Tx for PUD I Flashcards
What is dyspepsia?
any symptoms referable to the upper GIT… including upper abdominal
pain or discomfort, heart burn, acid reflux, nausea & vomiting
Symptoms arise from 5 main conditions. Name them.
- Non-ulcer / functional dyspepsia (indigestion)
- Gastro-oesophageal reflux disease (GORD)
- Gastritis
- Duodenal ulcers
- Gastric ulcers
What are the clinical features of indigestion? (6)
Vague abdominal discomfort associated with belching
* Bloated
* Flatulence
* Feeling of fullness
* Nausea / vomiting
* Heartburn
Explain the aetiology of GORD
Lower oesophageal sphincter
incompetence - ↓ muscle tone via
medicine / over treating
Aetiology of gastritis
Increased acid produc on →
inflammation of stomach, attributed to
Helicobacter pylori infection, NSAIDs /
acute alcohol ingestion
How does the H pylori affect the muosa?
- Duodenal & gastric ulceration
- H. pylori present in 95% and 70% of
ulcers respec vely → thought to secrete
chemical factors which cause gastric
mucosal damage.
When to refer a pt with dyspepsia
Anaemia
* Loss of weight / Anorexia
* Recent onset of progressive symptoms
* Severe pain (at night)
* Dysphagia (difficulty in swallowing) and haematemesis
* Persistent vomiting (with / without blood)
* Referred pain
* Treatment failure
What is the non-pharmacological advice for dyspepsia
Lifestyle advise:
* Move to a lower fat diet (decrease spicy food and chocolate)
* Eat smaller frequent meals
* Reduce alcohol & caffeine intake
* Smoke cessation
* Lose weight
Examples of H2 receptor antagonists
Cimetidine and Ranitidine
Examples of Proton pump inhibitors
Lansoprazole
Omeprazole
Examples of prostaglandins (1)
Misoprostol
What is the MOA of antacids?
Neutralise stomach acid
what are the active ingredients found in antacids?
- Sodium, potassium = quick acting, quick action
- Magnesium (diarrhoea), aluminium (constipation) = less soluble,
prolonged action - Calcium (constipation) = quick acting, prolonged action
Directions of use of antacids
1 tablet 1 hour after meals and at bedtime
Drug interactions of antacids
Affect absorption of drugs
tetracyclines, fluoroquinolones, iron,
digoxin, indomethacin - esp enteric coated tablets – leave gap of 2
hours between medications
Contraindications of antacids
patients on salt-restricted diets / cardiovascular disorders
(hypertension), children under 12 years
Why is it good to take antacids after a meal?
Take after food (pc), gastric emptying delayed, longer
duration of action
What is the first line of tx of heartburn and reflux? What is its MOA?
Alginates (gaviscon)
MoA: contact with gastric acid = precipitation – sponge-like matrix that floats on top of stomach contents
What is gelacid? how is it taken?
Comination of alginates and antacids
Take after each meal and
before bed-time
* Safe in pregnancy & lactation
CI of Gelacid
Pts on salt-restricted diets
What is the MOA of H2 antagonists?
Reduce gastric acid and
pepsin secretion by blocking
the action of histamine at the H2- receptors in the parietal cells of the stomach
DIs of H2 antagonists
Inhibits hepatic microsomal enzymes (cytochrome P450) and has the potential for multiple drug interactions
Adverse effects of H2 antagonists (6)
Headache, confusion, dizziness, diarrhoea, myalgia, skin rashes
Indications of Cimetidine and Ranitidine
short-term relief of heartburn, dyspepsia and
hyperacidity
Dosage of Cimetidine
max 200mg/dose & 800mg/day for max 14 days
Dosage of Ranitidine
max 75mg/dose & 300mg/day for max 14 days
