Non Essential Ions Lec:4 Fluoride Fluoride are widely used today for their anticariogenic action ( inhibition of dental cavity development ), also required required for bones and act as inhibitor of certain enzymes. About 9! of orally ta"en #uoride is absorbed. $odium #uoride has a wide range of therapeutic inde%. &any reports indicated that #uoride reduces the prevalence of osteoporosis. 'isible aortic calcication were actually higher in low #uoride area because #uoride facilitate calcium deposition in hard tissues rather than soft tissues. Bromide romides were introduced into medicine in *+ for their antiepileptic e-ect. Administration of small doses (./0 gm) of bromide serve to to cause depression to 12$, while large doses ( 3/+ gm) may depress all re#e%es re#e%es and cause narcotic type e-ect. romides usefulness in epilepsy depend on their ability to depress the motor areas of the brain , an e-ect brought about by large doses . romides are rapidly absorbed and are e%creted mainly in urine, and repeated doses tend to cause accumulation with a consequent replacement of chloride ion. 4he use of bromide is stopped stopped because of the possibility of bromism (bromide (bromide poisoning) , the early sign of into%ication include insomnia, dizziness, wea"ness and headache. 4reatment 4reatment of bromism by by administration of sodium chloride (5 gm daily in divided doses) or ammonium chloride used. Lithium 6t is readily absorbed from intestine , accumulates in the th e body. body. the e%tent of its accumulation depends on sodium inta"e (decrease sodium inta"e accelerate lithium accumulation) and potentiate to%icity. *
7ithium into%ication is treated by withhold lithium and provide sodium inta"e. 7ithium is a depressant to the 12$ and has a diuretic action. 7ithium carbonate is administered orally in manic depressive disorder. 7ithium carbonate can a-ect thyroid function causing my%edema( decient thyroid function) and decrease protein bound iodine levels and increase iodine inta"e. 7ithium can cause diabetes incipidus (increase urination without glucosurea).
Gold 6t is used in the rheumatoid arthritis, and therapeutic gold compounds are administered i.m. 8rally is poorly absorb and irritant. 4he gold is rapidly enters the plasma where it remains bound to albumin for several days so it is usually administered wee"ly. old to%icity involves the s"in, mucous membrane, :oints, blood, "idney, liver and nervous system. 4reatment of to%icity involve cessation of administration, supportive treatment and dimercaprol can be used. Aluminium $oluble aluminium compounds are astringent and antiseptic. $everal of soluble aluminium salts are used by the cosmetic industry as deodorants because of their mild astringent action. 4he insoluble aluminium compounds are mostly used as non systemic antacid. Lead 6ts salts were used topically as astringent. 8ral lead generally absorbed slowly and e%creted reasonably well. 6norganic lead can not pass through intact s"in but it will absorbed through abraded s"in, thus 7ead solution used as astringent could be absorbed systemically while organic 7ead such as tetraethyl 7ead can penetrate s"in rapidly.
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8nce absorbed , the 7ead can be found initially in the erythrocyte and soft tissue. 7ater the "idneys contain the most 7ead with the liver ,then over time redistribution occur to be found in bone,teeth and hair.
Lead poisoning ;hile 7ead may be considered a protein precipitant by combining with the cysteine sulfhydryl groups of protein, chronic 7ead poisoning manifests itself by inhibition of heme synthesis. 4he most serious 7ead poisoning symptoms is encephalopathy which is more common in children. g? and the mercuric >g?0 cations are to%ic, in addition that mercury vapour is to%ic. @oisoning by soluble inorganic mercury salts can be avoided while organic mercurial compounds are very to%ic and are the cause of most reports of mercury poisoning. 4o%ic e-ects of mercury similar to that of 7ead due to its combining with protein sulfhydryl groups. 8nce absorbed , the mercuric cation concentrates mostly in "idney, with less concentration in liver, blood, bone marrow, and other tissues. 6t is e%creted by "idney and colon.
Acute poisoning usually occurs by ingestion of soluble mercuric salts, vomiting and diarrhea may result with diuresis (suppression of tubular reabsorption) and "idney damage.
Treatment of acute poisoning gastric lavage. using of reducing agent such as sodium formaldehyde sulfo%ylate to reduce the mercuric cation forming less soluble mercurous salt. .using of chelating agents such as dimercaprol or pencillamine. Mercurial salts are used as : diuretics 0.antiseptics parasiticides Fungicides Disadantages of organic mercurial diuretics: *.@oor absorption from 64 0.$low onset of action .$ever to%icity
Gastrointestinal agents inorganic agents used to treat gastrointestinal disorders include products for altering gastric @>. 0.protectives for intestinal in#ammation. Adsorbents for intestinal to%ins. 1athartic or la%ative for constipation. &ost of 6 agents do not require a prescription which places the responsibility directly on the pharmacist.
Acidif!ing Agents Achlorhydria is the absence of hydrochloric acid in the gastric secretions. @atients with this condition fall into one of two groups 3
*.those who remain free of gastric hydrochloli.c acid after stimulation with histamine phosphate. 0.those in whom there is normally a lac" of gastric hydrochloric acid but who respond to stimulation by histamine. @atients with the rst type of achlorhydria include those with a subtotal gastrectomy, atrophic gastritis (chronic gastritis with atrophy of the mucous membranes and glands), carcinoma of the stomach or gastric/polyps. 4he second type, in which the patients are initially free of gastric hydrochloric acid but will secrete it upon histamine stimulation, Binclude those with chronic nephritis (in#ammation of the "idneys), chronic alcoholism, tuberculosis, hyperthyroidism, and parasitic infestations. 6t is common in otherwise normal individuals after age . astric hydrochloric acid functions by "illing the bacteria in ingested food and drin" ,softening brous food, and promoting formation of the proteolytic enzyme , pepsin. @epsin is formed by pepsinogen being converted to pepsin when the @> of gastric content drops below 5. 4hus , a lac" of hydrochloric acid could reasonably be e%pected to cause gastrointestinal disturbances. 4he symptoms of achlorhydria can vary with the associated disease, but they generally include mild diarrhea or frequent bowel movements, epigastric (upper middle portion of the abdomen) pain, and sensitivity to spicy foods. ecause pepsin possesses its greatest proteolytc activity below p> .. 4his usually is not considered to be a problem, since many proteolytic enzymes in the intestinal tract are still present and fully functional. 6t is common for patients with achlorhydria to have pernicious anaemia due to a lac" of intrinsic factor, the protein necessary to carry vitamin *0 across the intestinal wall. 6n an attempt to relieve the gastrointestinal symptoms caused by achlorhydria, Diluted Hydrochloric Acid has been utilized. 4he usual /ml dose of Diluted Hydrochloric Acid added to 0 ml of water provides about * mCq of acid.
6n order to avoid e%posure of dental enamel to hydrochloric acid, the use of products such as glutamic acid hydrochloride (AcidulinD) which is administered in capsules. >owever, this product provides only *.E mCq of hydrochloric acid, and the recent drug ecacy study of the 2ational Academy of $ciences/2ational
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