex is soluble in acid media.

[Al(H[Al(H22O)O)33. (OH). (OH)33]]00 + H + H33OO++ [Al(H [Al(H22O)O)44. (OH). (OH)22]]++ + H + H22OO Base acid conjugated acid conjugated baseBase acid conjugated acid conjugated base

[Al(H[Al(H22O)O)44. (OH). (OH)22]]++ + H + H33OO++ [Al(H [Al(H22O)O)55. (OH)]. (OH)]++++ + H + H22OO

[Al(H[Al(H22O)O)55. (OH)]. (OH)]++++ + H + H33OO++ [Al(H [Al(H22O)O)66]]++++++ + H + H22OOHexaquoaluminium ionHexaquoaluminium ion

This HThis H33OO++ acid is present in the stomach. acid is present in the stomach.


Constipation Mechanism of Constipation Mechanism of Al(OH)Al(OH)33 : :

Al(OH)Al(OH)33 + 3HCl ----- + 3HCl ----- AlCl AlCl33 + 3H + 3H22OO SolubleSoluble

AlAl3+3+ + PO + PO443-3- ----- ----- AlPO AlPO44

InsolubleInsoluble

ClCl-- ------------ ------------ Reabsorbed Reabsorbed


Commercial Preparation of Al(OH)Commercial Preparation of Al(OH)3 3 gel :gel :Aluminium hydroxide gel is an aqueous suspension of hydrated Aluminium hydroxide gel is an aqueous suspension of hydrated aluminium oxide with different amounts of basic aluminium aluminium oxide with different amounts of basic aluminium carbonate & bicarbonate. When a hot solution of K-alum is carbonate & bicarbonate. When a hot solution of K-alum is added slowly to a hot solution of Naadded slowly to a hot solution of Na22COCO33, (at 70, (at 7000C), Al(OH)C), Al(OH)33 is is produced.produced.

NaNa22COCO33+K+K22SOSO44. Al. Al22(SO(SO44))33+ H+ H22O --O -- K K22SOSO44+Na+Na22SOSO44+Al(OH)+Al(OH)33 + CO+ CO22

Method of Preparation :Method of Preparation : It is prepared by dissolving sodium carbonate in hot water & It is prepared by dissolving sodium carbonate in hot water & the solution is filtered. To the filtrate add clear solution of alum the solution is filtered. To the filtrate add clear solution of alum (Aluminium salt, chloride or sulphate) in water with constant (Aluminium salt, chloride or sulphate) in water with constant stirring. stirring. Add more of water and remove all gas. The Aluminium Add more of water and remove all gas. The Aluminium Hydroxide precipitate out, collect the precipitate , wash and Hydroxide precipitate out, collect the precipitate , wash and suspend in sufficient purified water.suspend in sufficient purified water.


2Al2(SO4)3 + 6Na2CO3 6Na2SO4 + 2Al2(CO3)3

2H-OH

4Al(OH)3 + 6H2CO3

6H2O + 6CO2

• Reaction occurred during preparation of Al(OH)3

gel:

Non-systemic antacidsNon-systemic antacidsAl(OH)3Al(OH)3

Purification :Purification :The ppt Al(OH)The ppt Al(OH)33 is washed thoroughly with hot water until it is free is washed thoroughly with hot water until it is free from SOfrom SO44

-2-2 ion which is confirmed with the addition of some BaCl ion which is confirmed with the addition of some BaCl22 to to the filtrate.the filtrate.Filtrate + BaClFiltrate + BaCl2 2 ---- BaSO BaSO44 (SO (SO44

-2 -2 present)present) ---- No change (SO No change (SO44

-2 -2 absent)absent)

Adjustment of the gel :Adjustment of the gel :The gel is adjusted with distilled water. Al(OH)The gel is adjusted with distilled water. Al(OH)33 gel USP is a gel USP is a suspension containing the equivalent of not less than 3.6% & not suspension containing the equivalent of not less than 3.6% & not more than 4.4% of Almore than 4.4% of Al22OO3 3 per 100 g of Al(OH)per 100 g of Al(OH)3.3.

Improvement of the formulation :Improvement of the formulation :The following substances are added --The following substances are added --

1. Viscosity imparting agent : Glycerin1. Viscosity imparting agent : Glycerin2. Flavoring agent (0.01-0.05%): Peppermint oil2. Flavoring agent (0.01-0.05%): Peppermint oil3. Sweetening agent : Sucrose or saccharin3. Sweetening agent : Sucrose or saccharin4. Preservative (0.1 – 0.5%) : Sodium Benzoate4. Preservative (0.1 – 0.5%) : Sodium Benzoate


Assay of Al(OH)Assay of Al(OH)33: : • Accurately weigh 5gm and dissolve in 3ml Accurately weigh 5gm and dissolve in 3ml

HCl by warming on water bath, cool to below HCl by warming on water bath, cool to below 20 °C and dilute to 100ml with water. 20 °C and dilute to 100ml with water.

• To 20ml of the above solution add 40ml of To 20ml of the above solution add 40ml of 0.05M disodium EDTA, 80ml water, 0.15ml 0.05M disodium EDTA, 80ml water, 0.15ml methyl orange/red and neutralize by the methyl orange/red and neutralize by the dropwise addition of 1M sodium hydroxide. dropwise addition of 1M sodium hydroxide.

