..PEPTIC ULCER DRUG..

aku br pas bc so aku nak vomitkan semua yg aku dah bc sbb aku dh nausea sangat dah bc nota ni dr maghrib td..hehehe

first sekali aku nak introducekan,

what is peptic ulcer?????
condition when there are ulcer-may happened at esophagus(rare),stomach and duodenal(most common)






who get peptic ulcers???
men > women
happen at elderly,rarely happened at teen or children

cause of peptic ulcer????
1.acid-pepsin secretion
2.impairment of mucosal defence
3.drugs-> non-steroidal anti-inflammatory drugs such as aspirin (dlm erti kata mudah painkiller)
4.presence of satu organism ni named helicobacter pylori

5.smoking(i said already smoking is very dangerous!!!!)
6.stress
7.alcohol(haram!!!!!!!!!!!!)
8.caffeine

symptoms
1.burning or gnawing epigastric pain
2.change in appetite
3.nausea or vomiting
4.frequent burping or bloating

treatment???
actually,peptic ulcer cannot be cure so what us can do is only..
-prevent recurrence
-prevent complication
-relieve symptom
-promote healing

drugs............
1.antisecretory
a)antimuscarinic
b)histamine antagonist
c)proton pump inhibitor
2.antacids
3.mucosal protective agents
a)sucralfate
b)bismuth chelate
c)misoprostol
4.helicobacter pylori(h.pylori) eradication

so now i want to describe each of them..

ANTIMUSCARINIC
EXAMPLE-telenzepine,pirenzepine(this two are the suitable antimuscarinic for git as they just effect git without really effect other system)
ACTION-1.inhibit acid secretion
2.prevent git(gastrointestinal) motility
ADVERSE EFFECT
1.dry mouth
2.blurred vision
3.flushing
4.constipation
5.urinary retention
6.impotence
7.bradycardia(followed by trachycardia)
OTHERS-not preferable drug as there are better drugs to treat peptic ulcer

HISTAMINE ANTAGONIST
EXAMPLE-cimetidine(the 1st produced so it is less potent and has more side effect)
-ranitidine
-famotidine
-nizatidine
ACTION-1.prevent histamine to bind to its receptor
2.also inhibit release of acetycholine and gastrin(for gastrin it will still
increase after eating even when there are drug so the effect of peptic ulcer
still happen)
ADVERSE EFFECT(no.3&4 effect is for cimetidine only)
1.GIT disturbance(constipation@diarrhea)
2. mental confusion
3.anti-adrogenic effect lead to gaenomastia and impotence ->man's problem with hormone
4.enzyme-inhibitor that lead to drug toxicity (this drug inhibit enzyme at the liver that function to metabolized drug so when the enzyme is inhibit so the drug will increase in our body that lead to drug toxicity)
OTHERS-very effective inhibiting nocturnal acid secretion (better in treat acid secretion at night)

PROTON-PUMP INHIBITOR
EXAMPLE-Omeprazole
-isomeprazole
-lansoprazole
-pantoprazole
-rabeprazole
ACTION-block the final step of acid secretion
ADVERSE EFFECT
1.git disturbance(constipation@diarrhea)
2.nausea &vomiting
3.hypersensitive reaction
4. gynaecomastia&impotence
5.enzyme-inhibitor
OTHERS-the best drug

ANTACIDS
-used when there are symptoms or expected symptom will occur(usually after meal or at bedtime)
-in 1-2 hours
-action-decrease the acidity
-mucosal protective effect

SUCRALFATE
-works locally it the stomach react with HCL(hydrochloric acid)-> form thick pastelike subtance that adhere to the gastric mucosa and ulcer -> protect it from damaging effects of acid&pepsin
-also stimulate prostagladin and bicarbonate secretion

BISMUTH CHELATE
-same action with sucralfate except for there are addition of action that is antimicrobial effect
-not used on its own as it is combined in triple theraphy

MISOPROSTOL(PROSTAGLANDIN ANALOG)
-has both antisecretory and cytoprotective agent
-action-stimulate mucus and bicarbonate secretion
-as it is analog to prostagladin it gives prostaglandin effect that is inhibit
acid secretion.
SIDE EFFECT-1.vaginal bleeding
2.dyspepsia and flatulence
3.nausea & vomiting
4. diarrhea@constipation
CONTRAINDICATION-in pregnant ladies as it can cause abortion

H. PYLORI ERADICATION
-must comfirmed there are presence of h.pylori
-by combining drugs in triple(1 PROTON-PUMP INHIBITOR& 2 ANTIBIOTICS) and quadruple therapy
TRIPLE THERAPY
1)OMEPRAZOLE+AMOXYCILLIN+CLARITHROMYCIN
or
2)OMEPRAZOLE+METRONIDAZOLE+CLARITHROMYCIN(if the patient has allergy to penicillin(that is amoxycillin))
QUADRUPLE THERAPY
PROTON-PUMP INHIBITOR+BISMUTH CHELATE+METRONIDAZOLE+TETRACYCLLINE