Peptic Ulcer Drugs

Question 1

1) Peptic ulcer refers to ulcer where?
2) Which ulcer is more frequent?
3) Release of HCl from parietal cells in stomach influenced by what?
4) Major risk factors?

Answer 1

1) Lower oesophagus; Stomach; Duodenum
2) Duodenal 10x more frequent
3) Histamine; Gastrin; Acetylcholine
4) - NSAIDs (aspirin, ibuprofen)
- H pylori infection (transmitted from person to person: close contact/exposure to vomit)
- Alcohol
- Smoking
- Chronic diseases
(emphysema, rheumatoid arthritis, cirrhosis, diabetes)

Question 2

1) Groups of Antiulcer drugs?( 4)

2) Drug treatment approach for each group?

Answer 2

Groups of Antiulcer drugs:
- Antibiotics: 
     * Eradicating H. Pylori infection
- Antisecretory agents 
    (Histamine H2 agonists; Proton Pump Inhibitors)
     * ˅ Gastric Acid secretion
- Mucosal protectants
     * ^ Mucosal resistance
- Antacids
     * Neutralise stomach acidity

Question 3

Antacids:
1) Action?
2) 3 antacids?
(fast/slow action? adverse effect?

Answer 3

1) ^ pH of stomach
(wound healing in frequent doses)
2) - Aluminium Hydroxide
(slower action; Constipation)
- Magnesium Hydroxide
(fairly rapid action; Diarrhoea)
- Sodium Bicarbonate
(rapid action; Systemic Alkalosis)

Question 4

Histamine H2-receptor antagonist:

1) Drug name? (2)
2) Action?
3) Use?
4) Adverse effects?

Answer 4

1) Cimetidine; Ranitidine
2) ˅ acid secretion
3) Relieve peptic ulcer pain; ^ healing
(60-100% recurrence after stopping)
4) Minor: headache, dizziness, diarrhea, muscle pain, confusion

Question 5

Proton-pump inhibitor

1) Drug?
2) Action?
3) Use?

Answer 5

1) Omeprazole
2) Suppress secretion of H+ into gastric lumen
3) Short term treatment:
- Erosive Eosophagitis
- Active Duodenal ulcer

Question 6

Mucosal protective agents:

1) Drug?
2) Action?
3) Alternative for?
4) Adverse effects?

Answer 6

1) Colloidal Bismuth Sucralfate
2) Protect ulcer crater from corrosive acid & pepsin by coating it
3) patients who Can’t tolerate H2 antagonists;
Long term maintenance
4) Constipation (well tolerated)

Question 7

Antimicrobial agents:

1) Drugs? (5)
2) Use?
3) Standard triple therapy?
4) Why triple therapy is standard?

Answer 7

1) - Amoxicillin
- Tetracycline
- Bismuth
- Metronidazole (Flagyl)
- Clarithromycin
2) Eradication of H. Pylori
(rapid healing & Low recurrence rate)
3) Bismuth, Metronidazole & Tetracycline for 2 weeks
(90% eradication rate)
4) Single antimicrobial drug treatment is less effective (20-40%)

Question 8

Antibiotic Regimens:

1) ACG guidelines recommend using how many antibiotics?
2) First line therapy?
3) Second line therapy?
4) Common side effects?

Answer 8

1) >2 antibiotics
2) Proton pump inhibitor + Clarithromycin 500mg + (Amoxicillin 1g OR Metronidazole 400mg) 7-14 days
3) Proton pump inhibitor + Bismuth 120mg + Metronidazole 400mg + Tetracycline 500mg 7-14 days
4) - Diarrhoea
- Flushing & Vomiting with alcohol (Metronidazole)
- Nausea; Vomiting; Abdominal cramp; Headache; Rash