• Again warm on water bath for 30 min, add Again warm on water bath for 30 min, add 3gm hexamine and titrate with 0.05M lead 3gm hexamine and titrate with 0.05M lead nitrate using 0.5ml xylenol orange as nitrate using 0.5ml xylenol orange as indicator. Each ml of 0.05M disodium EDTA indicator. Each ml of 0.05M disodium EDTA ≡0.002549 gm of Al≡0.002549 gm of Al22OO33


Advantages of Al(OH)Advantages of Al(OH)33 : :1. Long duration of action.1. Long duration of action.2. Does not produce systemic alkalosis.2. Does not produce systemic alkalosis.3. ANC is high.3. ANC is high.

Disadvantages of Al(OH)Disadvantages of Al(OH)33 : :1. Slow onset of action.1. Slow onset of action.2. Phosphorous depletion.2. Phosphorous depletion.3. Osteomalacia (Softening of the bones due to a lack of 3. Osteomalacia (Softening of the bones due to a lack of vitamin D) & Osteoporosis (Thinning of bone tissue and loss vitamin D) & Osteoporosis (Thinning of bone tissue and loss of bone density over time).of bone density over time).4. Neurotoxicity in renal failure.4. Neurotoxicity in renal failure.

Dose :Dose : 500 mg to 1800 mg 3 to 6 times a day between meals & 500 mg to 1800 mg 3 to 6 times a day between meals & bedtimebedtime

Non-systemic Non-systemic antacidsantacidsAl(OH)3Al(OH)3

Pharmacological action ofPharmacological action of Al(OH)Al(OH)3 3 :: It neutralizes the excess gastric acid and prevent the It neutralizes the excess gastric acid and prevent the

hyperacidity.hyperacidity. After neutralization the available AlAfter neutralization the available Al3+3+ conc. is raised which conc. is raised which

in turn gives rise to some astringent and antiseptic in turn gives rise to some astringent and antiseptic property.property.

Pepsin & intestinal bacteria are absorbed by Al(OH)3, gel Pepsin & intestinal bacteria are absorbed by Al(OH)3, gel and thus acts as a absorbent in the prevention of ulcer and thus acts as a absorbent in the prevention of ulcer creation.creation.

Due to its astringent and demulcent properties it forms a Due to its astringent and demulcent properties it forms a protective coating over the ulcer creator.protective coating over the ulcer creator.

It stimulates mucous secretion which enhances the It stimulates mucous secretion which enhances the mucosal barrier to acid.mucosal barrier to acid.

Non-systemic antacidsNon-systemic antacidsMg(OH)Mg(OH)22

Mg(OH)Mg(OH)22 : :There are a large no. of Mg There are a large no. of Mg containing antacids. The Mg cation containing antacids. The Mg cation causes this group of antacids to be causes this group of antacids to be laxatives.laxatives.They usually used in combination They usually used in combination with Al & Ca antacid in an attempt with Al & Ca antacid in an attempt to neutralize, constipative & to neutralize, constipative & laxative actions.laxative actions.


Preparation of Mg(OH)Preparation of Mg(OH)22 : :

They can be prepared by treating Mg salt They can be prepared by treating Mg salt with NaOH resulting Mg(OH)with NaOH resulting Mg(OH)22 precipitate & precipitate & Na salts.Na salts.

MgSO4 + 2NaOH = Mg(OH)2 + Na2So4

MgCl2 + 2NaOH = Mg(OH)2 + 2NaCl


Assay of Mg(OH)Assay of Mg(OH)22 : : Transfer about 400 mg of the sample, Transfer about 400 mg of the sample,

previously dried at 105previously dried at 105ooC for 2h and C for 2h and accurately weighed, into a conical flask. Add accurately weighed, into a conical flask. Add 25 ml of 1 N sulfuric acid and, after solution is 25 ml of 1 N sulfuric acid and, after solution is complete, add methyl red TS and titrate the complete, add methyl red TS and titrate the excess acid with 1 N sodium hydroxide. Each excess acid with 1 N sodium hydroxide. Each ml of 1 N sulfuric acid used to neutralize the ml of 1 N sulfuric acid used to neutralize the magnesium hydroxide is equivalent to 29.16 magnesium hydroxide is equivalent to 29.16 mg of Mg(OH)2. mg of Mg(OH)2.

1 N NaOH, H1 N NaOH, H22SOSO44+Mg(OH)+Mg(OH)22 - - MgSO MgSO44 + 2H + 2H22OO

1000 ml of N NaOH = 1N Mg(OH)1000 ml of N NaOH = 1N Mg(OH)22


Mechanism of action of Mg(OH)Mechanism of action of Mg(OH)22 : :

Mg(OH)Mg(OH)22 is very less soluble & only goes into solution is very less soluble & only goes into solution when there is acid & already contain minute amount of when there is acid & already contain minute amount of anion present in the stomach. In presence of acid Mg(OH)anion present in the stomach. In presence of acid Mg(OH)22 will dissolve the following way – will dissolve the following way –

Mg(OH)Mg(OH)22 acidacid Mg(OH) Mg(OH)22

(solid)(solid) (dissolved) (dissolved)

DissolvedDissolved Mg(OH) Mg(OH)22 Mg(OH)Mg(OH)++ + (OH) + (OH)--

Mg(OH)Mg(OH)++ Mg Mg++++ + (OH) + (OH)--

Now, (OH)- is the determine factor which will participate Now, (OH)- is the determine factor which will participate withwith


Mechanism of action of Mg(OH)Mechanism of action of Mg(OH)2 2 cont….cont…. : :proton from gastric HCl along with water & thus proton from gastric HCl along with water & thus neutralizes the acid, leaving the counterpart Mgneutralizes the acid, leaving the counterpart Mg+2 +2

HCl ------HCl ------ H H++ + Cl + Cl--

HH22O + HO + H+ + -------------- H H33OO++

(OH)(OH)-- + H + H33OO+ + ---------- 2H 2H22OO

Now Mg binds with Cl- to form insoluble MgCl2 which Now Mg binds with Cl- to form insoluble MgCl2 which is mainly responsible for laxative actions.is mainly responsible for laxative actions.

