proton pump inhibitors PPT

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proton pump inhibitors PPT

  1. 1. SEMINAR ON PROTON PUMP INHIBITORS. SUBMITTED BY AVS.PRAVEEN KUMAR 07P25R0005. UNDER THEGUIDENCE OF Mr. K.SURENDRA Assistant professor,M.Pharm, RAO’S COLLEGE OF PHARMACY
  2. 2. PEPTIC ULCER . <ul><li>INTRODUCTION: </li></ul><ul><li>DEFINITION: </li></ul><ul><li>Formation of sores or erosions in the lining of stomach and duodenum are referred as peptic ulcers. </li></ul>
  3. 3. <ul><li>Ulcers are known to be caused whenever </li></ul><ul><li>there occurs an imbalance b/n the protective </li></ul><ul><li>factors. </li></ul><ul><li>Use of non steroidal anti - inflammatory drugs </li></ul><ul><li>(NSAIDS). </li></ul><ul><li>Pathologic hypersecretory disorders. </li></ul>
  4. 4. <ul><li>Esophageal ulcers. </li></ul><ul><li>Gastric Ulcers. </li></ul><ul><li>Duodenal Ulcers. </li></ul><ul><li>Stress-induced Ulcers. </li></ul><ul><li>Marginal or anastomotic </li></ul><ul><li>Ulcers. </li></ul><ul><li>Drug or NSAID-induced </li></ul><ul><li>Ulcers.   </li></ul>
  5. 5. <ul><li>The common signs & symptoms of peptic ulcer </li></ul><ul><ul><li>Pain after 2-3 hours of food consumption. </li></ul></ul><ul><ul><li>Heart burn and indigestion. </li></ul></ul><ul><ul><li>Belching (expulsion of gas). </li></ul></ul><ul><ul><li>Nausea, vomiting, loss of appetite and weight </li></ul></ul><ul><ul><li>loss. </li></ul></ul><ul><ul><li>Black tarry stools. </li></ul></ul><ul><ul><li>Pain in the abdomen with the burning </li></ul></ul><ul><ul><li>sensation. </li></ul></ul><ul><ul><li>Blood vomiting and pain during night time. </li></ul></ul>
  6. 6.   <ul><li>DIAGNOSIS </li></ul><ul><ul><li>Endoscopy. </li></ul></ul><ul><ul><li>X-rays of Upper GI tract. </li></ul></ul><ul><ul><li>Gastric secretory studies show </li></ul></ul><ul><ul><ul><li>hyperchlorhydria. </li></ul></ul></ul><ul><li>Hemorrhage or bleeding. </li></ul><ul><li>Penetration or spreading. </li></ul><ul><li>Gastric perforation. </li></ul><ul><li>Gastric outlet obstruction & Shock. </li></ul><ul><li>COMPLICATIONS </li></ul>
  7. 7.   ANTI ULCER DRUGS <ul><li>DEFINITION </li></ul><ul><li>Anti ulcer drugs are medicines used to treat ulcers in </li></ul><ul><li>the stomach and the upper part of small intestine. </li></ul><ul><li>Anti secretory agents are the drugs that are used to </li></ul><ul><li>suppress or reduce the gastric acid secretion. </li></ul><ul><li> </li></ul>
  8. 8. <ul><li>1.Reduction Of gastric acid: </li></ul><ul><li>H2 Anti Histamines </li></ul><ul><li>Cimetidine </li></ul><ul><li>Ranitidine </li></ul><ul><li>Pantaprazole </li></ul><ul><li>b) Proton Pump Inhibitors. </li></ul><ul><li>Omeprazole </li></ul><ul><li>Lansoprazole </li></ul><ul><li>Pantoprazole </li></ul><ul><li>Rabeprazole </li></ul><ul><li>c) Anti cholinergics </li></ul><ul><li>Pirenzapine </li></ul><ul><li>Propantheline </li></ul><ul><li>Oxyphenonium </li></ul><ul><li>d) Prostaglandin Analogues </li></ul><ul><li>Misoprostil </li></ul><ul><li>Enprostil </li></ul><ul><li>2) Neutralization of </li></ul><ul><li>gastric acid </li></ul><ul><li>a) Systemic </li></ul><ul><li>Sodium bicarbonate </li></ul><ul><li>(NaHCO 3 ) </li></ul><ul><li>b) Non-Systemic </li></ul><ul><li>Magnesium hydroxide </li></ul><ul><li>Magnesium trisilicate </li></ul><ul><li>Aluminum hydroxide gel </li></ul><ul><li>Magaldrate calcium </li></ul><ul><li>3) Ulcer protective </li></ul><ul><li>Sucralfate </li></ul><ul><li>Colloidal bismuth </li></ul><ul><li>sub citrate </li></ul><ul><li>4)Ulcer Healing </li></ul><ul><li>Carbenoxolone </li></ul><ul><li>sodium </li></ul><ul><li>5)Anti-H.pylori drugs </li></ul><ul><li>Amoxicillin </li></ul><ul><li>Clarithromycin </li></ul><ul><li>Metronidazole </li></ul><ul><li>Tinidazole </li></ul><ul><li>Tetracycline </li></ul>
