This document provides information about peptic ulcers and H. pylori. It discusses the definition, causes, diagnosis, treatment and prevention of peptic ulcers. It describes peptic ulcers as discontinuities in the gastric or duodenal mucosa that penetrate the muscularis mucosa. H. pylori infection is identified as the main cause, present in 95% of duodenal ulcers and 70% of gastric ulcers. Treatment involves eradicating H. pylori with antibiotic and acid-suppressing therapy over 7-10 days, along with acid suppression for 1-1.5 months to allow ulcer healing. The document also outlines drugs that affect gastric acid secretion.
Drugs act on mucosa membrane of git by abu bakar tariqAbu Bakar Tariq
In this presentation slide my main concern is the pharmacology of GIT MUCOUS MEMBRANE but you will also know briefly about the anatomy,physiology and pathology of it.
Drugs act on mucosa membrane of git by abu bakar tariqAbu Bakar Tariq
In this presentation slide my main concern is the pharmacology of GIT MUCOUS MEMBRANE but you will also know briefly about the anatomy,physiology and pathology of it.
Pharmacology of Gastrointestinal Disorders dineshmeena53
This power point presentation will be helpful for Pharmacy, Medical and paramedical students. it consists of" what are the common GIT disorders and their pharmacological management "
A localized loss of gastric as well as duodenal mucosa leads to the formation of peptic ulcer.
A peptic ulcer is a sore on the lining of your stomach, small intestine or esophagus. A peptic ulcer in the stomach is called a gastric ulcer. A duodenal ulcer is a peptic ulcer that develops in the first part of the small intestine (duodenum). An esophageal ulcer occurs in the lower part of your esophagus.
Peptic ulcer arises when the normal mucosal defense mechanisms (mucus blood flow formation of HCO3- PGE2 ) are impaired or overpowered by damaging factors (acids pepsin pylori)
Ulcers occur 5 times more commonly in the duodenum and 95% of them are found in pyloric channel
Drugs affecting the GI system are used in the treatment of gastric acidity, peptic ulcers, and gastroesophageal reflux disease (GERD), bowel motility disorders (gastroparesis [delayed gastric emptying due to partial paralysis of the stomach muscles], constipation, and diarrhea), and for the treatment of nausea and vomiting.
Pharmacology of Gastrointestinal Disorders dineshmeena53
This power point presentation will be helpful for Pharmacy, Medical and paramedical students. it consists of" what are the common GIT disorders and their pharmacological management "
A localized loss of gastric as well as duodenal mucosa leads to the formation of peptic ulcer.
A peptic ulcer is a sore on the lining of your stomach, small intestine or esophagus. A peptic ulcer in the stomach is called a gastric ulcer. A duodenal ulcer is a peptic ulcer that develops in the first part of the small intestine (duodenum). An esophageal ulcer occurs in the lower part of your esophagus.
Peptic ulcer arises when the normal mucosal defense mechanisms (mucus blood flow formation of HCO3- PGE2 ) are impaired or overpowered by damaging factors (acids pepsin pylori)
Ulcers occur 5 times more commonly in the duodenum and 95% of them are found in pyloric channel
Drugs affecting the GI system are used in the treatment of gastric acidity, peptic ulcers, and gastroesophageal reflux disease (GERD), bowel motility disorders (gastroparesis [delayed gastric emptying due to partial paralysis of the stomach muscles], constipation, and diarrhea), and for the treatment of nausea and vomiting.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- 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
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.
2. Peptic ulcer
• discontinuity of the mucosa of the GIT that is
usually deep penetrate muscularis mucosa
• This is one of the features to differentiate
ulcers from erosions.
3. • Remember that mucosa is made up of 3 parts :
• 1. The epithelial lining → which varies as you go
through the duct
• 2. The lamina propria → loose areolar
connective tissue.
• 3. Muscularis mucosa →the small layer which
made from inner circular, outer longitudinal.for
secretion.
6. • Jejunum used to be
affected in the past
because the treatment of
peptic ulcer was mainly
surgical.
• particularly after
complications (when
there is fibrosis of
duodenal ulcer or closure
of pyloric antrum), and
therefore one of the usual
operations that was done
is the gastro-jejunustomy;
when we connect the
jejunum to the stomach,
so this was the cause of
the jejunual ulceration
stromal ulcer (ulcer that occur at the site of
the anastomosis).