MgMg++++ + 2 Cl + 2 Cl-- ------ ------ MgCl MgCl22


Laxative mechanism of Laxative mechanism of Mg(OH)Mg(OH)22 : :

Mg(OH)2 + 2HCl = MgCl2 + 2H2O


Advantages of Mg(OH)Advantages of Mg(OH)22 : :1. Fast onset of action.1. Fast onset of action.2. No systemic alkalosis.2. No systemic alkalosis.3. High ANC.3. High ANC.

Disadvantages of Mg(OH)Disadvantages of Mg(OH)22 : :1. Short duration of actions.1. Short duration of actions.2. Laxative 2. Laxative 3. Hypermagnesia.3. Hypermagnesia.

Dose of Mg(OH)Dose of Mg(OH)22 : :300 mg to 600 mg as antacid per day. 2 to 4 gm as 300 mg to 600 mg as antacid per day. 2 to 4 gm as cathartic per day.cathartic per day.

Milk of MagnesiaMilk of Magnesia

It is a 7-8.5% w/w suspention of magnesium It is a 7-8.5% w/w suspention of magnesium hydroxide, which may contain 0.1% citric and not hydroxide, which may contain 0.1% citric and not more then 0.05% of a volatile oil or a blend of more then 0.05% of a volatile oil or a blend of volatile oils, suitable for flavoring purpose.volatile oils, suitable for flavoring purpose.

It is a white, opaque, more or less viscous It is a white, opaque, more or less viscous suspension from varying proportion of water usually suspension from varying proportion of water usually separate on standing and has a pH of about 10.separate on standing and has a pH of about 10.

Storage at temperature not exceeding 35◦C not Storage at temperature not exceeding 35◦C not freezed. freezed.

DoesDoes:: As antacid: 5 ml four times a day, As antacid: 5 ml four times a day, As cathartic: 15 to 30 ml daily. As cathartic: 15 to 30 ml daily.

Antacids & Antacids & AntiflatulentsAntiflatulents Simethicone Simethicone Simethicon is a mixture of full methylated linear siloxane Simethicon is a mixture of full methylated linear siloxane

polymers containing repeating units of the formula [-(CH3)polymers containing repeating units of the formula [-(CH3)22 SiOSiO22]n, stabilized with trimethylsiloxy end- bulking units of ]n, stabilized with trimethylsiloxy end- bulking units of the formula [(CH3)the formula [(CH3)33 SiO-] and silicon dioxide. SiO-] and silicon dioxide.

Translucent, gray, viscous fluid, Sp. gravity 0.064 – 0.984, Translucent, gray, viscous fluid, Sp. gravity 0.064 – 0.984, viscosity not less then 300 centistokes at 25◦C.viscosity not less then 300 centistokes at 25◦C.

Use:Use: Antiflatulent, gastric protective to deform gastric juice Antiflatulent, gastric protective to deform gastric juice in order to decrease the tendency to gastro esophageal in order to decrease the tendency to gastro esophageal reflux.reflux.

Dose:Dose: 40-80 mg (tablet) 4 times a day after each meal & at 40-80 mg (tablet) 4 times a day after each meal & at bedtime.bedtime.

CH3 S

CH3

CH3

O Si

CH3

CH3

O

n

Si

CH3

CH3

CH3

Protectives or Protectives or AdsorbentsAdsorbents CriteriaCriteria :: Treatment for mild diarrheaTreatment for mild diarrhea Contain antibacterial agentContain antibacterial agent Decreases peristalsisDecreases peristalsis Adsorbent-protective – adsorb toxins, Adsorbent-protective – adsorb toxins,

bacteria, and viruses.bacteria, and viruses.

Protectives or Protectives or AdsorbentsAdsorbents BISMUTH-CONTAINING PRODUCTSBISMUTH-CONTAINING PRODUCTS

astringentastringentantisepticantiseptic

BISMTUH SUBNITRATEBISMTUH SUBNITRATEWhite BismuthWhite BismuthNon-irritant intestinal antisepticNon-irritant intestinal antisepticAlso used in gastric ulcer and inflammationsAlso used in gastric ulcer and inflammations

BISMUTH SUBCARBONATEBISMUTH SUBCARBONATEBasic Bismuth CarbonateBasic Bismuth CarbonateProtective and antacidProtective and antacidRadiopaque contrast mediumRadiopaque contrast medium

ACTIVATED CHARCOALACTIVATED CHARCOALAdsorbent for diarrheaAdsorbent for diarrheaAntidote for certain poisoningAntidote for certain poisoning

Protectives or Protectives or AdsorbentsAdsorbents Magnesium TrisilicateMagnesium Trisilicate : :

It is a compound of MgO and SiOIt is a compound of MgO and SiO22 containing containing varying proportion of water. Due to method of varying proportion of water. Due to method of manufacture, it is more likely to be a mixture of manufacture, it is more likely to be a mixture of magnesium metaslicate (MgSiOmagnesium metaslicate (MgSiO33) and colloidal ) and colloidal SiOSiO22, with varying amount of water. , with varying amount of water.

