Peptic Ulcer PDF

## Peptic Ulcer ### Clinical Features: - Symptoms & Signs - Epigastric pain and tenderness. - Anorexia, Nausea & Vomiting. - Hemorrhage - Endoscopy. - Presence of *H. pylori*: Endoscopic biopsy, serological test & Urea breath test ### Goals of Therapy: - Relief of pain. - Promotion o...

## Peptic Ulcer ### Clinical Features: - Symptoms & Signs - Epigastric pain and tenderness. - Anorexia, Nausea & Vomiting. - Hemorrhage - Endoscopy. - Presence of *H. pylori*: Endoscopic biopsy, serological test & Urea breath test ### Goals of Therapy: - Relief of pain. - Promotion of healing. - Prevention of recurrence. ### Drug Therapy: #### Antacids They Produce: - Neutralization of *HCI* and Relief of Pain. - Elevation of pH decreasing the Activity of Pepsin. - Some increase *PGs* & Eradication of *H. pylori* #### Useful in Treatment of: - Peptic Ulcer - Rapid relief - Supplement other drugs during initiation of treatment. - Gastro-Esophageal Reflux Disease (GERD) & Heart burn. - Gastritis #### Types: - Chemical Anti-Acids. E.g., Sodium Bicarbonate (*NaHCO3*) - Calcium Carbonate (*CaCO3*) - Physical Anti-Acids. They act by *ADSORBING HCI* & Pepsin and by *DEMULCENT* effect on the ulcer e.g. Gastric mucin. - *AI (OH)3* #### Anti-Secretory :Drugs They inhibit the secretion of gastric *HCI*. **A) Anti-Muscarinic :Drugs:** - Pirenzepine & Telenzepine Selective *M1*-blockers decrease Acidity. **B) Gastrin Antagonists:** - Proglumide: Gastrin-receptors Blocker. **C) Prostaglandins:** - Example: Misoprostol - Useful in treatment of NSAID-induced peptic ulcers **D) H2 Blockers:** - Cimetidine - Pharmacodynamics: - Selective Competitive Blocker of Histamine H2-receptors. - Reduces gastric acidity. - Side Effects: - Sudden stop - Recurrence of the ulcer & Bleeding - GIT Upsets - Constipation or diarrhea. - Hypersensitivity reactions e.g. Skin rash & Itching - Affect liver & kidney. - Decrease Hepatic blood flow. - Ranitidine - Similar to Cimetidine BUT LONGER duration of actions - Pharmacodynamics Similar to Cimetidine BUT STRONGER (5-10 Times). - Therapeutic Uses Similar to Cimetidine BUT BETTER. - Side Effects similar to Cimetidine BUT SAFER **E) Proton pump inhibitors:** - Omeprazole - Lansoprazole - Pantoprazole - Activated in the acidic environment of the secretory cells of the stomach. - Irreversible inhibitor of *H+/K+ ATPase* enzyme. - Therapeutic Uses: - Peptic ulcer (Drug of Choice). - Gastro-Esophageal Reflux Disorder (GERD). - Side Effects: - CNS: Headache, Dizziness & Drowsiness. - GIT: Nausea, Diarrhea & Abdominal colic. - Skin rash. ### Mucosal Protectives: #### Prostaglandins - Increase Mucus secretion. - Increase HCO3 secretion. - Increase Blood supply to mucosa. - Decrease HCl secretion (Anti-Secretory). - Promotes healing of ulcers. - Prevent gastric ulcer induced by analgesics. #### Side Effects: - Oxytocic (causes Abortion). Contraindicated in pregnancy. - Nausea & abdominal pain.