Acute ulcer shows no evidence of fibrosis.
7.
8. Due to NSAID
Repeated use of high doses of corticosteroids
Chronic renal failure , hypercalcemia:there’ll be more (H) ions secretions to
replace the calcium lead to higher acidity
psychological stress
9. prostaglandins
• the mucosa is protected
by the layer of mucus. You
can see that the PH in the
lumen is 1-2, while at the
level of the mucosa is
almost 7 which means
that it is almost protected
whenever there is mucus
and bicarbonate (this is
done by prostaglandins).
- extend from muscularis mucosa all the
way to lamina propria
- In each pit > you will see 5-7 gastric
gland open there
10. Regenerative (adult stem
cell):
- distinguished using
electron microscope.
- quiescent.
- heterochromatic(coiled)
ncleus, but they are very rich
in RER.
Parietal (Oxyntic):
- Pyramidal in shape.
- approximately half of the
size of this cell is
mitochondria (eosinophilic)
Chief (Zymogenic):-
Produce zymogen>proenzyme
(pepsinogen & g. lipase).
-Columnar cells with basophilic (RER)
-Mostly in the lower part of the gland
small pits in the cardia >>>>>> go to the body
>> pits will grow larger >>in Pyloric region >>
the pits are the longest.
foveolarcompartmentglandularcompartment
14. DNES Cells (diffuse neuro-
endocrine system cells )
- Diffuse : along the gut : from the esophagus , more in
the stomach, more in the small intestine, even in the
large intestine>>so diffuse ).
- Or APUD cell ) عبود خاليا(>>>>( amine precursor
uptake and decarboxylation) “old name”.
- the only unicellular endocrine gland
- They secrete products into the blood.
- 13 different types along the GIT.
- * Most common is G cells.
- Since they are endocrine, they are Located in the
base of the gland( most basal part).
15. • H.pylori (-) is the main cause or the etiologic
factor .
• most of the patients who are having duodenal
ulcer in 95% of them H.pylori is present, while
those of gastric ulcer only about 70% do have
H.pylori and the other 30% are usually
explains the NSAID uses.
Peptic ulcer
17. • the flagella will help H.pylori to dig deep in the
mucosa to have a more alkaline media in
order to resist the acid distraction .
H.pylori has certain enzymes
and cytotoxins that affect the
mucosa which result in
distraction
The urease enzyme of H.pylori
is quite useful clinically,
because it will help us to
diagnose or to detect the
presence of H.pylori by
radioactive carbon
produce phospholipases that destroy the
bicarbonate
-fastidious slow-growing organism.
18. • patient has received a radiolabeled urea then
he will expire radioactive carbon which means
that the patient has H.pylori.
• the ammonia will help H.pylori to survive the
acidic environment of the gastric mucosa.
(urease Will increase the PH this allows the
bacteria to colonize the mucosa). only colonize
stomach “especially in antrum”.
20. • Breath test is more likely to be used in hospitals
as a follow up treatment.
• to diagnose the patient we use endoscope, if the
ulcer is duodenal or gastric, f it is gastric; a biopsy
should be taken because of the possibility of
malignant ulcer.
• Also fecal antigen test can be used because it is
cheap as well as serology tests: Poor in children,
in elderly, for epidemiologic or surveillance tool.
• Blood culture has no role in diagnosis because
it’s not invasive.
21. Also it has
• VacA (vaculating toxin):destructing mucosal
barrier.
• Cag A (cytotoxin Antigen A)
22. History about H.pylori
• (they discovered it in 1979, in 1982 it was
approved and until 1995 to make people
accept the idea of infection).
23.
24. • This is a picture to show you how H.pylori can result
in excess acid secretion,
• you can see the disruption of somatostatin secreting
cell, this will lead to reduction of somatostatin
hormone, then this will lead to increase in gastrin
secretion which eventually increase acid production
that will reach the duodenum to cause ulcerations.
(-) inhibit gastrin
secretion
25. • H.pylori infection is more common in
industrialized countries than developed
countries, due to oral hygiene or the type of
food.
histologically identical to the fundus
pepsinogen I
mucus secreting cells.
Intrinsic factors
more
26. Pathology and Clinical features
• This disease is characterized by lymphocytic &
plasma cell infiltrate in lamina propria.