Preparation of Magnesium TrisilicatePreparation of Magnesium Trisilicate : :

Na4Si3O8 + MgCl2/MgSO4 Mg2Si3O8 + NaCl/Na2SO4

Protectives or Protectives or AdsorbentsAdsorbents Mechanism of Magnesium Trisilicate :Mechanism of Magnesium Trisilicate :

It has protective, neutralizing & laxative activity.It has protective, neutralizing & laxative activity.

Advantage:Advantage: 1. Protective action of ulcer 1. Protective action of ulcer DisadvantageDisadvantage: Siliceous nephrolith, Diarrhea.: Siliceous nephrolith, Diarrhea. DoesDoes: usually 1-16 gm daily (4 times) : usually 1-16 gm daily (4 times) UseUse: As antacid, as adsorbent/ protective. : As antacid, as adsorbent/ protective.

MgSi3O8 + 4HCl = 2MgCl2 + H4Si3O8

2H2SiO3 + SiO2 + nH2O

collidal mixture

Saline Cathartics or Saline Cathartics or laxativeslaxatives

Saline cathartics or purgatives are agents that quicken Saline cathartics or purgatives are agents that quicken and increase evacuation from the bowl. Laxatives are and increase evacuation from the bowl. Laxatives are mild cathartics. mild cathartics.

Cathartics are used:Cathartics are used: To ease defecation in patients with painful To ease defecation in patients with painful

hemorrhoids or other rectal disorders.hemorrhoids or other rectal disorders. To avoid excessive straining and concurrent increase To avoid excessive straining and concurrent increase

in abdominal pressure in patients with hernias or to in abdominal pressure in patients with hernias or to avoid potentially hazardous rise in B.P. avoid potentially hazardous rise in B.P.

During defecation in patients with hypertension, During defecation in patients with hypertension, cerebral coronary or other arterial disease cerebral coronary or other arterial disease

To relieve acute constipation or to remove solid To relieve acute constipation or to remove solid material from intestinal tract prior to certain material from intestinal tract prior to certain roentgenographic studies.roentgenographic studies.

Saline Cathartics or Saline Cathartics or laxativeslaxatives Four types of laxatives are Four types of laxatives are

known:known:1.1. Stimulant Laxatives – local irritation on the Stimulant Laxatives – local irritation on the

intestinal tractintestinal tract

2.2. Bulk-forming Laxatives – made from cellulose Bulk-forming Laxatives – made from cellulose that swell when wet, stimulating peristalsisthat swell when wet, stimulating peristalsis

3.3. Emollient Laxatives – stool softenersEmollient Laxatives – stool softeners

4.4. Saline Cathartics – increasing the osmotic Saline Cathartics – increasing the osmotic loadload

Examples of Saline Examples of Saline Cathartics or laxativesCathartics or laxatives Stimulants include phenolphthalein, aloin, cascara Stimulants include phenolphthalein, aloin, cascara

extract, rhubarb extract, senna extract, extract, rhubarb extract, senna extract, podophyllin, castor oil, bisacodyl, calomel etc.podophyllin, castor oil, bisacodyl, calomel etc.

Bulk forming laxatives are made from cellulose, Bulk forming laxatives are made from cellulose, sodium carboxyl methyl cellulose and karaya gum.sodium carboxyl methyl cellulose and karaya gum.

The emollient laxatives act either as lubricants The emollient laxatives act either as lubricants facilitating the passage of compacted fecal facilitating the passage of compacted fecal material or as stool softeners. E.g mineral oil, d-material or as stool softeners. E.g mineral oil, d-octyl sodium sulfosuccinate, an anionic surface octyl sodium sulfosuccinate, an anionic surface active agent.active agent.

Saline cathartics act by increasing the osmotic Saline cathartics act by increasing the osmotic load of the GIT. They are salts of poorly absorbable load of the GIT. They are salts of poorly absorbable anions –Hanions –H22POPO44- (biphosphate), -HPO4- (biphosphate), -HPO422- (phosphate), - (phosphate), sulphates, tartarates, andsoluble magnesium salt.sulphates, tartarates, andsoluble magnesium salt.

Saline Cathartics or Saline Cathartics or laxativeslaxatives Use of saline catharticsUse of saline cathartics : :

1. Saline cathartics are water soluble and are taken 1. Saline cathartics are water soluble and are taken with large quantities of water. This prevents excessive with large quantities of water. This prevents excessive loss of water from body fluids and reduces nausea loss of water from body fluids and reduces nausea vomiting if a too hypertonic solution should reach the vomiting if a too hypertonic solution should reach the stomach. They act in the intestine and a full cathartic stomach. They act in the intestine and a full cathartic dose produces a water evacuation within 3-6 hrs.dose produces a water evacuation within 3-6 hrs.2. They are used for bowel evacuation before 2. They are used for bowel evacuation before radiological, endoscopic and surgical procedures and radiological, endoscopic and surgical procedures and also to expel parasite and toxic materials.also to expel parasite and toxic materials.

