Pharmacology of Peptic Ulcer Treatment

Gastric mucosal protective agents are drugs that help protect the stomach lining from damage, often by promoting prostaglandin synthesis.

Sucralfate acts as a barrier against stomach acid, but requires an acidic environment to work. It can be taken with PPIs, but should not be taken with antacids or H2 blockers.

Bismuth subsalicylate has multiple actions, including reducing intestinal motility, binding intestinal toxins, and stimulating fluid absorption. It can also be used as an anti-diarrheal medication and in quadruple therapy for H. pylori infections.

Common side effects of bismuth subsalicylate can include dark-colored tongue and stool, as well as hindering the absorption of tetracycline.

Gastric mucosal protective agents are used in the treatment of peptic ulcer disease and promote healing of ulcers. Bismuth subsalicylate is also used as an anti-diarrheal agent and in quadruple therapy for H. pylori infections.

Drugs that block the H2 receptors on parietal cells, decreasing cyclic AMP levels and inhibiting the H+/K+ proton pump, ultimately reducing gastric acid secretion.

Ranitidine, cimetidine, famotidine, and nizatidine.

Gastroesophageal reflux disease, peptic ulcer disease, and other diseases associated with gastric ulcers.

Cimetidine, in particular, can cause gynecomastia (breast enlargement in men) due to its anti-androgenic effects. It can also inhibit CYP450 enzymes, leading to potential interactions with drugs like warfarin.

H2 receptor blockers may interfere with the metabolism of other drugs, potentially leading to increased drug levels in the body.

A condition where the lining of the stomach or duodenum is inflamed or irritated.

A 59-year-old man presents with upper abdominal pain after meals, weight loss, and dark stools. This suggests potential peptic ulcer disease.

Prochlorperazine is an anti-emetic that blocks dopamine receptors in the chemoreceptor trigger zone, preventing activation of the vomiting reflex. It also has some anti-cholinergic and alpha-1 adrenergic blocking activity.

Prochlorperazine can cause sedation, hypotension, diarrhea, extrapyramidal symptoms (including tardive dyskinesia), peripheral edema, depression, and neuroleptic malignant syndrome.

Laxatives are medications used to treat constipation by increasing bowel movements. They work by different mechanisms, such as stimulating gut motility, drawing water into the intestine, or softening the stool.

Irritants or stimulants like castor oil, senna, and bisacodyl increase intestinal peristalsis by irritating the gut lining, leading to faster movement of stool.

Bulking laxatives, such as lactulose, sorbitol, polyethylene glycol, and magnesium salts, attract water into the intestine via osmosis, distending the bowel and promoting bowel movements.

Stool softeners, such as docusate and mineral oil, soften the stool by emulsifying with it, making it easier to pass.

Laxatives are used to treat constipation and prepare the bowel for colonoscopic procedures.

Common side effects of laxatives include abdominal cramps and diarrhea.

Lactulose is also used in the treatment of hepatic encephalopathy, a condition characterized by brain dysfunction due to liver failure.

A condition characterized by impaired brain function due to high levels of ammonia in the blood, often seen in patients with liver disease.

A synthetic sugar that is not absorbed by the body but broken down by gut bacteria into acids that lower pH and promote ammonia excretion.

Lactulose helps by acidifying the gut and promoting nitrogen excretion, which reduces ammonia levels in the blood.

A non-absorbable antibiotic that inhibits bacterial RNA polymerase, reducing ammonia-producing bacteria in the gut.

Rifaximin targets ammonia-producing bacteria, lowering ammonia levels in the blood and improving hepatic encephalopathy.

A condition where the liver is unable to function properly, leading to a buildup of toxins in the blood.

Rapid, involuntary flapping movements of the hands when the arms are extended and the wrists are dorsiflexed, often a sign of hepatic encephalopathy.

A yellowing of the skin and whites of the eyes, indicating a buildup of bilirubin in the blood, often associated with liver dysfunction.

An increased level of ammonia in the blood, often found in patients with liver disease.