6. peptic ulcer drugs 323

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Pharmacology
Third Year

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6. peptic ulcer drugs 323

  1. 1. Peptic Ulcer Any disruption in the surface epithelium of the gastric & duodenal mucosa. It occurs due to an imbalance between defensive factors & aggressive factors. Duodenal ulcer is 4 times more common than gastric ulcer.
  2. 2. Causes A- Overproduction of gastric HCL B- H. pylori C- Risk factors like smoking, stress, NSAIDs etc
  3. 3. Pathophysiology There is inflammation of the mucosa.The H. pylori produce ammonia which further increase inflammation & thus the acid & H. Pylori help each other to increase inflammation.
  4. 4. Treatment of peptic ulcer. 1- To neutralize the acid, antacids are given. e.g. Sodiumbicarbonate (systemic antacid) & salts of allominium, calcium & magnesium (non-systemic antacid) 2- Drugs to reduce gastric acid secretion e.g cont.
  5. 5. a. H2 receptor antagonists -Cimetidine -Ranitidine -Nizatidine -Famotidine b. Proton pump inhibitors -Omeprazole -Lanzoprazole -Pantoprazole -Rabiprazole cont.
  6. 6. c. Anticholinergic ( M1-blocker) e.g pirenzepine 3-Mucosal protective like bismuth chelate e.g sucralfate (Ulsanic) 4- Antibiotics e.g Amoxicillin,Clarithromicin to kill H. pylori.
  7. 7. Cimetidine It blocks the H2 receptors in the parietal cells & thus decrease the over production of gastric HCl.
  8. 8. Clinical uses a. Peptic ulcer b. Reflux esophagitis c. Non- ulcer dyspepsia d. Before anaesthesea (Decrease acid)
  9. 9. Adverse effects a. CNS: Confuion, hallucination, Agitation specially when given i.v. b. Endocrine effects Inhibits binding of dihydrotestosterone to androgen receptors,increase serum prolactin level & cause loss of libido,gynaecomastea & impotance in male.This occur due to prolong use or high dose.It also increase serum prolactin level.The rest of H2 blockers have no such effect. c. Can cause bradyardia & hypotension
  10. 10. Prescription for peptic ulcer a. Omeprazole caps. 20 mg PO OD for one & a half month. b. Amoxacillin caps. 500 mg POTDS for 7 days c. Metronidazole tabs. 400 mg PO TDS for 7days.
  11. 11. Drug interactions It acts as enzyme inhibitor for many drugs like erythromycin, warfarin, propranolol etc & thus should not be used with these drugs or their dose should be reduced. Cautions: Should not be used in renal impairment, pregnancy & lactation

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