The document discusses various topics related to anti-ulcer drugs:
1) It describes the mechanisms of common anti-ulcer drug classes including H2 receptor antagonists, proton pump inhibitors, prostaglandin analogues, and anti-H. pylori drugs.
2) It summarizes the structures, mechanisms of action, and uses of representative drugs from these classes like ranitidine, omeprazole, and misoprostol.
3) It explains the roles of gastric acid secretion, H. pylori infection, and mucosal defense in ulcer formation and how different drug classes address these factors.
Overview of Discussion-
Anti-rheumatoid drugs
Classification of anti-rheumatoid drugs
Pharmacology of disease modifying anti-rheumatic drugs (DMARDs)
Pharmacology of adjuvant drugs
this will give brief about the peptic ulcer and give information about the drug used for peptic ulcer and classification of drugs including drugs and there use adverse effect.
Overview of Discussion-
Anti-rheumatoid drugs
Classification of anti-rheumatoid drugs
Pharmacology of disease modifying anti-rheumatic drugs (DMARDs)
Pharmacology of adjuvant drugs
this will give brief about the peptic ulcer and give information about the drug used for peptic ulcer and classification of drugs including drugs and there use adverse effect.
Appetite Stimulant And Suppressants.pptxGokul546572
# Definition of Appetite
# What causes a decrease in appetite
# Definition of Appetite Stimulants
# Classification of Appetite Stimulants
# Zinc
# Mechanism of action Zinc
# Thiamine
# Dronabinol
# Mechanism of action Dronabinol
# Use & Side effects of Dronabinol
# Oxandrolone
# Mechanism of action of Oxandrolone
# Use & Side effects of Oxandrolone
# Definition of Appetite Suppressants
# Classification of Appetite Suppressants
# Mechanism of action of Centrally Acting Drugs
# Side effects and other effects of Centrally acting drugs
# Definition of Serotonergic agents
# Fenfluramine
# Definition of Adrenergic Serotonergic agents
# Sibutramine
Constipation is a comdition which causes difficulty in ecretion of feaces, less than three bowel in a week. the drugs that are used to treat constipation are cathartics.
Diarrhoea is a condition of excretion of loose stool and water equal or more than three bowel movement in a day. it is of three types, acute, dysentry, chronic diarrrhoea. may caused by bacteria E.coli, and Rotavirus in children. drugs used to treat are called anti diarrhoeal drugs.
Haematinics , coagulants and anticoagulants-Dr.Jibachha Sah,M.V.Sc,LecturerDr. Jibachha Sah
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
H2 RECEPTOR ANTAGONISTS
The H2 receptor antagonists (H2RA) are a class of drugs used to block the action of histamine on parietal cells (specifically the histamine H2 receptors) in the stomach, decreasing the production of acid by these cells.
PROTON - PUMP INHIBITORS
Proton-pump inhibitors (PPIs): are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production.
They are the most potent inhibitors of acid secretion available.
These drugs are among the most widely sold drugs in the world, and are generally considered effective.
The vast majority of these drugs are benzimidazole derivatives, but promising new research indicates the imidazopyridine derivatives may be a more effective means of treatment.
Med chem lecture on Anticholinergic drugs for B.Pharm level in Nepal
Content from Foye's Principle of medicinal chemistry, my own thoughts and some articles
Appetite Stimulant And Suppressants.pptxGokul546572
# Definition of Appetite
# What causes a decrease in appetite
# Definition of Appetite Stimulants
# Classification of Appetite Stimulants
# Zinc
# Mechanism of action Zinc
# Thiamine
# Dronabinol
# Mechanism of action Dronabinol
# Use & Side effects of Dronabinol
# Oxandrolone
# Mechanism of action of Oxandrolone
# Use & Side effects of Oxandrolone
# Definition of Appetite Suppressants
# Classification of Appetite Suppressants
# Mechanism of action of Centrally Acting Drugs
# Side effects and other effects of Centrally acting drugs
# Definition of Serotonergic agents
# Fenfluramine
# Definition of Adrenergic Serotonergic agents
# Sibutramine
Constipation is a comdition which causes difficulty in ecretion of feaces, less than three bowel in a week. the drugs that are used to treat constipation are cathartics.
Diarrhoea is a condition of excretion of loose stool and water equal or more than three bowel movement in a day. it is of three types, acute, dysentry, chronic diarrrhoea. may caused by bacteria E.coli, and Rotavirus in children. drugs used to treat are called anti diarrhoeal drugs.
