Treatment of peptic ulcer

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

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]

Treatment of peptic ulcer

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Treatment of peptic ulcer