Pharmacology b
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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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Pharmacology b

Pharmacology B

Lin, I-Yao


Pharmacology b

  • 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.


Diagnosis peptic ulcer of duodenum

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.


Pharmacology b

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


Lab examination

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.


Treatment approaches include

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.


Treatment medication

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


Pharmacology b

<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


Pharmacology b

<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.


Pharmacology b

<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).


Non pharmacology

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.


Pharmacology b

Thank You !


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