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ANTACIDS Systemic  ANC  Sodium bicarbonate-  1-12 mEq HCl sodium citrate-  1- 10 mEq HCl
Non-Systemic  ANC Magnesium Hydroxide  1- 30 mEq HCl Magnesium trisilicate  1- 10 mEq HCl Aluminium Hydroxide gel  1- 2.5 mEq HCl Magaldrate  1- 28 mEq HCl Calcium carbonate  1- 20 mEq HCl
Treatment of Peptic Ulcer
ACh PGE 2 Histamine Gastrin Adenyl cyclase ATP cAMP Protein Kinase (Activated)   Ca ++ Ca ++ Proton pump K K + H + Gastric acid  Parietal cell Lumen of stomach H 2 M PGE  receptor Gastrin receptor Proglumide _ + + Antacid Omeprazole _ _ _ _ + + + + + + Misoprostol Ranitidine Pirenzepine _
[object Object],[object Object],[object Object],[object Object],Histamine H 2  Receptor Antagonist
Bioavailability  80  50  40  >90 Relative Potency  1  5 -10  32  5 -10 Half life (hrs)  1.5 - 2.3  1.6 - 2.4  2.5 - 4  1.1 -1.6  Duration of  6  8  12  8  action (hrs)  Inhibition of  1  0.1  0  0  CYP 450  Dose mg(bd)  400  150  20  150 Cimetidine  Ranitidine  Famotidine  Nizatidine
H 2  Blockers- Uses 1.  Duodenal ulcer 2.  Gastric ulcer 3.  Stress ulcers and gastritis 4.  Zollinger-Ellison syndrome 5.  Gastroesophageal reflux disease (GERD)
H 2  Blockers–Side effects & Interactions  ,[object Object],[object Object],[object Object],[object Object]
Proton Pump Inhibitors (PPIs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drugs Omeprazole  20 mg o.d. Esomeprazole  20 - 40 mg o.d. Lansoprazole  30 mg o.d. Pantoprazole  40 mg o.d. Rabeprazole  20 mg o.d.
Proton Pump Inhibitors – Kinetics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Uses 1.  Gastric ulcer 2.  Zollinger-Ellison syndrome 3.  Gastroesophageal reflux disease (GERD) Note : drug of choice for NSAID induced  gastric/duodenal ulcer
P.P.I. – Side effects & Interactions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prostaglandin Analogues ,[object Object],[object Object],[object Object],[object Object]
Misoprostol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Uses 1.  NSAID associated GI disease 2.  Patients not responding to H 2  blocker 3.  Ulcer Patients who continue to smoke Side effects Diarrhoea Abdominal cramps Abortion
Anticholinergics Pirenzipine - M 1  selective Propantheline  Oxyphenonium  Atropine ↓  volume of gastric juice
Mucosal Protective Agents/Ulcer protectives ,[object Object],[object Object]
Sucralfate ,[object Object],[object Object],[object Object],[object Object],[object Object]
Colloidal Bismuth Compounds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ulcer Healing Drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eradication of H.pylori (Anti-H.Pylori Drugs) Triple Therapy Omeprazole / Lansoprazole  - 20 / 30 mg bd Clarithromycin  - 500 mg bd Amoxycillin / Metronidazole  - 1gm / 500 mg bd ,[object Object],[object Object]
Some other Triple Therapy Regimens are   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quadruple Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You

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Treatment of peptic ulcer

  • 1. ANTACIDS Systemic ANC Sodium bicarbonate- 1-12 mEq HCl sodium citrate- 1- 10 mEq HCl
  • 2. Non-Systemic ANC Magnesium Hydroxide 1- 30 mEq HCl Magnesium trisilicate 1- 10 mEq HCl Aluminium Hydroxide gel 1- 2.5 mEq HCl Magaldrate 1- 28 mEq HCl Calcium carbonate 1- 20 mEq HCl
  • 4. ACh PGE 2 Histamine Gastrin Adenyl cyclase ATP cAMP Protein Kinase (Activated) Ca ++ Ca ++ Proton pump K K + H + Gastric acid Parietal cell Lumen of stomach H 2 M PGE receptor Gastrin receptor Proglumide _ + + Antacid Omeprazole _ _ _ _ + + + + + + Misoprostol Ranitidine Pirenzepine _
  • 5.
  • 6. Bioavailability 80 50 40 >90 Relative Potency 1 5 -10 32 5 -10 Half life (hrs) 1.5 - 2.3 1.6 - 2.4 2.5 - 4 1.1 -1.6 Duration of 6 8 12 8 action (hrs) Inhibition of 1 0.1 0 0 CYP 450 Dose mg(bd) 400 150 20 150 Cimetidine Ranitidine Famotidine Nizatidine
  • 7. H 2 Blockers- Uses 1. Duodenal ulcer 2. Gastric ulcer 3. Stress ulcers and gastritis 4. Zollinger-Ellison syndrome 5. Gastroesophageal reflux disease (GERD)
  • 8.
  • 9.
  • 10. Drugs Omeprazole 20 mg o.d. Esomeprazole 20 - 40 mg o.d. Lansoprazole 30 mg o.d. Pantoprazole 40 mg o.d. Rabeprazole 20 mg o.d.
  • 11.
  • 12. Uses 1. Gastric ulcer 2. Zollinger-Ellison syndrome 3. Gastroesophageal reflux disease (GERD) Note : drug of choice for NSAID induced gastric/duodenal ulcer
  • 13.
  • 14.
  • 15.
  • 16. Uses 1. NSAID associated GI disease 2. Patients not responding to H 2 blocker 3. Ulcer Patients who continue to smoke Side effects Diarrhoea Abdominal cramps Abortion
  • 17. Anticholinergics Pirenzipine - M 1 selective Propantheline Oxyphenonium Atropine ↓ volume of gastric juice
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.