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ANTI DIARE

Dharma Permana, PhD, Apt


Anti Diare
In diarrhea, the food and fluids you ingest
pass too quickly or in too large an amount
or both through your colon
The most common causes of
diarrhea include:
Viruses. Common viruses that cause diarrhea are the
Norwalk virus, cytomegalovirus, viral hepatitis and the
herpes simplex virus. Rotavirus is the most common
cause of acute childhood diarrhea. Viral diarrhea
spreads easily.
Bacteria and parasites. Contaminated food or water can
transmit bacteria and parasites to your body.
- Parasites such as Giardia lamblia and cryptosporidium
can cause diarrhea.
-Common bacterial causes of diarrhea include
campylobacter, salmonella, shigella, vibrio cholerae and
Escherichia coli.
This type of diarrhea can be common for people
traveling to developing countries.



Common causes of travelers diarrhea

Bacteria (70%) Parasites Viruses
E. coli Giardia lamblia Noro-viruses
Salmonella spp Cryptosporidium parvum Rotavirus
Campylobacter jejuni Entamoeba hystolitica
Shigella spp Cyclospora cayetanensis
Vibrio cholerae and other spp
Other causes of diarrhea:

Lactose. A sugar found in milk and milk products, lactose is a common
cause of diarrhea in some people.
Medications. Diarrhea can also be a side effect of many medications,
particularly antibiotics. Antibiotics destroy both good and bad bacteria,
which can disturb the natural balance of bacteria in your intestines. This
disturbance sometimes leads to an infection with bacteria called
Clostridium difficile, which can also cause diarrhea.
Artificial sweeteners. Sorbitol and mannitol, artificial sweeteners found in
chewing gum and other sugar-free products, can cause diarrhea in some
otherwise healthy people.
Surgery. Some people may experience diarrhea after undergoing
abdominal surgery or gallbladder removal surgery.
Other digestive disorders. Chronic diarrhea has a number of other
causes, such as Crohn's disease, ulcerative colitis, celiac disease and
irritable bowel syndrome.
Obat obat anti diare
Oralit
Adsorben dan Pembentuk masa
Anti Spasmodik/ anticholinergic
Anti Motilitas
Anti Microbabakteri, amuba

Oralit
Pertolongan pertama pada diare
Komposisi oralit
Glukosa anhidrat 4
NaCl 0,7
Na sitrat dihydrat 0.58
aqua ad 200 ml

- Oralit tidak menghentikan diare, tetapi mengantikan
cairan tubuh yg hilang bersama tinja
- Tiap kali BAB diberi Oralit Dehidrasi ringan/
sedang
< 1th min 300 ml, 1-4 th min 600ml
5-12 th min 1,2 L dan Dewasa 2,4 L

Adsorben dan Pembentuk masa
Adsorben
Norit tdk diserap usus, eksresi melalui
tinja
-menyerap toksin
Pembentuk Masa Tinja
-Kaolin
-Attapulgit
tdk diserap usus, eksresi melalui
tinja

Anti Spasmodik
Menghambat peristaltik usus dan lambung
Penghambatan thd asetilkolin eksogen ( ester
kolin)
- Bekerja pada reseptor muskarinik
anti muskarinik
-Mudah diserap, eksresi melalui ginjal (sebagian
dlm bentuk asal )
-Efek sampingmulut kering, dilatasi pupil
dan rasa haus

Obat obat anti spasmodik
Atropin0,25mg dan 0,5 mg Inj dan tab
Ekstrak belladon10 mg/tab
Hyosin n-butil bromida 10 mg/tab dan
20mg/tab
Papaverin HCl 40 mg/tab

Anti Motilitas
Memperlambat motilitas saluran cerna dgn
mempengaruhi otot sirkuler dan
longitudinal usus
decreases colonic mass movements and
suppresses the gastrocolic reflex
Berkaitan dgn reseptor opioid u reseptor
Kontraksi sal cerna berkurang

Obat obat anti motilitas
1.Loperamid (Imodium)
Tidak diserap baik secara oral
ekresi ( tinja)
Loperamide is a synthetic anti-diarrheal indicated for the
control and symptomatic relief of acute nonspecific
diarrhea and of chronic diarrhea associated with
inflammatory bowel disease.
Sediaan tab 2mg & sirup 1 mg/5 ml
Tdk dianjurkan utk anak2 (fatal paralytic ileus )
Side effects: constipation; difficulty breathing , dizziness ,
drowsiness
If there is a suspicion of diarrhea associated with
organisms that can penetrate the intestinal walls, such
as E. coli or salmonella, loperamide is contraindicated.
not recommended for use in hepatic failure
2.Codein Phospat
Tdk dianjurkan utk anak2
3.Morfin

Zinc and Diarrhea
In May 2004, WHO/UNICEF issued a joint
statement recommending the use of zinc, an
essential micronutrient for human growth,
development and maintenance of the immune
system, and a new formulation oral rehydration
solution (ORS), with reduced levels of glucose
and salt, as a two-pronged approach to
improved case management of acute diarrhea in
children.
WHO and UNICEF recommend 20 mg of zinc
per day for 10 -14 days for infants and children,
10 mg for infants under six months of age.
ZINC SUPPLEMENTS REDUCE THE SEVERITY AND
DURATION OF DIARRHOEA
Twelve studies examined the impact of zinc supplements
on the management of acute diarrhoea. Eleven of these
showed a reduction in the duration of the diarrhoeal
episode; the reduction was statistically significant.
The data shows that zinc supplementation during and
until cessation of diarrhoea (either syrup containing 20
mg of elemental zinc per 5 ml, or tablets of 20 mg zinc
such as zinc sulphate, gluconate or acetate) has a
significant and beneficial impact on the clinical course of
acute diarrhoea, reducing both its duration and severity.

Diarrheal Disease Control website at
www.eddcontrol.org,
Pharmacokinetics of Zinc
Zn and its salts are poorly absorbed from GIT
Zinc is absorbed and is widely distributed throughout the
body and excreted mainly in the feces and only traces
are found in the urine since kidney has little role in
regulating body Zn content. Endogenous Zn be
reabsorbed in ileum and colon creating enterohepatic
circulation of Zn

Zinc is primarily stored in muscle, bone, Skin, Kidneys,
Liver, Pancreas,retina, prostate

Zn supplements is usually administered 1 hour before or
2 hours after food. In the presence of gastric irritation Zn
has to be given with food.
Read more:
SIDE/ADVERSE EFFECTS OF
ZINC:
-Gastrointestinal abnormalities - Dyspepsia
- Epigastric pain & heart burn
- Nausea
- leucopenia (fever, chills, sore throat)
- Neutropenia (continuing ulcers & sores in
mouth and throat)
- Sideroblastic anemia (unusual
weakness/tiredness)
-Zinc overdose - Hypotension


References
Katzung, Bertram G. Basic and Clinical
Pharmacology, 9th ed. (2004).
F Awouters, C J E Niemegeers, and P A J
Janssen. Pharmacology of Antidiarrheal Drugs .
Annual Review of Pharmacology and
ToxicologyVol. 23: 279-301
Butler T (October 2008). "Loperamide for the
treatment of traveler's diarrhea: broad or narrow
usefulness?". Clinical Infectious Diseases 47 (8):
10156.
Farmakologi dan Terapi ed IV




Thank you

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