• cryptitis when the lymphocytic infiltrate is in
the crypt wall
• crypt abscess when the lymphocytic infiltrate
is inside the crypt (more sever).
Many lymphoid tissues in the mucosa of the
stomach, there is some sort of
destruction in the crypts. The overall
architecture of the mucosa is disrupted.
27.
28. Treatment
• Relief symptoms (pain & dyspepsia):
Some patients have H.pylori without peptic
ulcer disease or some patients have no
H.pylori but they suffer from peptic ulcer
symptoms (dyspepsia, heartburn….), so
these patient have non-ulcer dyspepsia
usually occurs in obese people and people
who eat a lot.
29. • Heal ulcer.
• Prevent recurrence
In the past the recurrence was very great
because the only treatment was H2-blockers
but nowadays the recurrence rate has been
reduced
recurrence may occur especially in patients who
have very severe form of excessive acid
secretion as in Zollinger–Ellison syndrome.
Treatment Cont.
30.
31. • Prevent complications (hemorrhage and
perforation).
Nowadays there is no surgery for peptic ulcer,
unless there is hemorrhage or perforation.
due to the presence of effective treatment for
peptic ulcer, therefore the patient will not
develop any complications.
• Eradicating H. pylori and Restoring balance
Treatment Cont.
33. • 2 antimicrobial agents + acid suppressor
(proton pump inhibitor)
clarithromycin + Amoxicillin or metronidazole
This treatment usually takes 7-10 days some
patients may take it for 2 weeks to eradicate
the infection .not healing the ulcer.
34. • we should take another course of proton
pump for one month or one month and a half
to heal the ulcer
35.
36. SIDE-EFFECTS OF H. PYLORI
ERADICATION THERAPY
• 1- Diarrhea followed by the use of
antibacterial agent specially
this might progress to pseudomembranous
colitis.
(The treatment of pseudomembranous colitis
is
penicillin(amoxicillin
Cl.difficile
vancomycin or
metronidazole
37.
38. • 2-Metallic taste :
by Metronidazole
Also the patients how take alcohol with
metronidazole they will have Flushing and
vomiting (disulfiram-like reaction).
39. If chronic gastritis isn't treated well, it will progress
to peptic ulcer disease; but if it's left untreated,
there will be an expansion of the lymphoid cells and
it will progress to gastric lymphoma.(it's the only
type of lymphoma that can be treated by
antibiotics)but in late stages, it will be resistant.
40. chronic gastritis
• we look for five histologic features; chronicity,
activity” intra-epithelial lymphocytic
infiltrate”, atrophy, intestinal metaplasia
(presence of goblet cells in the stomach )and
dysplasia.
• Dysplasia: we look whether it's present or not.
Why gastric atrophy, intestinal metaplasia?
When there is an atrophy The intestinal
metaplasia will take place Try to compensate
for the loss of glandular epithelium.
43. • For those that stimulate acid secretion, when
they are activated they will activate protein
kinase which initiate the action or the function
of the proton pump (which is the main pump
that secrets acid into the lumen), this is why
the proton pump inhibitors are the best
suppressor of acid secretion.
• there is some sort of interaction between
these receptors (they can stimulate each
other).
48. • They are effective in neutralizing the acidity, but
clinically we prefer Magnesium hydroxide
[Mg(OH)2].and Aluminum hydroxide, because
their neutralization is acceptable.
• unlike Sodium bicarbonate[NaHCO3] with HCl to
form CO2, it neutralizes the acid to a very high
PH very rapidly, and usually this result in CO2
production and therefore gases will occur in the
abdomen, as well as Na will be absorbed into the
body causing water to be absorbed, and this may
lead to problems in patients with heart failure,
kidney problems or hypertension.
50. • Generally, these drugs are used in
combinations.
because Aluminum compound lead to
Constipation(Air Condition), while Magnesium
compound may lead to Diarrhea (Must go to
toilet)and therefore to overcome this effect
either constipation or diarrhea they are
usually given in combination.
51.
52. • Calcium carbonate is also good but the
problem with it is that if it’s taken with excess
milk in some individuals, it results in a
condition or a syndrome called milk-alkaline
syndrome, where the patient feels headache
with nausea and abdominal discomfort and
vomiting so it is not well-recommended.
53.
54. The indications
• 1- To relieve pain.
