00:01
Let's move on to pancreatic
replacement therapies.
00:04
This is one of those other categories
that are relevant to the GI system.
00:10
Pancrelipase and pancreatin
are given to patients
who have inadequate secretion
of endogenous pancreatic lipase.
00:18
So the problem with not having
enough pancreatic lipase
is that you have these undigested or not
broken down fragments of fat in the stool.
00:28
And this causes severe diarrhea
and malabsorption syndromes.
00:32
Remember that vitamins A, D, E,
and K are fat-soluble vitamins.
00:37
If you don't have good
pancreatic lipase activity,
you're not going to
absorb these vitamins.
00:43
Now these products do come from
pigs, so they are porcine drugs.
00:49
So there can be some issues
with some our Muslim patients
who don't want to
take these agents.
00:54
They are a substitute for
human pancreatic lipase.
00:58
They are inactivated
at pH levels below 4.0
which is why we give
them as coated capsules
so that we can get them pass the
stomach and into the small bowel.
01:08
Now, if you give these
agents with antacids,
it will actually improve the
functionality of these agents.
01:15
So unlike most drugs
where we want the low pH,
in this particular case,
we weren't able to formulate it that way,
and so we want a higher
pH in the stomach.
01:25
So giving it with antacids
is quite reasonable.
01:28
Let's move on to
gallstone prevention.
01:31
Ursodiol is the
most commonly used
and probably the single
agent at most countries
used in the prevention
of gallstones.
01:40
Now, remember that
cholesterol stones
are caused by the precipitation of
cholesterol out of solution in the bile.
01:47
So, what ursodiol does is it reduces
cholesterol content of the bile
by decreasing cholesterol
uptake in the intestine.
01:56
It breaks up micelles
that contain cholesterol
and it also decreases hepatic
cholesterol secretion.
02:05
Now, toxicity with this
agent is actually quite rare.
02:09
And we also have used this
medication in pregnant patients
who are complaining of
severe pruritus or itching
which is often caused by
obstetric cholestasis.
02:19
So, patients who have obstetric
cholestasis, we use ursodiol,
which tells you that it's a
relatively non-toxic agent.