..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

...BIRTHDAY MOOD....

assalamualaikum..
bertemu kembali..n3 ni nak still in the mood of ""i'm already nineteen"..yang penting teen tu hehehe still young+available hohoho
for me this birthday is the best birthday ever..why????sbbnya thn ni ada 2 celebration birthday with 2 cakes hoho i love cake!!!!!
n3 sblm ni dah cta mlm birthday tu kan..memang rasa terharu bangat la kat planer2 birthdayku yang berjasa that is bela,ain dntal,zue,zaty,sue,and my rmates aina and cek sue..yg mnambahkan terharunya zue snggup bersusah payah masak bihunnya sdgkan exam is around the corner je..really terharu and thanks so much..in addtion, i also got many present huhu best!!!!!hehehe then,g kuliah mmg ramai gak yang tahu and ingat so tetiba ain sabrina jd famous hehehe ramai gak yang wish kat gtalk and ym and also by hp..really thanks everybody..yang tak menahannya ada gak sms from adik2 fasi aku masa program msft(medical student fasilitator team)ari tu kat sek. men. pangkal kalong..ingat lagi diorg kat aku huhu terharu....
tengahari ckit ada mama ngan abah fon wish hehe malu pulak bila mama ngan abah yang wish hehehe inat,my sis pun nyibuk gak nak wish hehehe then,when mama ask "nak hadiah apa?" aku juz terdiam,tak tau nak jawab pa hehehe dah tua bangka segan dah nak meminta-minta hadiah..hehehe
then,ptg tu masa PBL ada la iklan satu restoran makan ni then tetiba je aku rasa nak makan kat luar sangat so plan nak makan kat luar ngan aini and addy pas asar trus sbb i'm still trauma driving at night huhuhu dasyat betul penangan eksiden ari tu..then tetiba nik nak join and nak ajak hazwan sekali sbb kononnya segan dia laki sorg,tolonglah nik cam tak besa lak..hehehe then program yang kononnya nak g petang ditunda ke malam and bcoz i'm still in trauma so nik will be our driver that night hehehe dah lama rasanya tak jadi penumpang,bahagia sebentar hehehe ye la sejak ada lesen ni asyik2 kena jd drebar je bkn saja kat kelate ni kat umah pun abahku dah naik takhta dan melantik aku menjadi drebar lak huhu malas tul nak tekan clash,nak tukar gear etc..

so malam tu pas maghrib pegi la ke restoran(restoran dalam iklan) tu dengan harapan yang mengunung tinggi..alih2 restoran tu sangatlah tak best and tak kena..last2 kami g ja ikut drebar nik bw g restoran dekat sek lama dia dulu..jauh gila restoran tu..but b4 that diorang g beli kek birthday tuk aku..that's is my 2nd birthday cake..bcoz of that,diorng tak bagi aku kuar dr keta kononnya nak bagi suprise la..bila diorang masuk ja keta diorg takut2 kan aku kata kat kek tu takda nama aku pun..kek tu ada nama2 diorg je la hehehe tak kisah pun...yang penting bagi aku benda tu kek and aku boleh makan kek tu hehehe i really love cake!!!!

then,lastly br la smpai kat restoran tu..pesan mcm2 aneka laut cam 5 tahun tak makan hehehe kami pesan lauk siakap 3 rasa,telur dadar,kailan ikan masin,paprik sotong and udang goreng tepung and 6 nasi kosong..betul2 melantak..hehehe then sementara nak tunggu lauk sampai kek tu pun dibuka then suprise me tgk cake..ada tulis "Anda dah tua,ain"



then cepat ja respon aku.."tua2 aku pun aku yang paling muda kat cni tau"..suka betul aku dengan title 'paling muda' tu hehehe then selepas sesi lagu hepi birthday+sesi potong memotong terjadi la pulak sesi mengambil gambar..ni la hasilnya..









then,pas makan,kami g singgah tesco jap..aku sibuk membeli hadiah tuk sahabat2 ku yang birthday bulan ni huhu tiap2 bulan kuar beli hadiah ye la tiap2 bulan mesti ada ja kawan punya birthday..then,aini ngan mira trus bli hadiah depan aku ja..cik mira belikan aku jam yg aini belikan aku mug,so bertambahlah koleksi hadiah aku hehehe then masa nak balik tu one more sesi bergambar..

bergaya?????????hehehe



...............................nik yang tersangatlah poyo.......................

then,kembalilah ke pangkal jalan..smpai bilik ja kat meja aku ada lg satu hadiah era bagi hehe sukanya..bertambahlah koleksi hadiahku..





the latest pic of my 19th birthday present..ada 3 frame,the latest from ainul yg frame ayam tu,then,bekas tu from era,jam from mira,mug from aini and the card from my pbl members-the card thanks to claire..gambar kat atas ada adition of choclate cadbury yang best from nana..thanks everybody that make my birthday this year very sweeet....