Both duodenal and gastric ulcer diseases are closely associated with Helicobacter pylori infection. An infected individual has an estimated lifetime risk of 10 -20% for the development of peptic ulcer disease, which is at least 3-4 fold higher than in non-infected subjects. Many drugs are being used as inhibitors of acid secretion and antacids are also effectively used. New potential drugs are also developed and introduced for acid related disease. Combination therapy like triple and quadruple therapy more effective for removal of Helicobacter pylori. Homeopathy and Ayurvedic therapy are also consider as treatment of ulcer. Role of surgery can be option for the bleeding ulcer or ant severe case.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
Ulcers range from small, painful sores in the mouth to bedsores and serious lesions of the stomach or interstine
Gastric ulcers :are peptic ulcers in the stomach.
Duodenal ulcers :are peptic ulcers in the duodenum
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
Ulcers range from small, painful sores in the mouth to bedsores and serious lesions of the stomach or interstine
Gastric ulcers :are peptic ulcers in the stomach.
Duodenal ulcers :are peptic ulcers in the duodenum
Drugs Acting on Gastro-Intestinal System
Pharmacotherapy PUD and GERD
Antiemetic Drugs
Agents for constipation
Antidiarrheal agents
Pharmacotherapy OF IBD
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Treatments for PEPTIC ULCER
1. AN OVERVIEW OF TREATMENT MODALITIES FOR
PEPTIC ULCER
PRESENTED BY: DIPTESH T. PATIL
ROLL NO. 18
FIRST YEAR M. PHARM
GUIDED BY: MRS. VAISHALI MISTRY
1
2. Definition
• A peptic ulcer is a mucosal break,
3 mm or greater in size with
depth, that can involve mainly the
stomach or duodenum.
• It has to be deep enough to
penetrate the muscularis mucosa.
2
3. REASON
• The gastroduodenal mucosal integrity is determined by
protective (defensive) & damaging (aggressive) factors
• When the aggressive factors increase or the defensive factors
decrease, mucosal damage will result, leading to ulcerations
Aggressive
factors, e.g,
acid, pepsin,
bile etc.
Defensive
factors, e.g.
mucus, HCO3,
PG
3
6. CAUSES
• Helicobacter pylori
• NSAIDs
• Ethanol
• Tobacco
• Severe physiologic
stress (Burns, CNS trauma,
Surgery, Severe medical illness)
• Steroids
6
7. Ulcers associated with
H. pylori
Ulcers associated with
NSAIDs
• More often in duodenum • More often in stomach
• Often superficial • Often deep
• Less severe GI bleeding • More severe GI bleeding
• Usually pain with dyspepsia • Sometimes asymptomatic
7
9. ACID NEUTRALIZING AGENTS:
(ANTACIDS)
• OVER THE COUNTER and are taken by mouth for quick relief.
• Treatment with antacids alone is symptomatic and only justified for minor symptoms.
• Antacids are distinct from acid-reducing drugs like H2-receptor antagonists or proton
pump inhibitors and they do not kill the bacteria Helicobacter pylori, which causes most
ulcers.
• Fast onset of action makes them first choice for serious PUD for all patients and for every
condition of PUD.
• Antacids contain alkaline ions that chemically neutralize stomach gastric acid, reducing
damage and relieving pain.
9
10. 1. Systemic
• Sodium bicarbonate is a systemic alkalizer, which increases plasma bicarbonate, buffers
excess hydrogen ion concentration, and raises blood pH
• thereby reversing the clinical manifestations of acidosis.
• Sodium bicarbonate acts as an antacid and reacts chemically to neutralize or buffer existing
quantities of stomach acid but has no direct effect on its output. This action results in increased pH
value of stomach contents, thus providing relief of hyperacidity symptoms.
2. Non-Systemic
• Aluminum hydroxide, Calcium carbonate, Magnesium hydroxide are a basic inorganic salts
• Acts by neutralizing hydrochloric acid in gastric secretions.