Side effects :Side effects :Small amounts of these drugs may be absorbed in the Small amounts of these drugs may be absorbed in the blood causing occasional toxicity. The absorption of blood causing occasional toxicity. The absorption of magnesium may cause marked CNS depression while magnesium may cause marked CNS depression while that of sodium worsens the existing congestive cardiac that of sodium worsens the existing congestive cardiac failure (CCF).failure (CCF).

Antacid combinationsAntacid combinations

Every single compound among antacid have Every single compound among antacid have some side effect especially when used for some side effect especially when used for longer period or used in elderly patients. To longer period or used in elderly patients. To avoid certain side effects associated with avoid certain side effects associated with antacids, combinations of antacids are used antacids, combinations of antacids are used such as :such as :(i) Magnesium and aluminium containing (i) Magnesium and aluminium containing preparation e.g. magnesium hydroxide a fast preparation e.g. magnesium hydroxide a fast acting antacid with aluminium hydroxide acting antacid with aluminium hydroxide which is a slow acting antacid.which is a slow acting antacid.(ii) Magnesium and calcium containing (ii) Magnesium and calcium containing preparation where one is laxative and the preparation where one is laxative and the later one is constipative in nature later one is constipative in nature

Advantages of antacid Advantages of antacid combinationscombinations

Different advantages are given below --Different advantages are given below --1. To balance laxative & constipation action1. To balance laxative & constipation action : :

When laxatives & constipating compound are When laxatives & constipating compound are formulated in mixture, the gastro-intestinal disturbances formulated in mixture, the gastro-intestinal disturbances may not occur or less occur.may not occur or less occur.

Al(OH)Al(OH)33 + Mg(OH) + Mg(OH)2 2 less or no GI less or no GI disturbances.disturbances.

250 mg 400 mg250 mg 400 mg(Constipating agent) (Laxative)(Constipating agent) (Laxative)2. To maintain fastation & solvation2. To maintain fastation & solvation : :

To increase total buffering time, a fasting acting To increase total buffering time, a fasting acting compound with slow acting antacid are formulated in compound with slow acting antacid are formulated in mixtures.mixtures.

NaHCONaHCO33 + Mg(OH) + Mg(OH)22 or MgCO or MgCO33 Maintain fastation Maintain fastation

& solvation & solvation

Advantages of antacid Advantages of antacid combinations cont…combinations cont…

3. To reduce toxicity : 3. To reduce toxicity : In a single entity antacids may cause high In a single entity antacids may cause high

toxicity. So to reduce toxicity antacids are formulated toxicity. So to reduce toxicity antacids are formulated in a mixture.in a mixture.4.To increase patient tolerance :4.To increase patient tolerance :

Mixture antacids increase the patient tolerance Mixture antacids increase the patient tolerance rather than by multiple separate preparation.rather than by multiple separate preparation.5. For bone formation :5. For bone formation :

Long time continuous use of AlLong time continuous use of Al++++++ may produce may produce lack of POlack of PO4 4

3- 3- which inhibit the bone formation.which inhibit the bone formation.Al(OH)Al(OH)33 + HCl + HCl AlCl AlCl33 + H + H22OO

AlClAlCl3 3 Al Al3+3+ + 3Cl + 3Cl--

AlAl3+3+ + PO + PO44 3-3- AlPOAlPO44

ANCANC

ANC may be defined as a no. of mili ANC may be defined as a no. of mili equivalent of 1 N HCl that brought to equivalent of 1 N HCl that brought to pH 3.5 within 15-60 minutes by an unit pH 3.5 within 15-60 minutes by an unit of antacid preparation.of antacid preparation.

Antacids are compared quantitatively Antacids are compared quantitatively in terms of ANC.in terms of ANC.

ANC depends on crystal form, ANC depends on crystal form, precipitants used, presence of reactive precipitants used, presence of reactive suspension agents.suspension agents.

AchlorhydriaAchlorhydria

Achlorihydria is the absence of hydrochloric acid Achlorihydria is the absence of hydrochloric acid in the gastric secretion.in the gastric secretion.Patients with this condition fall into one of the two Patients with this condition fall into one of the two conditions :conditions :

1. Those who remains free of gastric hydrochloric 1. Those who remains free of gastric hydrochloric acid after stimulation with histamine phosphate.acid after stimulation with histamine phosphate.Causes Causes :: This type of achlorihydria includes those patient This type of achlorihydria includes those patient with with

- Subtotal gastrectomy- Subtotal gastrectomy- Atropic gastritis (Chronic gastritis with - Atropic gastritis (Chronic gastritis with

atropy of the membranes and glands)atropy of the membranes and glands)- Carcinoma of the stomach- Carcinoma of the stomach- Gastric palyps, etc.- Gastric palyps, etc.


Treatment :Treatment :Dilute hydrochloric acid N.F. has been utilized to Dilute hydrochloric acid N.F. has been utilized to relative this type of achlorhydria.relative this type of achlorhydria.In order to avoid exposure of dental enamel to In order to avoid exposure of dental enamel to hydrochloric acid, the use of drinking straw laid hydrochloric acid, the use of drinking straw laid well back on the tongue has been well back on the tongue has been recommended or the use of equivalent product recommended or the use of equivalent product such as glutamic acid hydrochloride which is such as glutamic acid hydrochloride which is administrated in capsule.administrated in capsule.Dose :Dose : The usual 5 ml dose of diluted HCl N.F. added to The usual 5 ml dose of diluted HCl N.F. added to 200 ml of water provides about 15mEq of acid.200 ml of water provides about 15mEq of acid.