Haematinics , coagulants and anticoagulants-Dr.Jibachha Sah,M.V.Sc,LecturerDr. Jibachha Sah
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
H2 RECEPTOR ANTAGONISTS
The H2 receptor antagonists (H2RA) are a class of drugs used to block the action of histamine on parietal cells (specifically the histamine H2 receptors) in the stomach, decreasing the production of acid by these cells.
PROTON - PUMP INHIBITORS
Proton-pump inhibitors (PPIs): are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production.
They are the most potent inhibitors of acid secretion available.
These drugs are among the most widely sold drugs in the world, and are generally considered effective.
The vast majority of these drugs are benzimidazole derivatives, but promising new research indicates the imidazopyridine derivatives may be a more effective means of treatment.
Med chem lecture on Anticholinergic drugs for B.Pharm level in Nepal
Content from Foye's Principle of medicinal chemistry, my own thoughts and some articles
Peptic Ulcer Disease Affects All Age Groups. Can occur in children, although rare. Duodenal ulcers tends to occur first at around the age 25 and continue until the age of 75. Gastric ulcers peak in people between the ages of 55 and 65. Men Have Twice The Risk as Women Do
Drugs Acting on Gastro-Intestinal System
Pharmacotherapy PUD and GERD
Antiemetic Drugs
Agents for constipation
Antidiarrheal agents
Pharmacotherapy OF IBD
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
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Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
BÀI TẬP BỔ TRỢ TIẾNG ANH GLOBAL SUCCESS LỚP 3 - CẢ NĂM (CÓ FILE NGHE VÀ ĐÁP Á...
Med chem lecture on Anti ulcer drugs
1. • Give the structure and uses of
ranitidine.(2013,2.5)
• How omeprazole inhibit acid secretion?
(2010,2.5)
• Write in short about the chemistry of
prostaglandin. (2010,2.5)
• How proton pump inhibitors heal ulcers?
(2009,2.5)
• Classify Anti-ulcer drugs (2008,5)
3. Ulcer
• An ulcer is a kind of open wound accompanied by
inflammation. It can occur both on outer skin and
internal epithelium such as surface of the
stomach or inside the mouth.
• Ulcers start when the top layer (surface) of skin
or mucous membrane is hurt. This top layer dies.
When it dies, the skin or mucous membrane and
opens. This leaves an open sore called an ulcer.
• Ulcers can be from
– infection with H.pylori (responsible 90% 0f petide
ulcers)
– substances that will burn skin or mucous membranes,
such as stomach acid
– from pressure on a part of the skin.
– from cancer to diseases of blood vessels.
5. Acid secretion in stomach
• Within the gastric mucosa lies the oxystic glands those
parietal cells secrete about 2-3 litre of HCl of pH 1 into
the stomach
• The cells don’t store a reservoir of HCl acid. H+ and Cl-
are secreted separately into the stomach;H+ by
proton pumps and Cl- by chlorine ion channels
• The working of proton pump is controlled by various
regulators and drugs for ulcers have effect on them
– Histamine at H2 receptors
– Gastrin at G receptors
– Acetylcholine at M2 receptors
– Prostaglandin (PgE2)
– Somatostatin (SST)
Promote acid secretion
Inhibit acid secretion
9. How H. Pylori causes ulcer?
• This bacteria burrows through the protective 1mm
thick mucus layer and attaches itself to the epithelial of
stomach walls to avoid acidic conditions. Furthermore
it also produces large amounts of urease, which breaks
down the urea present in the stomach to carbon
dioxide and ammonia. The ammonia protects it from
stomach acidity and is toxic to epithelial cells which
secrete mucus. It also produces cell damaging
chemicals such as proteases and vacuolating cytotoxin
A (VacA). All together the mucus barrier is damaged
and made thinner than 0.5 mm and in this state the
stomach becomes more susceptible to attack by acid
and pepsin
10.
11. H2 Histamine antagonists
• Histamine is released from mast cell in gastric
mucosa by gastrin and acetylcholine
• MOA- Histamine acts on H2 receptor and
stimulates proton pump through the cAMP
pathway which leads to acid secretion. These
drug antagonize H2 receptor and block
Histamine mediated acid secretion
• They are associated with libido loss or erectile
dysfunction
12. SAR of H2 Histamine antagonists
• 1) Need an aromatic/hetero-aromatic ring. The imidazole ring is
not required but if it is present there must be electron donors at
position 5 to promote t tautomer .