  9. 9. PROTON PUMP INHIBITORS DRUG OF CHOICE <ul><li>OMEPRAZOLE </li></ul><ul><li>ESOMEPRAZOLE </li></ul><ul><li>LANSOPRAZOLE </li></ul><ul><li>PANTOPRAZOLE </li></ul><ul><li>RABEPRAZOLE </li></ul>
  10. 10. Omeprazole. The proton pump inhibitor OMEPRAZOLE
  11. 11. OMEPRAZOLE . Systematic ( IUPAC ) name 6-methoxy-2-((4-methoxy-3,5-dimethylpyridin-2-yl) methylsulfinyl)-1 H -benzo[ d ]imidazole Chemical data Formula C 17 H 19 N 3 O 3 S   Mol. mass 345.4 g/mol Pharmacokinetic data Bioavailability 35–60% Metabolism Hepatic ( CYP2C19 , CYP3A4 ) Half life 1 - 1.2 hours Excretion 80% Renal 20% Faecal Therapeutic considerations Routes Oral, IV
  12. 12. PHARMACO K INETICS <ul><li>ABSORPTION   </li></ul><ul><li>The absorption of omeprazole takes place in the </li></ul><ul><li>small intestine and is usually completed within 3–6 </li></ul><ul><li>hours. </li></ul><ul><li>The systemic bioavailability of omeprazole after </li></ul><ul><li>repeated dose is about 60%.Plasma protein binding is </li></ul><ul><li>about 95%. </li></ul><ul><li>DISTRIBUTION </li></ul><ul><li>Distribution of the drug is wide and about 95% of the </li></ul><ul><li>drug is bound to proteins. </li></ul>
  13. 13. METABOLISM <ul><li>Omeprazole. Sulphenic acid. </li></ul><ul><li>Enzyme inhibitor complex. Sulphenamide. </li></ul>
  14. 14. <ul><li>Omeprazole under goes rapid first pass </li></ul><ul><li>metabolism & systemic hepatic metabolism by </li></ul><ul><li>cytochrome P450,(CYP2C19 and CYP3A4). </li></ul><ul><li>The plasma half life of the drug is 0.5 to 1 hour </li></ul><ul><li>EXCRETION: </li></ul><ul><li>Urine : 80% </li></ul><ul><li>Faeces : 20% </li></ul>
  15. 15. PHYSIOLOGY OF HCL SECRETION
  16. 16. MECHANISM OF ACTION OF OMEPRAZOLE <ul><li>Omeprazole belongs to the category of anti secretory </li></ul><ul><li>compound that act primarily by suppressing the gastric </li></ul><ul><li>acid secretion. This action is achieved by inhibiting the </li></ul><ul><li>H + /K + ATPase enzyme system selectively at the </li></ul><ul><li>secretory surface of the gastric parietal cells. </li></ul>
  17. 17. <ul><li>Adverse reactions </li></ul><ul><li>CNS Manifestations </li></ul><ul><li>CVS Manifestations </li></ul><ul><li>Endocrinal Manifestations </li></ul><ul><li>Gastrointestinal Manifestations </li></ul><ul><li>  Drug interactions </li></ul><ul><li>Omeprazole decreases plasma concentrations of Atazanavir. </li></ul><ul><li>Omeprazole increases plasma concentrations of </li></ul><ul><li>Crabamazepine, Tacrolimus, Diazepam. </li></ul><ul><li>Omeprazole effects are reduced incase of Amino glutethimide. </li></ul><ul><li>CONTRA INDICATIONS </li></ul>
  18. 18. Omeprazole 20 mg, Capsules Omeprazole 10 mg, Capsules OMEZ :10, 20, 40,mg capsules. PROTOLOC :20, 40,mg capsules. <ul><li>MARKETED PRODUCTS </li></ul>
  19. 19. OTHER DRUGS <ul><li>PANTOPRAZOLE </li></ul><ul><li>LANSOPRAZOLE </li></ul><ul><li>ESOMEPRAZOLE </li></ul><ul><li>RABEPRAZOLE </li></ul>
  20. 20. <ul><li>CONCLUSION </li></ul><ul><li>Proton pump inhibitors are the first class drugs in </li></ul><ul><li>the treatment of peptic ulcer and other gastro intestinal </li></ul><ul><li>disorders. </li></ul><ul><li>Mainly the drug omeprazole have less side effects when </li></ul><ul><li>compared to other drugs in this class. So this drug is used </li></ul><ul><li>very commonly in treating gastric disorders. </li></ul><ul><li>PPI use is not driven by secondary care admission. </li></ul><ul><li>Most patients prescribed a therapeutic rather </li></ul><ul><li>than maintenance dose. </li></ul>
  21. 21. REFFERENCE Essentials of medical pharmacology, by KD. Thripathi. Pharmacology & pharmaco therapeutics, by R.S. satoshkar. Text book of medical pharmacology, by Padmaja uday kumar. Pharmacology & clinical pharmaco kinetics, by G. Kutzung. Www. Proton pump inhibitor wikipedia, the free encyclopedia.

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