Those in whom there is normally a lack of gastric Those in whom there is normally a lack of gastric hydrochloric acid , but who responds to stimulation hydrochloric acid , but who responds to stimulation by histamine.by histamine.Causes :Causes :Patients with this type of achlorhydria includes Patients with this type of achlorhydria includes those with those with

-Chronic nephritis-Chronic nephritis-Chronic alcoholism-Chronic alcoholism-Tuberculosis-Tuberculosis-Hyperthyroidism-Hyperthyroidism-Pellagra (caused by lack of vit B and protein)-Pellagra (caused by lack of vit B and protein)-Normal individual after the age of 50.-Normal individual after the age of 50.

Treatment :Treatment :Administration of histamine phosphate.Administration of histamine phosphate.


Symptoms of achlorhydriaSymptoms of achlorhydria : :The symptoms of achlorhydria can vary with The symptoms of achlorhydria can vary with the associated disease, but generally include –the associated disease, but generally include –

1. Mild diarrhea1. Mild diarrhea2. Frequent bowel movement 2. Frequent bowel movement 3. Epigastric pain3. Epigastric pain4. Sensitivity to spicy foods4. Sensitivity to spicy foods5. Pernicious anemia due to lack of 5. Pernicious anemia due to lack of

intrinsic factor.intrinsic factor.6. Lack of pepsin activity due to 6. Lack of pepsin activity due to

increased pH.increased pH.7. Protien metabolism7. Protien metabolism

DiarrheaDiarrhea

Definition :Definition :Diarrhea is a frequent passage of uniformed watery bowel Diarrhea is a frequent passage of uniformed watery bowel movements. Very briefly, it results when some factors movements. Very briefly, it results when some factors impairs digestion or absorption, thereby the intestinal impairs digestion or absorption, thereby the intestinal content is increased & cell damage is started. This content is increased & cell damage is started. This increased bulk of intestinal tract stimulates peristalsis, increased bulk of intestinal tract stimulates peristalsis, propelling the intestinal contents to the anus (i.e. the propelling the intestinal contents to the anus (i.e. the fluids come from the body)fluids come from the body)

Causes of Diarrhea :Causes of Diarrhea :– DietDiet– Gastro-intestinal infectionsGastro-intestinal infections– Certain damageCertain damage– Psychogenic factorsPsychogenic factors– Inflammation or irritation of the mucosa of the Inflammation or irritation of the mucosa of the

intestines.intestines.

Classification :Classification : Diarrhea may be of several types :Diarrhea may be of several types :– Acute DiarrheaAcute Diarrhea– Caused by toxins, chemical poisons, drugs, allergy, Caused by toxins, chemical poisons, drugs, allergy,

diseasedisease– Chronic DiarrheaChronic Diarrhea– Result from gastrointestinal surgery, carcinomas, chronic Result from gastrointestinal surgery, carcinomas, chronic

inflammatoryinflammatory Acute diarrhea :Acute diarrhea :

Acute diarrhea may be caused byAcute diarrhea may be caused by Bacterial toxinsBacterial toxins Chemical poisonsChemical poisons DrugsDrugs Some diseaseSome disease AllergyAllergy

DiarrheaDiarrhea

Mechanism of acute diarrhea :Mechanism of acute diarrhea : These agents for causing acute diarrhea causes These agents for causing acute diarrhea causes

effects ranging from tissue damage to irritation to that effects ranging from tissue damage to irritation to that of causing electrolytes to flow from body fluids into of causing electrolytes to flow from body fluids into the intestinal tract, there by increasing the osmotic the intestinal tract, there by increasing the osmotic load of the intestinal tract.load of the intestinal tract.

Chronic diarrhea :Chronic diarrhea :Chronic diarrhea can result from –Chronic diarrhea can result from –

GI surgeryGI surgery CarcinomaCarcinoma Chronic inflammatory conditionsChronic inflammatory conditions Various absorptive defectsVarious absorptive defects

DiarrheaDiarrhea

TreatmentTreatment : :Most products for the treatment of diarrhea will consist of Most products for the treatment of diarrhea will consist of – Adsorbent propertiesAdsorbent properties : These agents supposedly : These agents supposedly

absorb toxins, bacteria & viruses along with providing a absorb toxins, bacteria & viruses along with providing a protective coating of the intestinal mucosa. For example protective coating of the intestinal mucosa. For example – Bismuth salt, Special clays & activated charcoal etc.– Bismuth salt, Special clays & activated charcoal etc.

– AntispasmodicAntispasmodic : These agents act directly on the : These agents act directly on the smooth muscles of the gut to produce a spasm-like effect smooth muscles of the gut to produce a spasm-like effect which decrease peristalsis & increased segmentation.which decrease peristalsis & increased segmentation.

– Antimicrobial agentAntimicrobial agent : It is only effective if there is an : It is only effective if there is an actual infection in the intestinal tract or during epidermis actual infection in the intestinal tract or during epidermis previously shows to be caused by a micro-organism. previously shows to be caused by a micro-organism.

DiarrheaDiarrhea

Dehydration is the condition resulting from excessive water loss of Dehydration is the condition resulting from excessive water loss of body fluids.body fluids.

