Pancreatic enzyme supplements, hepato-protective drugs and drugs which affect the biliary system.

Question 1

Explain pancreatic enzyme supplements.

Answer 1

“PANCRELIPASE is the replacement enzyme of choice, which contains a mixture of amylase, lipase and protease. Administered orally before every meal, they are rapidly inactivated by stomach acid, require enteric coating to pass stomach acidity.

Oral preparations are not to be chewed as there is risk of developing oropharyngeal mucositis. 3 factors should be considered when calculating enzyme replacement dose.

1. Age and weight of the pateint.
2. Amount of dietary fat intake. (Lipase).
3. Degree of severity of the pancreatic insufficiency.

Question 2

hepato-protective agents classification.

Answer 2

1. Drugs, stimulating regeneration processes

• Silymarin
• Phosphatidylcholine (Essentiale forte N)
• Ademetionine
• Liponorm

2. Drugs, suppressing fatty infiltration
   - Thiotic Acid
3. Drugs with detoxification activity
   - L-ornithine-L-aspartate (Hepa-Merz)

Question 3

Explain the hepato-protective drugs which stimulate regeneration processes.

Answer 3

1. SILYMARIN : Limits hepatic injury caused by toxins, anti-inflammatory properties, Increase RNA polymerase activity in healthy hepatocytes (not malignant ones) which stimulates regeneration. “Laxative effect” at high doses (Increase evacuation and bowel movements).
2. Essentiale forte: Stabilisation of cell membrane, maintenance of cell metabolism and inhibition of connective tissue formation in the liver.
3. Adementionine: Improves hepatocyte metabolism and anti-oxidant activity (prevents oxidative damages).
4. Liponorm: Improves liver/hepatocyte metabolism.

Question 4

Explain the drugs with detoxification activity.

Hepa-Merz

Answer 4

They are indicated for parenteral nutrition in liver disease and as prevention and treatment of liver encephalopathy. They lower ammonia levels and are used in detoxification in liver encephalopathy (Caused by the accumulation of un- metabolised ammonia in the liver).

Question 5

Classification of the drugs which affect the Biliary system?

Answer 5

1. Choleretic agents
   - Cynarix
   - Cholagol
2. Cholekinetic agents
   - Rowachol
3. Drugs for treatment of gallstones
   o Ursodeoxycholic acid

Question 6

Explain the drug used for the treatment of gall stones (Ursodeoxycholic acid)

Answer 6

URSODEOXYCHOLIC ACID is used for dissolution of small gallstones in patients with low surgical compliance. Normally constituting 5% of normal bile, after modification 30-50%.

Oral absorption, liver conjugation and biliary excretion.

Question 7

Explain the “Choleretic agents:.

Answer 7

1. CHOLAGOL : Cholespasmolytic and choleantiseptic activty
2. CYNARIX : Choleretic and hepatoprotective activity.

Choleretics are substances that enhance bile production and/or increase the volume of bile secreted from the liver.

Used in cholecystopathy with decreased bile secretion, dyspeptic syndrome, chronic cholecystitis and cholangitis

Question 8

Explain “Cholikinetic agents”

Answer 8

Cause increased bile secretion by increasing the gall bladder tone and increasing the contractile power of the bile duct. Used in situations where there is low bile secretion e.g: cholelithiasis, cholecystopathy and cholecystitis (gall bladder inflammation).

1. ROWACHOL : It stimulates bile secretion and has a spasmolytic effect on the biliary tract.