• 2- Promote healing of duodenal ulcer.
• 3- To prevent stress ulcers.
• 4- Prevent hyperphosphatemia in patients
having kidney failure .
(aluminum hydroxide, because in the intestine it
will be converted into aluminum phosphate,
so it will drain all the phosphate into the
stool), so this will lead to hypophosphatemia.
58. MOA
• have a short half-life but they have long
duration of action, because they irreversibly
block the activity of the proton pump enzyme
(H/K ATPase). unlike H2 blockers, which are competitive in
their activity.
59. • The coating is removed in the alkaline
duodenum,and the prodrug, a weak base, is
absorbed and transported to the parietal cell.
• There, it is converted to the active drug and
forms a stable covalent bond with the H+/K+-
ATPase enzyme.
by combining with their SH group.
Sulfonamide
60. • It takes about 18 hours
for the enzyme to be
resynthesized, and acid
secretion is inhibited by
more than 90% during
this time.
• involving the basal as well
as the stimulated (basal
stimulation mainly occur
at night).
61. The indications:
• 1- Definitely to treat peptic ulcer disease
• 2- Stress ulcer whether treatment or prophylaxis.
• 3- Gastroesophageal reflux disease (GERD).
• 4- Erosive esophagitis.
• 5- Prevention of NSAID induced ulcers.
• 6- Hyper-secretory states ()
they are more effective than H2 blockers because the acid
secretion is very high so it need a very effective treatment.
Zollinger-Ellison
syndrome
62. • Proton pump inhibitor is by far better than
either of the two so they are preferred to treat
GERD and erosive esophagitis.
63. acid is required for its absorption in a complex
with intrinsic factor.
64.
65. • Omeprazole and Esomeprazole are enzyme inhibitors.
• they will interfere with the metabolism of certain
drugs, particularly those which have narrow
therapeutic index (e.g. Diazepam, phenytoin and
warfarin).
• because they inhibit the enzyme if they are given with
clopidogrel (anti-platelet agent) it results in decreasing
its effect; because clopidogrel is a prodrug so it has to
be converted to its active drug in order to be effective.
• so patients with cardiac problems who receive PPI with
clopidogrel are more liable for cardiac attacks or
ischemic attacks.
70. • They competitively block histamine (H2)
receptors which means that one single dose
may not be enough.why?? reversible
71. • so the duration of action will be shorter than
that of PPI; the general protocol of the
treatment by these drugs was by giving them
4 times a day.
• Nowadays, they reached a conclusion that the
main cause of the ulcer is the secretion that
occurs during night and therefore if these
drugs are prescribed, they are given usually at
supper & bedtime to suppress the basal acid
secretion.
72. • The other difference between PPI and H2
blockers is the incidence of recurrence. In the
past, when we were using H2 blockers the
incidence was much greater than the
incidence nowadays with PPI, probably it is
not due to the difference of their mechanism
of action, but it is due to the fact that we are
eradicating the causative organisms and
therefore the recurrence rate has been greatly
reduced.
73.
74. The indication
• Promote healing of duodenal and gastric ulcers.
(recurrence is more common)
• Provide long-term treatment of pathological GI hyper
secretory conditions.
Some schools think that in cases of hyper secretory
conditions, if we would like to use the drug for a very long
time, they prefer the H2 blockers over PPI; because the side
effects and interactions of H2 blockers were very well
known, but PPI when they are introduced, their side effects
and interactions were not be known at that time.
• Reduce gastric acid production and prevent stress ulcers.
(PPIs are preferred).
The use of these agents has decreased with
the advent of PPIs
75. • Interaction = same PPI
Patients with NSAID-induced ulcers?? PPI
76. Adverse reactions:
• Headache, bowel upset, nausea, vomiting (all
H2 blockers can cause them).
• CNS effects; restlessness, confusion,
convulsions in elderly patients especially If
these drugs were given in excess or IV.
77. • done by cimetidine only :
Gynecomastiain male, galactorrhea(continuous
release/discharge of milk)in female, and
reduced sperm count (this is due to anti-
androgenic effect of cimetidine) so it should
not be given to health adult male patients
practically if they are newly married or they
are going to get married.
80. Sucralfate
• It’s a complex of aluminum hydroxide and
sulphated sucrose, so because it has aluminum
hydroxide, it can prevent the absorption of
antimicrobial agents.