• 2) The terminal nitrogen group should be polar but not basic for
maximal potency
• 3) Separation of the ring from the nitrogen group by 4 atoms
gives maximal potency
13. Normally both tautomers are equally favored
If at position 5 R’ = electron donating group
eg CH3, OH,NH3, then τ tautomer is favored
Imidazole
15. Note
• All these contain the NHCH3 or NH2 group at
right terminal which are very basic. But the SAR
demands that this Nitrogen not be basic. So how
is it achieved?
• Same way the N in amide is not basic. The
presence of electron withdrawing group next to
the terminal nitrogen, in form of C=O as in amide
or CN, SO2NH2 and NO2 as in this case, attracts
N’s lone pair electron and can no longer share it
to act like a base. The C=N and C=C along with
the withdrawing groups that is attached to
terminal N account for polarity.
16. Cimetidine
• It is a imidazole derivative H2-antagonist
• It inhibits CYP, which leads to many drug–drug
interactions.
• It exhibits antiandrogenic action and can cause
gynecomastia if used for more than 1 month.
• It has 63-78% bioavailability
• Uses
– Peptide Ulcer, heartburn, Zollinger–Ellison syndrome,GERD
• MOA -Histamine acts on H2 receptor and stimulates
proton pump through the cAMP pathway which leads
to acid secretion. These drug antagonize H2 receptor
and block Histamine mediated acid secretion
17. •It is a furan derivative H2-antagonist, which is an
isostere of the imidazole ring.
•It is a weaker CYP inhibitor than cimetidine and has no
antiadrogenic effect
•It is about 6 times more potent than Cimetidine with a
longer Duration of action.
•It’s bioavailability is 52%.
•Uses
Peptide Ulcer, heartburn
•MOA -Histamine acts on H2 receptor and stimulates
proton pump through the cAMP pathway which leads to
acid secretion. These drug antagonize H2 receptor and
block Histamine mediated acid secretion
Ranitidine
18. Famotidine
• It is a thiazole derivative H2-anatgonist.
• It does not cause gynecomastia and is a weak
inhibitor of CYP.
• It is 40 times more potent than Cimetidine but it has
only 37 to 45% bioavailability.
• Uses
– Peptide Ulcer, heartburn,GERD
• MOA -Histamine acts on H2 receptor and stimulates
proton pump through the cAMP pathway which
leads to acid secretion. These drug antagonize H2
receptor and block Histamine mediated acid
secretion
19. Nizatidine
• It is a thiazole derivative similar to Ranitidine.
• It does not inhibit CYP and has no
antiandrogenic effect.
• It is 10 times more potent than Cimetidine. and it
has more than 98% bioavailability
• Uses
– Peptide Ulcer, heartburn,GERD
• MOA -Histamine acts on H2 receptor and stimulates
proton pump through the cAMP pathway which leads to
acid secretion. These drug antagonize H2 receptor and
block Histamine mediated acid secretion
20. Ranitidine ‘s Furan ring vs Nizatidine’s Thiazole ring
Note how only the rings are different in these 2 drugs
Ranitidine Nizatidine
6 X potent than
cimetidine
10 X potent than cimetidine
52% bioavailability > 98% bioavailability
Bioisoterism has powerful effect on drug efficacy and
biocompatibility!
22. Proton Pump Inhibitors (PPI)
• Inhibition of Histamine receptor does not fully prevent acid
secretion because Ach and gastrin also separately promote
acid secretion.
• But all these 3 regulators ultimately act on proton pump. The
pump can also be independently inhibited which fully inhibits
acid secretion.
• Hence, PPI have stronger acid suppression and are thus
favored over H2-antagonists.
• PPI are irreversible antagonists too, which means once they
bind to a pump it cannot regain it’s function anymore and is
thus destroyed and replaced by a new one which takes time.
This makes their effect stronger and longer (drug action
persists even after it disappears from blood!)
• Also they have demonstrated antibacterial activity which is
an advantage against H.pylori infection.
• Because they prevent acid secretion very strongly than H2
anatgonists, they interfere absroption of drugs needing acidic
condition like antifungals, Iron salts, Digoxin, Ampicillin.
23. How PPI’s work?
1) Benzimidazole PPI’s are prodrug that are converted into
sulphenamide within the acidic environment of parietal cells
in stomach.