• Aluminum hydroxide is slowly solubilized in the stomach and reacts with hydrochloric acid to form
aluminium chloride and water.
• It also inhibits the action of pepsin by increasing the pH and via adsorption. Cytoprotective effects
may occur through increases in bicarbonate ion (HCO3-)and prostaglandins
10
11. • EXAMPLES
a) Aluminium hydroxide
b) Magnesium hydroxide
c) Aluminum hydroxide with magnesium hydroxide
d) Aluminum carbonate gel
e) Calcium carbonate
f) Sodium bicarbonate
g) Hydrotalcite [Mg6Al2(CO3)(OH)16 · 4(H2O)]
h) Bismuth subsalicylate
• Simethicone: (polydimethylsiloxane and hydrated silica gel)
Decrease surface tension thereby reduce bubble formation - added to prevent reflux.
• Alginates: Form a layer of foam on top of gastric contents & reduce reflux
• Oxethazaine/Oxetacain: Surface anaesthetic
11
12. REDUCTION IN GASTRIC ACID SECRETION:
H2 ANTIHISTAMINES
1. Extremely safe drugs and well tolerated
2. Promote the healing of gastric and duodenal ulcers
• Duodenal ulcer – 70 to 90%
• Gastric Ulcer – 50 to 75% (NSAID ulcers))
• Stress ulcer and gastritis
• GERD
EXAMPLES: Cimetidine, Ranitidine, Famotidine, Roxatidine, Nizatidine
12
13. Mechanism Of Action
• Reversible competitive inhibitors of H2 receptor
• Highly selective, no action on H1 or H3 receptors
• All phases of gastric acid secretion
• Very effective in inhibiting nocturnal acid secretion (as it depends
largely on Histamine )
• Modest impact on meal stimulated acid secretion (as it depends on
gastrin, acetylcholine and histamine)
• Volume of pepsin content also reduced
• Volume reduced by 60 – 70% - anti ulcerogenic effect
• No effect on motility
13
14. Main ADRs are related to Cimetidine:
• Antiandrogenic effects
• Increases prolactin secretion and inhibits degradation of estradiol by liver
• Cytochrome P450 inhibition – theophylline, metronidazole, phenytoin,
imipramine etc.
• Antacids
Others:
• Headache, dizziness, bowel upset, dry mouth
• Bolus IV – release histamine – bradycardia, arrhythmia, cardiac arrest
• Elderly - precaution
14
16. MECHANISM OF ACTION
• Acts by irreversibly blocking the hydrogen/potassium adenosine triphosphatase
enzyme system (the H+/K+ ATPase, or, more commonly, the gastric proton pump) of
the gastric parietal cells.
• Targeting the terminal step in acid production, as well as the irreversible nature of the
inhibition, results in a class of drugs that are significantly more effective than H2
antagonists and reduce gastric acid secretion by up to 99%.
• Decreasing the acid in the stomach can aid the healing of duodenal ulcers and reduce
the pain from indigestion and heartburn.
16
17. ANTICHOLINERGICS
• Unpopular as a first choice because of high incidence of
anticholinergic side effects (dry mouth and blurred vision)
(receptors on parietal cells are M3)
• Atropine:
• Block the M1 class receptors
• Reduce acid production
• Abolish gastrointestinal spasm
• Pirenzepine and Telenzepine:
• Reduce meal stimulated HCl secretion by reversible blockade of muscarinic
(M1) receptors on the cell bodies of the intramural cholinergic ganglia
17
18. PROSTAGLANDIN ANALOGUE
• Inhibit gastric acid secretion
• Exhibit ‘cytoprotective’ activity
• Enhance local production of mucus or bicarbonate
• Promote local cell regeneration
• Help to maintain mucosal blood
• ONLY ONE DRUG IS IN MARKET MISOPROSTOL
(Reinforcing of mucous layer buffered by HCO3 secretion from epithelial
cells)
18
19. Mechanism Of Action:
Inhibit histamine-stimulated gastric acid secretion
Stimulation of mucin and bicarbonate secretion
Increase mucosal blood flow
Therapeutic uses:
Prevent ion of NSAID-induced mucosal injury (rarely used
because it needs frequent administration – 4 times daily)
Misoprostol is contraindicated in Pregnacy.