CausesCauses : :– Excessive loss of water from body such as sweating, cholera, diarrhea, Excessive loss of water from body such as sweating, cholera, diarrhea,

haemohhrage.haemohhrage.– Reduction of total quantity of electrolytes.Reduction of total quantity of electrolytes.– From fluid deprivation.From fluid deprivation.– Injection of hypertonic solution.Injection of hypertonic solution.

Sign of dehydrationSign of dehydration::– Sunken of eye ball.Sunken of eye ball.– Dryness of tongueDryness of tongue– Wrinkles of skin.Wrinkles of skin.– Dryness & roughness of skin.Dryness & roughness of skin.

TreatmentTreatment : :– Oral rehydration salt (ORS)Oral rehydration salt (ORS)– Ringer’s injectionRinger’s injection– Lactated Ringer’s injectionLactated Ringer’s injection– NaCl injectionNaCl injection– Dextrose & NaCl injectionDextrose & NaCl injection– Dextrose injectionDextrose injection

DehydrationDehydration

ConstipationConstipation is the infrequent defecation with passage of is the infrequent defecation with passage of unduly hard and dry fecal material or sluggish action of the unduly hard and dry fecal material or sluggish action of the bowels. It may cause due tobowels. It may cause due to – –– Predisposing factors – No regular bowel habits from Predisposing factors – No regular bowel habits from

childhoodchildhood– A person who resist the natural urge to defecate.A person who resist the natural urge to defecate.– Causing the fecal material which remains in the colon to loss Causing the fecal material which remains in the colon to loss

fluid to become relatively hard & dry.fluid to become relatively hard & dry.– Intestinal due to lack of mucous secretionIntestinal due to lack of mucous secretion– Intestinal spasm.Intestinal spasm.– EmotionEmotion– DrugsDrugs– DietsDiets

Treatments :Treatments :– Plenty of fresh vegetables, fruits, milk & abundance of water.Plenty of fresh vegetables, fruits, milk & abundance of water.– Saline cathertics : e.g. Sodium- bi-phosphateSaline cathertics : e.g. Sodium- bi-phosphate

CONSTIPATIONCONSTIPATION

ORSORS is used in the replacement of fluid & electrolytes is used in the replacement of fluid & electrolytes lost through dehydration (Diarrhea). Mainly they lost through dehydration (Diarrhea). Mainly they contain salt of Na & K & anhydrous glucose or dextrose.contain salt of Na & K & anhydrous glucose or dextrose.

CriteriaCriteria : :– It should contain an alkalizing agent to counter It should contain an alkalizing agent to counter

acidosis (As acid increases with increased quantity acidosis (As acid increases with increased quantity of electrolytes)of electrolytes)

– It should be simple to use in hospital & at home.It should be simple to use in hospital & at home.– It should be palatable & acceptable.It should be palatable & acceptable.– It should be readily availableIt should be readily available– It should replace the electrolyte deficit adequately & It should replace the electrolyte deficit adequately &

safely.safely.– It should enhance optimally the absorption of water It should enhance optimally the absorption of water

& electrolytes.& electrolytes.

ORSORS

When a hot solution of K-Alum is added to a hot solution of When a hot solution of K-Alum is added to a hot solution of NaCONaCO33 (at 70 (at 7000C), Al(OH)C), Al(OH)33 in produced. in produced.NaNa22COCO33 + K + K22SOSO44. Al. Al22(SO(SO44))33 K K22SOSO44+Na+Na22SOSO44+ Al(OH)+ Al(OH)33 + CO + CO22

In this reactions, no KIn this reactions, no K22COCO33 & Na & Na22COCO33 & Al & Al22(CO(CO33))33 is produced. is produced. Reasons :Reasons :

K-Alum is a double salt (KK-Alum is a double salt (K22SOSO44. Al. Al22(SO(SO44))33). And actually the ). And actually the AlAl22(SO(SO44))33 part of K-alum reacts with the NaCO part of K-alum reacts with the NaCO33 & form & form AlAl22(CO(CO33))33. The reactions does not occur with K. The reactions does not occur with K22SOSO44 , so the , so the number of K is equal in the both side of reaction.number of K is equal in the both side of reaction. AlAl22(SO(SO44))33 + Na + Na22COCO3 3 AlAl22(CO(CO33))3 3 + Na+ Na22SOSO44

This AlThis Al22(CO(CO33))3 3 ppt is dissociated by hot water into Al(OH)ppt is dissociated by hot water into Al(OH)33.. AlAl22(CO(CO33))33 + H + H22O Al(OH)O Al(OH)33 + CO + CO22

So K or Al carbonate is not produced.So K or Al carbonate is not produced.

Why K or Al COWhy K or Al CO3 3 is not produced during is not produced during the preparation of Al(OH)the preparation of Al(OH)33 ? ?

