AntiULCERS DRUG Flashcards
What is a peptic ulcer
ulcerations and erosions in the stomach and duodenum
Symptoms of PU
Risk factors
Causes
Symptoms : Gnawing/Aching pain, especially after eating.
- Gastric ulcer: 30min-1 hr after eating
- Duodenal Ulcer: 2-3 hours after eating
Predisposing factors: H. PYLORI (MOST COMMON) Mechanical Genetic Environmental Drugs Stress
○ Causes for Peptic Ulcers: ■ H. pylori ■ NSAIDs use ■ Hypersecretion of HCl acid and Pepsin ■ Defective cardiac or pyloric sphincter ■ Hyper motility of stomach ■ Increase in parietal cells ■ Excess acetylcholine and histamine ■ Caffeine ■ Fatty/Fried/Spicy foods ■ Alcohol ■ Cigarette Smoking ■ Pregnancy ■ Stress ■ Massive Trauma ■ Major Surgery ○ Risk Factors: ■ H. Pylori ■ Family History: type O blood ■ COPD and Chronic renal failure
GERD
Main cause?
■ Chronic Disorder: inflammation of the lower part of the esophagus due to abnormal reflux of gastric contents into the esophagus.
Main cause is an incompetent Lowe esophageal sphincter
—Smoking tends to accelerate the disease process
Symptoms for GRED
■ Dysphagia ■ Dyspepsia: chest pain (heartburn) after eating ■ Pyrosis (burning sensation in esophagus) ■ Chronic Cough ■ Morning Hoarseness ■ Dental Caries ■ Adult onset asthma ■ Regurgitation (food or gastric acid) ■ Odynophagia (painful swallowin
Causes/Risk Factors for GERD:
■ Obesity ■ Pregnancy ■ Hiatal hernia ■ LES hypotension ■ Loss of esophageal motility ■ Increased compliance of the hiatal canal ■ Increased states of gastric secretion ■ Eating large meals ■ Delayed emptying of gastric contents ■ Presence of Nasogastric tube ■ Tight belts or girdles
Non-Pharmacologic treatment methods
■ Avoid Tobacco, Alcohol, hot, spicy, and greasy foods
■ Do not eat before bedtime
■ Sit upright after eating, wear loose-fitting clothing
■ Take NSAIDs, WITH FOOD or REDUCED DOSAGE
Phases
A signal is first sent to the vagus nerve
Vagus nerve is going to secrete acetylcholine
Acetylcholine is going to activate H2 receptors (which is always found in your GI tract)
H2 receptors is going to cause the stomach to secrete HCL acid
the 7 groups of antiulcer agents are?
(1) tranquilizers, which decrease vagal activity;
(2) anticholinergics, which decrease acetylcholine by blocking the cholinergic receptors;
(3) antacids, which neutralize gastric acid;
(4) H2 blockers, which block the H2 receptor;
(5) PPIs, which inhibit gastric acid secretion, regardless of acetylcholine or histamine release;
(6) the pepsin inhibitor sucralfate;
(7) the prostaglandin E1 analogue misoprostol, which inhibits gastric acid secretion and protects the mucosa
Tranquilizers
Chlordiazepoxide(Librium)
Clidiniumbromide (Quarzan)
Reduce vagal stimulation, decrease anxiety
• Adverse effects may include edema, ataxia, confusion, extrapyramidal syndrome (EPS), and agranulocytosis.
Anticholinergics
Propantheline(Pro-Banthine)
Inhibits release of HCl by blocking acetylcholine and
histamine
drugs relieve pain by decreasing GI motility and secretion.
Take before meals
Anticholinergics delay gastric emptying time, so they are used more frequently for duodenal ulcers than for gastric ulcers.
Anticholinergics should be taken before meals to decrease the acid secretion that occurs with eating. Antacids can slow the absorption of anticholinergics and therefore should be taken 2 hours after anticholinergic administration.
Anticholinergics have many side effects, including dry mouth, decreased secretions, headache, blurred vision, drowsiness, dizziness, lethargy, palpitations, bradycardia, tachycardia, urinary
retention, and constipation.
Antacids
Sodium bicarbonate (Alka-Seltzer)
Calcium carbonate (Tums)
Magnesium (Mg) hydroxide/aluminum hydroxide
(Maalox) Aluminum (Al) hydroxide (Amphojel)
Antacids: neutralize hydrochloric acid and reduce pepsin activity
