As a result of studying this chapter, the student must:


• Means that affect appetite;

• the concept of anorexic action, the mechanisms of action of anorexigenic drugs;

• regulators of the motor function of the gastrointestinal tract;

• antispasmodics;

• drugs that increase the tone of smooth muscles of the digestive tract;

• antisecretory means;

• Characteristics of antiemetics;

• classification and mechanism of action of antacids;

• classification and mechanism of action of antisecretory drugs

• agents that protect the gastroduodenal mucosa - cytoprotectors;

• means of substitution therapy for insufficient secretion of the glands of the stomach;

• enzyme preparations;

• drugs that reduce secretion and reduce the activity of pancreatic enzymes in acute pancreatitis;

• classification and mechanism of action of antispasmodics;

• classification and mechanism of action of gastroprotectors;

• classification and mechanism of action of hepatoprotectors;

• classification and mechanism of action of cholagogue funds;

• classification and mechanism of action of laxatives;

• antidiarrheal (antidrastic) remedies;

• funds that promote the dissolution of gallstones;

• funds that reduce gassing in the intestines;

• drugs that regulate the balance of the intestinal microflora;

• laxatives;

be able to

• analyze the effect of drugs that affect the functions of the digestive system, but the totality of their pharmacological properties;

• Evaluate the use of drugs in this group for pharmacotherapy;

• evaluate the possibility of toxic effects of drugs of this group;

• justify the use of drugs in this group;

• compare the features of the use of drugs in this group;

• evaluate the effectiveness of the use of drugs in this group;

• Prevent side effects of drugs in this group;

• determine the benefits of herbal preparations before others;

own skills

• The choice of the medicinal product of this group for the totality of its pharmacological properties, mechanisms and localization of action and the possibility of substitution by a drug from other groups;

• the choice of a certain dosage form of this group, the dose and route of administration of drugs taking into account the pathological condition;

• predicting the possible interaction of drugs of this group with the combined use of various drugs.

Abnormal diet, sedentary lifestyle, stress, environmental pollution lead to the fact that many people around the world suffer from various diseases of the digestive system. In particular, as a result of numerous international and United States epidemiological studies, it has been established that the rate of slowing the transit of food through the gastrointestinal tract (functional constipation) in industrialized countries reaches 40% among people of working age. Along with dietary correction of gastrointestinal diseases in the prevention and treatment of violations of the gastrointestinal tract, medicines are of great importance. The structure of the digestive system is shown in Fig. 6.1.

The structure of the digestive system

Fig. 6.1. The structure of the digestive system


Appetite is regulated by a complex neurohumoral system. It includes both central and peripheral mechanisms. Taste, olfactory, visual sensations, signals from the digestive tract, metabolism in peripheral tissues, hormonal influences - all this can be conditionally attributed to peripheral mechanisms. In the central nervous system, appetite is controlled by the center of hunger (lateral nuclei of the hypothalamus) and the center of saturation (ventromedial nuclei of the hypothalamus). To a large extent, the appetite depends on the functional state of the limbic system and the cortex (especially the frontal lobes). A schematic representation of the regulation of appetite is shown in Fig. 6.2.

The main value in the regulation of appetite is the noradrenergic, dopaminergic and serotonergic systems. The body found substances involved in controlling appetite and energy balance. Some of them increase appetite (orexigenic effect), but endogenous compounds that suppress appetite (anorexigenic effect) are also isolated.

Schematic representation of appetite regulation

Fig. 6.2. Schematic representation of appetite regulation

With a reduced appetite appoint funds that stimulate appetite. To this end, bitterness can be used, for example tincture of wormwood, obtained from wormwood bitter. Tincture of wormwood contains glycoside absintine, as well as an essential oil consisting of terpenes and isomer camphor abcitol. The mechanism of their action lies in the fact that they excite the receptors of the oral mucosa and reflexively increase the excitability of the center of hunger. Other bitterness: bitter tincture; infusions of grass of a thousand-centimeter, rhizome of ayr, dandelion root, leaves of a three-leaf watch; juice of plantain; collection for the excitation of appetite.

Ciprogenadine, anabolic steroids, some psychotropic drugs (aminazine, amitriptyline, lithium carbonate), neurotropic antihypertensives (clonidine), anabolic steroids also stimulate appetite. There are also special tools that reduce appetite (anorectic agents). They are used in the treatment of obesity associated with overeating (alimentary obesity), which burdens the course of many diseases, leads to a violation of metabolism, disorders of the cardiovascular system. The most appropriate way to treat obesity is to limit the amount and caloric content of the diet (diet). However, in this case, the limiting moment is a painful feeling of hunger. To eliminate a hundred, sometimes they use suppressants. In addition, anorexigenic sympathomimetic amines or serotonergic drugs that suppress the central physiological system for maintaining a stable body weight are used to facilitate the diet.

Sibutramine ("Redoxin") inhibits the reuptake of neurotransmitters - serotonin and norepinephrine - from the synaptic cleft, potentiates synergistic interactions of central noradrenaline and serotonergic systems, reduces appetite and the amount of food consumed (increases satiety ), increases thermogenesis (due to the mediated activation of β3-adrenoreceptors), affects brown fatty tissue. It belongs to the group of drugs for the treatment of obesity and is used for complex maintenance therapy of patients with excessive body weight. In obesity, a specific inhibitor of gastrointestinal lipases orlistat ("Xenical"), which does not affect appetite, but reduces body weight, is used in combination with other drugs. The drug is mixed with fat drops, covalently binds to the active center of pancreatic and gastric lipases, thereby inactivating them. Due to inhibition of gastrointestinal lipases, fats can not penetrate the blood. This creates an energy deficit, which leads to the mobilization of fat from the depot. Under the influence of orlistat, the mass of fat in the abdominal cavity (viscero-abdominal fat) decreases. It helps to lower the level of cholesterol in the blood - due to the decrease in the amount of free fatty acids in the lumen of the gut, the solubility of cholesterol decreases, which reduces its ability to penetrate into the blood. Contraindications: impaired absorption (malabsorption syndrome) in the intestines, children's age, kidney stones (as with the use of xenical increases the concentration of oxalate salts in the urine).

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