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Peptic ulcer disease2

Peptic ulcer disease

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Peptic ulcer disease2

  1. 1. Peptic Ulcer Disease
  2. 2. OBJECTIVES  Discuss peptic ulcer disease.  Describe what factors contribute to peptic ulcer disease.  Discuss the treatment goal for peptic ulcer disease.  Discuss the role of medications in the treatment of peptic ulcer disease.  Describe other interventions to compliment drug therapy.
  3. 3. PEPTIC ULCER DISEASE  Group of upper GI disorders  Defensive factors  GI upsets
  4. 4. TREATMENT GOALS  Alleviate symptoms  Promote healing  Prevent complications  Prevent recurrences
  5. 5. ANTACIDS  Neutralize stomach acid  Calcium • Tums, Rolaids  Aluminum + Magnesium • Maalox, Riopan, Mylanta, Gelusil  Sodium • Alka-Seltzer  Magnesium • Milk of Magnesia
  6. 6. SIDE EFFECTS  Magnesium  Diarrhea, dehydration, hypermagnesmia, renal stones  Aluminum  Constipation, intestinal impaction, anorexia, weakness  Calcium  Constipation, rebound hyperacidity, metabolic alkalosis, hypercalcemia, renal stones, fecal impaction  Sodium  Systemic alkalosis, sodium overload
  7. 7. CONTRAINDICATIONS  Magnesium  Renal insufficiency  Aluminum  Gastric outlet obstruction  Sodium  Hypertension, CHF, sodium restricted diets
  8. 8. INTERACTIONS  Will inhibit absorption of  Tetracyclines  Digoxin  Phenothiazines  Captopril  Isoniazid  Valium  Dilantin
  9. 9. H2 ANTAGONISTS  Cimetidine (Tagamet)  Ranitidine (Zantac)  Famotidine (Pepcid)  Nizatidine (Axid)
  10. 10. SIDE EFFECTS Confusion Diarrhea / Constipation Hepatitis Dizziness Headache Anxiety Hypotension Agranulocytosi s Thrombocytope nia
  11. 11. INTERACTIONS  Cimetidine (Tagamet) will inhibit drug metabolizing enzymes and increase plasma concentrations for:  Benzodiazepines Coumadin  Theophylline Caffeine  Oral hypoglycemics Dilantin  Tricyclic antidepressants Flagyl  Propranolol  Tegretol
  12. 12. PROTON PUMP INHIBITORS  Omeprazole (Prilosec)  Lansoprazole (Prevacid)
  13. 13. SIDE EFFECTS  Short term use  Headache, diarrhea, nausea, vomiting  Long term use  Questions about gastric carcinoid cancer
  14. 14. SULCRALFATE - CARAFATE  Viscous gel  Adheres to ulcerated tissue and protects it from acid / pepsin  Minor side effect is constipation  No major side effects  May impede absorption of some drugs
  15. 15. MISOPROSTIL  Prostaglandin analog that replaces prostaglandins lost in stomach as result of NSAID therapy  Only indicated for NSAID induced ulceration  Side effects include diarrhea and abdominal pain
  16. 16. HELICOBACTER PYLORI  Standard Therapy  14-16 days  Bismuth subsalicylate (Pepto Bismol)  Metronidazole  Tetracycline  Newest Treatment  Helidac (three antibiotic regimen)
  17. 17. NON-DRUG THERAPY  Diet plays only a minor role in ulcer management.  No conclusive evidence that caffeine containing beverages promote ulcer formation or interfere with recovery.  Thought that alcohol can be harmful to lining of stomach  Beneficial to eat 5-6 small meals a day instead of 3 large ones to decrease fluctuations in gastric pH.
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