PHCP2 PU, ALL RH

Treatment Goals

• Relieve ulcer pain, heal the ulcer, prevent ulcer recurrence, and reduce ulcer-related complications
• Eradicate H.pylori, heal the ulcer, and cure the disease in H.pylori-positive patients
• Heal the ulcer as rapidly as possible in patients with NSAID-induced ulcers

Pharmacologic Treatment

• PPI-based therapy: PPI, Clarithromycin, Amoxicillin or Metronidazole
• Bismuth-based quadruple therapy: PPI or H2RA, Bismuth subsalicylate, Metronidazole, Tetracycline
• Non-bismuth quadruple therapy (concomitant therapy): PPI, Clarithromycin, Amoxicillin, Metronidazole
• All medications except PPI should be taken with meals and at bedtime

Nasal Corticosteroids

• Relieve sneezing, rhinorrhea, pruritus, and nasal congestion with minimal side effects
• Reduce inflammation by blocking mediator release, suppressing neutrophil chemotaxis, causing mild vasoconstriction, and inhibiting mast cell-mediated late-phase reactions
• Examples: Beclomethasone, Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone

Cromolyn Sodium

• A mast cell stabilizer, available as a non-prescription nasal spray for symptomatic prevention and treatment of allergic rhinitis
• Prevents antigen-triggered mast cell degranulation and release of mediators, including histamine
• Most common side effect is local irritation (sneezing and nasal stinging)

Ipratropium Bromide

• An anticholinergic agent that may be useful in persistent allergic rhinitis
• Exhibits antisecretory properties when applied locally and provides symptomatic relief of rhinorrhea

Montelukast

• A leukotriene receptor antagonist approved for treatment of persistent allergic rhinitis in children as young as 6 months and for seasonal allergic rhinitis in children as young as 2 years
• Effective alone or in combination with an antihistamine
• Less effective than intranasal corticosteroids, making it a third-line therapy

Immunotherapy

• Process of administering doses of antigens responsible for eliciting allergic symptoms to induce tolerance
• Subcutaneous immunotherapy: very dilute solutions are given initially once or twice weekly
• Sublingual immunotherapy: available for ragweed and certain grass allergies

Adverse Reactions

• Subcutaneous immunotherapy: mild local adverse reactions (induration and swelling at the injection site), rare severe reactions (generalized urticaria, bronchospasm, laryngospasm, vascular collapse, and death from anaphylaxis)
• Sublingual immunotherapy: pruritus of the mouth, ears, and tongue, throat irritation, and mouth edema

Non-Pharmacologic Treatment

• Avoiding offending allergens
• Reducing exposure to dust mites
• Preventing poor air quality in homes
• Keeping windows closed and minimizing time spent outdoors during pollen seasons

Evaluation of Outcomes

• Monitor patients regularly for reduction in severity of identified target symptoms and presence of side effects
• Ask patients about their satisfaction with the management of their allergic rhinitis
• Management should result in minimal disruption to their normal lifestyle
• Use the Medical Outcomes Study 36-Item Short Form Health Survey and the Rhinoconjunctivitis Quality of Life Questionnaire to measure symptom improvement and quality of life.

Learn about the treatment goals for ulcers which include pain relief, ulcer healing, prevention of recurrence, and reduction of complications. Explore pharmacologic treatment options for H.pylori-positive and NSAID-induced ulcers.