This document discusses drugs used to treat peptic ulcer disease. It begins by defining peptic ulcers and their causes, including H. pylori infection and NSAID use. It then categorizes and describes the mechanisms and uses of common drug classes to reduce acid secretion like H2 blockers and proton pump inhibitors or protect the mucosa with drugs like sucralfate and bismuth. Adverse effects and interactions of representative drugs from each class like cimetidine and omeprazole are also outlined.
2. Peptic ulcer
• Ulcer formation in the stomach or first part of the duodenum
• Damage to the mucosa and deeper tissues exposed to acid
and pepsin
TYPES
-DUODENAL ULCER (of duodenum)
-ESOPHAGEAL ULCER(of esophagus)
-GASTRIC ULCER(of stomach)
3.
4. SYMPTOMS
• Abdominal pain
• Nausea
• Loss of appetite
• Weight loss
• Hematemesis (vomiting of blood)
• Rarely , duodenal or gastric perforation
5. Causes
• Increased secretion of gastric acid
• Decreased resistance of GIT mucous membrane
• Use of NSAIDS
• Infection with Helicobacter pylori
8. CIMETIDINE
Mechanism of action
• Blocks H2- receptors for histamine on the parietal cells and inhibit gastric
acid production
• Decreases volume of gastric secretion
• Inhibit gastric acid secretion due to acetylcholine and gastrin inhibition
• Secretion of pepsin is also reduced
H2-Receptors
Parietal cell -Cimetidine
-Ranitidine
-Famotidine
(Antagonists)
Histamine
(Agonist)
9. Other H2- Antagonists
Ranitidine, famotidine and nizatidine are similar to cimetidine but some
differences
COMPARISON
Cimetidine
• Less potent
• Shorter duration of action
• More drug interactions
• Anti-androgenic effects
• Cross BBB and produce CNS
side effects
Ranitidine
• More potent
• Longer duration
• Rare drug interactions
• No androgenic effects
• Poorly cross BBB and rare
side effects
10. Clinical uses of cimetidine
• Treatment of duodenal and gastric ulcer
• Reflux oesophagitis
• Stomal ulcer
• Prophylaxis of bleeding from GIT
• Prevention of peptic ulcer due to NSAIDS
• Respiratory aspiration
• Pancreatic insufficiency
11. Adverse effects
• Headache, constipation, diarrhea, dizziness, weakness and pain in the
body
• Due to weak antiandrogenic effects-Impotence and gynaecomastia
• In elderly- confusion, lethargy and hallucinations
• Decreased heart rate and conduction defects
Drug interaction
• Cimetidine x phenytoin,warfarin,digoxin,propranolol =prolongs their effect
12. PROTON PUMP INHIBITORS
Mechanism of action (omeprazole)
• Inhibits the ezyme H+K+ATPase irreversibly in the cell
membrane of parietal cell (this enzyme plays an important
role in the final step of gastric acid secretion)
13. Clinical uses of PPIs
• Gastric and duodenal ulcers
• Reflux oesophagitis(GERD)
• Zollinger-ellison syndrome
• Eradication of H-pylori infection
Adverse effects
Rarely cause nausea, dizziness, constipation, diarrhea and skin
rashes
14. ANTACIDS
• Alkaline drugs, neutralize gastric acid to form salts
• Raise gastric pH
• Do not affect acid production
Adverse effects
• Sodium bicarbonate - rapidly absorbed from GIT, can cause alkalosis and
rebound acidity
• Magnesium compounds - may produce diarrhea
• Aluminum hydroxide – causes constipation
Clinical uses
• Rapid relief of ulcer symptoms
• Healing of ulcer
15. ANTIMUSCRINICS
Pirenzepine
Mechanism of action
• Blocks M1 receptors for acetylcholine on parietal cells
• Inhibit gastric acid secretion
Adverse effects
• Blurring of vision
• Constipation
• Dry mouth
16. Drugs causing mucosal protection
Bismuth chelate
• Forms a sticky substance with proteins at the base of ulcer
• Adheres there and form a protective coating
Adverse effects
• 2 Bs
B
Black ( blacken teeth and
tongue)
Brain (causes encephalopathy
i-e damage to brain)
17. • Sucralfate
• Complex salt of aluminum hydroxide with sucrose sulphate
• Aluminum separates in acid environment
• The rest of the molecules attains a negative charge and binds with positive
proteins of ulcer
• Sticky paste formed
• Binds to ulcer
• Binds with pepsin and bile
Adverse effects
• Constipation
• Toxic effects
• Inhibit absorption of some drugs i-e phenytoin,ciprofloxacin,digoxin
