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Factors Influencing Drug Absorption: Disease States and Pharmacology01:25

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Multiple disease states can significantly influence the oral drug absorption process by affecting blood flow and the functionality of the gastrointestinal (GI) system. Various GI diseases, including conditions that alter GI motility, such as diarrhea, decreased acid secretions (achlorhydria), and infections, have been associated with reduced drug absorption.
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
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Prokinetic agents are specialized medications that stimulate gastrointestinal (GI) motility, promoting food movement through the GI tract. Dopamine, an inhibitory neurotransmitter, plays a significant role in this process, reducing GI motility and indirectly controlling the speed of digestion. Dopamine receptor antagonists, such as metoclopramide and domperidone, offer a unique advantage as prokinetic agents. By blocking the dopamine receptors, these drugs increase GI motility, improving food...
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The process of oral drug absorption can be influenced by several factors. Weakly acidic drugs tend to be absorbed more readily from the stomach due to their nonionized state. However, absorption may be less efficient in the upper intestine, where drugs are often ionized. Interestingly, despite the stomach's apparent advantage for drug absorption, its mucous layer can hinder diffusion. Its surface area is also smaller than the intestine's, which can further slow down the absorption rate.
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Acute diarrhea, a common gastrointestinal disturbance, is characterized by the rapid evacuation of fluid stools, leading to an excessive weight in fluid. This condition typically arises from disorders affecting intestinal water and electrolyte transport. It can be triggered by an increased osmotic load within the intestine, excessive secretion of electrolytes and water, mucosal exudation of protein and fluid, or altered intestinal motility. The primary risks of acute diarrhea are dehydration...
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Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists01:23

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Serotonin, a crucial neurotransmitter synthesized by enterochromaffin cells, plays a cardinal role in regulating gastrointestinal (GI) motility. With over 90% of the body's total serotonin in the GI tract, its influence on digestive processes is profound. Serotonin is swiftly released upon various stimuli, such as food boluses or certain drugs, triggering intrinsic sensory neurons in the myenteric plexus and extrinsic vagal and spinal sensory neurons. This leads to the activation of the...
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Medications that Regulate Gastrointestinal Transit Influence Inpatient Blood Glucose.

Amanda Momenzadeh1, Caleb Cranney2, So Yung Choi3

  • 1Department of Computational Biomedicine; Cedars-Sinai; Los Angeles, CA USA.

Medrxiv : the Preprint Server for Health Sciences
|August 12, 2024
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Summary

Many medications, including some affecting gastrointestinal motility, can alter hospitalized patients' blood glucose (BG). This study identified 10 new medications impacting BG, improving glycemic management and patient safety.

Keywords:
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Area of Science:

  • Clinical Pharmacology
  • Health Informatics
  • Endocrinology

Background:

  • Hospitalized patients exhibit complex blood glucose (BG) variability due to numerous factors.
  • Existing knowledge on medications affecting BG is incomplete, risking patient safety and glycemic control.
  • Identifying novel drug-induced BG alterations is crucial for improved clinical practice.

Purpose of the Study:

  • To identify previously unrecognized medications that significantly influence blood glucose levels in hospitalized patients.
  • To analyze the strength and timing of relationships between various factors and BG variability.
  • To enhance patient safety and glycemic management by uncovering new drug-BG associations.

Main Methods:

  • Utilized electronic health record (EHR) data from over 100,000 inpatient encounters spanning 8 years.
  • Extracted data on over 500 medications, laboratory results, and clinical predictors of BG.
  • Employed Lasso regression for feature selection and linear mixed models for statistical significance, validating against an adverse drug event database.

Main Results:

  • Identified 29 statistically significant features associated with BG variability.
  • Discovered 10 medications not previously documented to affect BG, including gastrointestinal motility agents.
  • Other significant predictors included race, type 2 diabetes history, prior BG levels, and creatinine.

Conclusions:

  • This study highlights medications affecting gastrointestinal transit as novel predictors of BG variability.
  • Findings suggest certain medications require cautious use in patients with or at risk for hyperglycemia or hypoglycemia.
  • Further research is warranted to fully integrate these findings into clinical decision-making for enhanced patient care.