2) The sulfonamide then covalently and irreversibly interacts
with sulphahydryl groups in cysteine amino acid of the
binding site of the proton pump to create a disulphide bond.
• The disulphide bond between drug and pump is not
completely irreversible. There are enzymes capable of
reactivating the pump by breaking this disulphide bond. But
if this bond is made with a particular cysteine in the binding
sire, cysteine 822, then is ensures maximum resistance to
such reduction thus incurring longer duration of action.
• They are made into delayed release or enteric coated
formulation which prevents their release in the stomach.
This is done because if they are activated in the stomach
then the charged sulphonamide form won’t be easily
absorbded.
25. Omeprazole
• It is an benzimidazole prodrug proton pump inhibitor
• It’s acid inhibition activity is far stronger than H2 antagonists
such that it is incompatible with drugs needing acidic
condition for absorption
• It duration of action is 24-72 hrs, even after it has cleared
from plasma due to its irreversible
• It’s S enantiomer is called esomeprazole and has more
potency and 3 times lower clearance than the R isomer.
Esomeprazole can be used against NSAIDS induced ulcer.
• Uses
– Peptide ulcer, GERD, heart burn, Zollinger-Ellision syndrome
MOA- It activates into sulphamide form in the acid
environment and bonds to sulphahydryl groups of cysteine
amino acids in the binding site of the proton pump
26. Lansoprazole
• It is an benzimidazole prodrug proton pump inhibitor
• It’s acid inhibition activity is far stronger than H2
antagonists such that it is incompatible with drugs
needing acidic condition for absorption
• It is highly plasma bound but bioavailability is double
than omeprazole
• Uses
– Peptide ulcer, GERD, heart burn, Zollinger-Ellision
syndrome, NSAIDS induced ulcers
MOA- It activates into sulphamide form in the acid
environment and bonds to sulphahydryl groups of
cysteine amino acids in the binding site of the proton
pump
27. Prantoprazole
• It is an benzimidazole prodrug proton pump inhibitor
• It’s acid inhibition activity is far stronger than H2
antagonists such that it is incompatible with drugs
needing acidic condition for absorption
• It is highly plasma bound and has better bioavailability
than omeprazole and is also extensively liver
metabolized
• Uses
– Peptide ulcer, GERD, heart burn, Zollinger-Ellision
syndrome
MOA- It activates into sulphamide form in the acid
environment and bonds to sulphahydryl groups of
cysteine amino acids in the binding site of the proton
pump
28. Rabeprazole
• It is an benzimidazole prodrug proton pump inhibitor
• It’s acid inhibition activity is far stronger than H2
antagonists such that it is incompatible with drugs
needing acidic condition for absorption
• It is highly plasma bound and has better bioavailability
than omeprazole and is also extensively liver
metabolized
• Uses
– Peptide ulcer, GERD, heart burn, Zollinger-Ellision syndrome
MOA- It activates into sulphamide form in the acid
environment and bonds to sulphahydryl groups of
cysteine amino acids in the binding site of the proton
pump
29. Try associating PK differences as a result of structural
variability (just note that any pattern u may find is
only valid in PPI, not other drug category)
30. Prostaglandins
• The prostaglandins are group of hormone like lipid
compounds containing 20-carbon unsaturated fatty acids
which is biosynthetically derived from metabolism of
arachidonic acid.
• They have a wide pharmacological actions on the
cardiovascular system, GI smooth muscle, the reproductive
system, the nervous system, platelets, kidney, the eye, etc.
• They are of interest as anti ulcer drugs because they can
not only inhibit acid secretion completely like PPI’s but also
suppress pepsin which prevents autodigestion of exposed
epithelial cells. On top of that, it also has maintains the
integrity of mucus layer, termed cytoprotection.
31. Misoprostal
• It is a prostaglandin based antiulcer drug
• It is semi-synthetic derivative of PgE1
• It has both anti-secretory and cytoprotective effect
• It is also a prodrug that after being quickly absorbed gets
deesterified rapidly into it’s active acid form
• It has 90% chance of inducing abortion
• Uses
– NSAIDS causes gastric ulcer
– Doudenal ulcer unresponsive to H2-antagonists
– In Arthritis in combination with diclofenac
– Off- label use to end pregnancy (before 12 weeks) with or
without mifepristone (anti-progesterone)
• MOA: It agonizes PgE receptors and mediates inhibition of
proton pump and also cytpprotective action is based on
increases in GI mucus an bicarbonate secretion