Drugs for acid related disorders 3 Flashcards
CI for prostaglandin analogues
CI in pregnancy- uterine contractions, premature abortion
AE for prostaglandin analogues
AE: abdominal cramp, diarrhoea
MoA of prostaglandins and it is used with what other agents
Refresher: Prostaglandins E2 and I2 inhibit acid, stimulate mucus and bicarbonate secretion, and dilate mucosal blood vessels
Misoprostol, prostaglandin analogues
Used with NSAIDs
Explain the pathophysiology of peptic ulcer disease
The pathophysiology of gastric and duodenal ulcers is determined by the imbalance between aggressive (gastric acid and pepsin) and protective (mucosal defense and repair) factors.
Common causes of peptic ulcer disease
Common causes:
* Helicobacter pylori (HP) infection
* Nonsteroidal anti-inflammatory drugs (NSAIDs)
* Critical illness (stress-related mucosal damage)
what are the uncommon causes of peptic ulcer disease
Uncommon causes:
* Hypersecretion of gastric acid (Zollinger-Ellison syndrome)
* Viral infections
* Radiation therapy
* Cancer chemotherapy
* Medical illnesses (cirrhosis, chronic kidney disease)
Cigarette smoking effects in ppetic ulcer disease
Cigarette smoking impairs ulcer healing and may be associated with ulcer-related GI complications
NSAIDS causes gastric mucosal damage by?
NSAIDs cause gastric mucosal damage by:
* Direct irritation of gastric epithelium
* Systemic inhibition of endogenous mucosal prostaglandin synthesis
Helicobacter pylori infection causes what?
Helicobacter pylori infection causes release of enzymes (urease, lipases, proteases) that cause gastric inflammation and mucosal injury.
List the NSAID-Induced Ulcer risk factors
- Age >65
- Previous peptic ulcer
- High-dose NSAIDs
- Multiple NSAID use
- Selection NSAID (COX-1 vs COX-
2) - Aspirin
- Chronic debilitating disorders
(cardiovascular disease,
rheumatoid arthritis) - Concomitant use of:
- NSAID + aspirin
- Oral bisphosphonates
- Corticosteriods
- Anticoagulants
- Antiplatelets
- SSRIs
- Helicobacter pylori infection
- Cigarette smoking
- Alcohol consumption
NSAID-Induced Ulcer Risk Factors
List the clinical presentation for peptic uler disease
Symptoms
* Abdominal pain that is often epigastric and described as burning but may present as vague discomfort, abdominal fullness, or cramping
* A typical nocturnal pain that awakens the patient from sleep (especially between 12 and 3 AM)
* The severity of ulcer pain varies between patients and may be seasonal, occurring more frequently in the spring or fall; episodes of discomfort usually occur in clusters, lasting up to a few weeks and followed by a pain-free period or remission lasting from weeks to
years
* Changes in the character of the pain may suggest the presence of complications
* Heartburn, belching, and bloating often accompany the pain
* Nausea, vomiting, and anorexia are more common for patients with gastric ulcer than with duodenal ulcer but may also be signs of an ulcer-related Complication
Signs
* Weight loss associated with nausea, vomiting, and anorexia
* Complications including ulcer bleeding, perforation, penetration, or obstruction
Explain the PUD resistant disease
and also the medication
Ulcer not healing.
High-risk patients, i.e. poor surgical risk and the elderly or concomitant disease.
Maintenance therapy:
PPIs, e.g.: Lansoprazole, oral, 30 mg daily. Specialist initiated.
The GUs and DUs are associated with which infetcion
The vast majority of GUs and DUs are associated with H. pylori infection and
eradication therapy is indicated if infection is present. This will greatly reduce the
rate of recurrent ulceration. Empiric eradication of H. pylori is not recommended.
Lists the drugs used for PUD treatment for H.pylori +ve
- Proton pump inhibitors (PPIs)
- PPI, e.g.: Lansoprazole, oral, 30 mg 12 hourly.
- Duodenal ulcer: for 7 days.
- Gastric ulcer: for 28 days.
- AND
- H. PYLORI ERADICATION:
- Amoxicillin, oral, 1 g 12 hourly for 14 days. OR For severe penicillin allergy:
Azithromycin, oral, 500 mg daily for 3 days. - AND
- Metronidazole, oral, 400 mg 12 hourly for 14 days
List the drugs for PUD treatment for H. pylori -ve
These are usually a consequence of NSAID use.
* PPI, e.g.:
* Lansoprazole, oral, 60 mg daily.
* Duodenal ulcer: for 14 days.
* Gastric ulcer: for 28 days.
* Stop NSAID until ulcer has healed.
* If patient is unable to stop NSAID:
* Decreasing NSAID dose
* Switching to paracetamol
* Using more selective COX-2 inhibitor
