Peptic Ulcer Management and Drug Therapy

Peptic Ulcer

• Clinical Features:
  • Symptoms and signs: Epigastric pain and tenderness, anorexia, nausea, vomiting, and hemorrhage.
  • Endoscopy.
  • Presence of H. pylori: Confirmed through endoscopic biopsy, serological tests, and urea breath tests.

Goals of Therapy

• Relief of pain.
• Promotion of healing.
• Prevention of recurrence.

Drug Therapy: Antacids

• Mechanism: Neutralization of HCl, relief of pain, elevation of pH decreasing pepsin activity, and some increase in prostaglandins (PGs) and eradication of H. pylori.

Types of Antacids

• Chemical: Sodium bicarbonate, calcium carbonate.
• Physical: Act by adsorbing HCl and pepsin and have a demulcent effect on the ulcer, e.g., gastric mucin.

Anti-Secretory Drugs

• Mechanism: Inhibit the secretion of gastric HCl.
  • Anti-muscarinics: Pirenzepine, telenzepine, selective M1 blockers to decrease acidity
  • Gastrin antagonists: Proglumide, gastrin receptors blocker.
  • Prostaglandins: Misoprostol

H2 Blockers (e.g., Cimetidine)

• Pharmacodynamics: Selective competitive blockers of histamine H2 receptors; reduce gastric acidity.
• Side effects: Sudden stop - recurrence of the ulcer & bleeding, GIT upsets (constipation or diarrhea), hypersensitivity reactions (skin rash & itching), affects liver and kidney, decreases hepatic blood flow.

Ranitidine

• Comparison to Cimetidine: Similar mechanism but with a longer duration of action, pharmacodynamics similar but stronger (5-10 times), therapeutic uses similar to cimetidine but better, and side effects similar to cimetidine, but safer.

Proton Pump Inhibitors (e.g., Omeprazole, Lansoprazole, Pantoprazole)

• Mechanism: Activated in the acidic environment of the stomach to become irreversible inhibitors of H+/K+ ATPase enzyme.
• Therapeutic Uses: Peptic ulcer (drug of choice), gastroesophageal reflux disorder (GERD).
• Side Effects: CNS effects (headache, dizziness, drowsiness), GIT effects (nausea, diarrhea, abdominal colic), and skin rash.

Mucosal Protectives (e.g., Prostaglandins)

• Mechanism: Increase mucus secretion, increase HCO3 secretion, increase blood supply to mucosa, decrease HCl secretion (anti-secretory), promote healing of ulcer, and prevent gastric ulcer induced by analgesics.
• Side Effects: Not covered explicitly

Additional Points (from the provided text)

• Misoprostol is useful in treatment of NSAID-induced peptic ulcer.
• Omeprazole, Lansoprazole, Pantoprazole are activated in the acid environment of the stomach.
• Oxytocin (a side effect of some drugs) is contraindicated in pregnancy.
• Nausea and abdominal pain can be side effects.

This quiz explores the clinical features of peptic ulcers, the goals of therapy, and the various drug therapies available, including antacids and anti-secretory drugs. Test your knowledge on the mechanisms of action, types of medications, and the role of H. pylori in ulcer management.