Electrolytes used in IVElectrolytes used in IV : :Solution of electrolytes are given intravenously to meet normal fluid and Solution of electrolytes are given intravenously to meet normal fluid and electrolytes requirements or to replenish substantial defects or continuing losses electrolytes requirements or to replenish substantial defects or continuing losses when the patient is nauseated or vomiting & is unable to take adequate by when the patient is nauseated or vomiting & is unable to take adequate by mouth. The following electrolytes solution of intravenous infusion may be listed --mouth. The following electrolytes solution of intravenous infusion may be listed --a) Sodium containing electrolytes solutiona) Sodium containing electrolytes solution : :

• NaCl solutionNaCl solution• Na-lactate injectionNa-lactate injection• Monobasic Na phosphateMonobasic Na phosphate• NaNa33POPO44 injection injection• Na-citrate & citric acid solutionNa-citrate & citric acid solution• NaHCONaHCO33 solution solution• Na-acetate solution.Na-acetate solution.

b) Potassium containing electrolytes solutionb) Potassium containing electrolytes solution : :• Potassium InjectionPotassium Injection• Ringer’s injectionRinger’s injection• Latated ringer’s injectionLatated ringer’s injection• Potassium gluconatePotassium gluconate

C) Calcium Containing electrolytes solutionC) Calcium Containing electrolytes solution : :• Latated ringer’s injectionLatated ringer’s injection• Ringer’s injectionRinger’s injection• Calcium GluconateCalcium Gluconate

What are the solutions of electrolytesWhat are the solutions of electrolytesthat are given intravenously?c that are given intravenously?c

Systemic antacid are those which are Systemic antacid are those which are soluble in water and absorbed through soluble in water and absorbed through the membrane of intestine in to the the membrane of intestine in to the blood circulation (systemic). Such as blood circulation (systemic). Such as Sodium bicarbonate is a systemic Sodium bicarbonate is a systemic antacid.antacid.Sodium Bicarbonate has a very rapid Sodium Bicarbonate has a very rapid onset of action but its duration of onset of action but its duration of action is short. It causes a sharp action is short. It causes a sharp increase gastric pH upto or above 7.increase gastric pH upto or above 7.

NaHCONaHCO33 is very effective antacids with is very effective antacids with strong limitations - explainstrong limitations - explain

The other limitations of this systemic antacids are -The other limitations of this systemic antacids are -• The proteolytic action of pepsin act in pH 1.8-3.5. As The proteolytic action of pepsin act in pH 1.8-3.5. As

NaHCONaHCO33 raises the pH upto 7 or above, the action of raises the pH upto 7 or above, the action of pepsin is hampered. To maintain the gastric pH, rebound pepsin is hampered. To maintain the gastric pH, rebound acidity occurs.acidity occurs.

• Absorption of sodium ion causes systemic alkalosis Absorption of sodium ion causes systemic alkalosis increasing the pH of blood of systemic circulation which increasing the pH of blood of systemic circulation which ultimately results over excitability of nervous system.ultimately results over excitability of nervous system.

• Sodium retention can be caused by the absorbed sodium Sodium retention can be caused by the absorbed sodium ion. It is a great problem for those patients who have ion. It is a great problem for those patients who have sodium-restricted diet as sodium is responsible for raising sodium-restricted diet as sodium is responsible for raising of blood pressure.of blood pressure.

• Sodium bicarbonate is definitely not indicated for those Sodium bicarbonate is definitely not indicated for those patients who need antacid therapy for even limited period patients who need antacid therapy for even limited period of time.of time.

• It inhibits the absorption of Tetracycline from the It inhibits the absorption of Tetracycline from the gastrointestinal tract.gastrointestinal tract.

NaHCONaHCO33 is very effective antacids with is very effective antacids with strong limitations – explain cont…..strong limitations – explain cont…..

Milk of magnesia , USP is a suspension of magnesium hydroxide Milk of magnesia , USP is a suspension of magnesium hydroxide containing not less than 7% and not more than 8.5% of Mg(OH)containing not less than 7% and not more than 8.5% of Mg(OH)22 ..

For purposes of minimizing the alkalinity of milk of magnesia For purposes of minimizing the alkalinity of milk of magnesia 0.1% citric acid is added.0.1% citric acid is added.

Normally, Mg(OH)Normally, Mg(OH)22 ionizes into Mg ionizes into Mg2+2+ & OH & OH-- ion. The citric acid ion. The citric acid upon addition reacts immediately to form magnesium citrate upon addition reacts immediately to form magnesium citrate which ionizes to supply magnesium ion & citrate ion.which ionizes to supply magnesium ion & citrate ion.Mg(OH)Mg(OH)2 2 MgMg2+2++ 2 OH+ 2 OH- - ---------(i) ---------(i) MgMg33(C(C66HH55OO77) 3Mg) 3Mg2+2++ 2C+ 2C66HH55OO77

3-3- ---------(ii) ---------(ii)

This increases the concentration of MgThis increases the concentration of Mg2+2+ ions. According to the ions. According to the law of mass action, forces the reaction to the left (expressed by law of mass action, forces the reaction to the left (expressed by equation-i). Such as action decreases hydroxide ion equation-i). Such as action decreases hydroxide ion concentration giving the product a milder & less chalky taste.concentration giving the product a milder & less chalky taste.

The alkalinity contributed by the glass container is like wise The alkalinity contributed by the glass container is like wise counteracted.counteracted.

Why citric acid is added in the Why citric acid is added in the preparation of milk of magnesia ?preparation of milk of magnesia ?

Additional questions…..Additional questions…..

Why antibiotic & antacid is not given together?Why antibiotic & antacid is not given together? Give some examples of Al & Mg containing Give some examples of Al & Mg containing

antacids?antacids? Write down the side effect or contraindication Write down the side effect or contraindication

of Mg(OH)of Mg(OH)22 antacid therapy? antacid therapy? Why non-systemic antacids does not produce Why non-systemic antacids does not produce

systemic alkalosis?systemic alkalosis? Write down some market preparation of Write down some market preparation of

antacids?antacids? Why it’s a great problem to put NaWhy it’s a great problem to put Na22COCO33

in K-alum?in K-alum?

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