19
20. ULCER PROTECTIVES
• Example:- Bismuth subsalicylate
• Pharmacological actions:
• Undergoes rapid dissolution in the stomach into bismuth and salicylates
• Salicylates are absorbed
• Bismuth coats ulcers and erosions protecting them from acid and pepsin and
increases prostaglandin and bicarbonate production
• Uses:
• Treatment of dyspepsia and acute diarrhoea
20
21. ANTI-H. PYLORI DRUGS
• It was identified in 1982 by Australian scientists
Barry Marshall and Robin Warren, In recognition of
their discovery, Marshall and Warren were awarded
the 2005 Nobel Prize in Physiology or Medicine.
• To avoid the acidic environment of the interior of the
stomach (lumen), H. pylori uses its flagella to
burrow into the mucus lining of the stomach to
reach the epithelial cells underneath, where it is
less acidic.
• It also neutralizes the acid in its environment by
producing UREASE, which breaks down the urea
present in the stomach to carbon dioxide and
ammonia. These react with the strong acids in the
environment to produce a neutralized area around
H. pylori.
21
22. When H. pylori infection is present, the most effective treatments are
combinations of 2 antibiotics and a proton-pump inhibitor (PPI), sometimes together with
a bismuth compound. In complicated, treatment-resistant cases.
• Amoxicillin acts by inhibiting the synthesis of bacterial cell walls.
• Clarithromycin prevents bacteria from growing by interfering with their protein
synthesis.
• Metronidazole and Tinidazole inhibits nucleic acid synthesis by disrupting the DNA of
microbial cells.
• Tetracycline inhibits protein synthesis by blocking the attachment of charged
aminoacyl-tRNA to the A site on the ribosome. Tetracycline binds to the 30S subunit of
microbial ribosomes.
• Thus, it prevents introduction of new amino acids to the nascent peptide chain.
22
23. Triple Therapy
The BEST among all the Triple therapy regimen is:
Omeprazole / Lansoprazole - 20 / 30 mg bd
Clarithromycin - 500 mg bd
Amoxycillin / Metronidazole - 1gm / 500 mg bd
Given for 14 days followed by P.P.I for 4 – 6 weeks
Short regimens for 7 – 10 days not very effective
23
25. NON PHARMACOLOGICAL TREATMENT
• DO’s and DON’Ts
• Spicy and fatty foods should be avoided as those generally irritate the stomach
lining.
• Smoking and drink should be stopped in moderation.
• OTC pain relievers such as aspirin and NSAIDS should be avoided
• Acupuncture
• Homeopathy
• Argentum nitricum
• Arsenicum album
• Kali bichromicum 25
26. • Herbs
• Cranberry (Vaccinium macrocarpon)
• Mastic (Pistacia lentiscus)
• Licorice (Glycyrrhiza glabra)
• Probiotics
• SURGERY
• Truncalvagotomy or Pyloroplasty
• Gastrojejunostomy
• Billroth I and II Gastrectomy
• Antrectomy
• AYURVEDIC TREATMENT
• VACCINATION
26
27. REFERENCE
• “AN OVERVIEW OF TREATMENT MODALITIES FOR PEPTIC ULCER”
Diptesh T. Patil, Pratiksha V. Doke, Dr. Vanita Kanase, Dr. Pramila Yadav
World Journal of Pharmaceutical Research, Volume 4, Issue 8, 2302-2314
• Najm, WI. "Peptic ulcer disease" Primary care, September 2011; 38(3): 383–94, vii.
• Milosavljevic, T; Kostić-Milosavljević, M; Jovanović, I; Krstić, M. "Complications of
peptic ulcer disease“ Digestive diseases (Basel, Switzerland), 2011; 29(5): 491–3.
• "Ulcer Disease Facts and Myths". BY http://ulcerdisease.net/
27