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Pharmacology B

Pharmacology B. Lin, I-Yao. A 43y/o male CEO of a multinational company experienced severe burning pain one and a half hour after a sumptuous lunch. This is accompanied by mild nausea and vomiting. He was given a glass of milk and some cookies which apparently provided some relief.

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Pharmacology B

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  1. Pharmacology B Lin, I-Yao

  2. A 43y/o male CEO of a multinational company experienced severe burning pain one and a half hour after a sumptuous lunch. This is accompanied by mild nausea and vomiting. He was given a glass of milk and some cookies which apparently provided some relief.

  3. Diagnosis: Peptic ulcer of duodenum • Ulcer of the distal stomach and proximal duodenum caused by gastric secretions (hydrochloric acid and pepsin) and impaired mucosal defenses. • It’s associate with Helicobacter pylori which increased hydrochloric acid secretion, and inadequate mucosal defense against gastric acid.

  4. Cause: • Using aspirin medicine • Drinking alcohol excessively • Smoking cigarettes and using tobacco • Others. Sign and symptoms: • Nausea and vomiting. • Weight loss • Fatigue • Heartburn, indigestion, belching. • Vomiting blood • Bloody or dark tarry stools

  5. Lab examination: • Gesophagogastroduodenoscopy (EGD) . • Take biopsy to test for H, pylori. • Stool guaiac to test for blood in the stool. • Schilling test to check for anemia.

  6. Treatment approaches include: • Eradicating the H. pylori infection. • Reducing secretion of gastric acid or neutralizing the acid after it is released. • Providing agents that protect the gastric mucosa from damage.

  7. Treatment - medication <Antacids> NaHCO3, Mg(OH)2, Al(OH)3. <Acid secretion reducers> Proton-Pump inhibitors: Omprazole, Lansoprazole. H2 – Antagonists: Cimetidine, Ranitidine. <Mucosal strengtheners> Sucralfate, Bismuth chelate, Prostaglandins <H. pylori eradication> Omprazole + Clarithromycin + Amoxillin/ Metronidazole

  8. <Antacids> -weak base that react with gastric HCl to form salt and water -reduce gastric acidity -reduce pepsin activity Side effect: NaHCO3-systemic alkalosis Mg(OH)2-diarrhea, hyper magmesemia Al(OH)3-constipation, hypophosphatemia

  9. <Acid secretion reducers> 1. Proton-Pump inhibitors: Omprazole, Lansoprazole. -inhibits gastric parietal cell proton pump H+/K+ ATPase, dercease gastric acid secretion. 2. H2 – Antagonists: -blocker H2-receptor and reduce cAMP which inhibit gastric acid secretion. Side effect: Cimetidine-confusion, reversible gynecomastia. Ranitidine-headache. The H2-receptor antagonist can’t combined with PPI inhibitor which the H2-receptor antagonist even inhibit omeprazole.

  10. <Mucosal strengtheners> • Sucralfate -selective binding to necrotic ulcer tissre and act as barrier to acid, pepsin, bile. -requires acid pH to be activated, there fore should not be used with antacid, H2 antagonist or proton pump inhibitors. 2. Bismuth chelate -binds and ulcer tissue, coat it and protectit from acid and pepsin. 3. Prostaglandins -inhibits secretion of HCl and stimulates secretion of mucus and bicarbonate (cytoprotective effect).

  11. Non pharmacology: • Avoid food and drink that seems to cause more severe symptoms such as spicy foods, coffee and possibly alcohol. • stop smoking. • Should be lose excess weight if overweight.

  12. Thank You !

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