{"id":6599,"date":"2024-11-17T21:40:03","date_gmt":"2024-11-17T21:40:03","guid":{"rendered":"https:\/\/workhouse.sweetdishy.com\/?p=6599"},"modified":"2024-11-17T21:40:04","modified_gmt":"2024-11-17T21:40:04","slug":"drugs-used-in-acid-peptic-disease","status":"publish","type":"post","link":"https:\/\/workhouse.sweetdishy.com\/index.php\/2024\/11\/17\/drugs-used-in-acid-peptic-disease\/","title":{"rendered":"Drugs used in Acid-peptic disease:"},"content":{"rendered":"\n<p>Acid-peptic disease includes peptic ulcer (gastric and duodenal), gastroesophageal reflux and<br>Zollinger \u2013 Ellison syndrome.<br>Peptic \u2013 ulcer disease is thought to result from an imbalance between cell \u2013 destructive effects<br>of hydrochloric acid and pepsin and cell-protective effects of mucus and bicarbonate on the<br>other side. Pepsin is a proteolyic enzyme activated in gastric acid, also can digest the stomach<br>wall.<br>A bacterium, Helicobacter pylori is now accepted to be involved in the pathogenesis of ulcer.<br>In gastroesophageal reflux, acidic stomach contents enter into the esophagus causing a burning<br>sensation in the region of the heart; hence the common name heartburn, or other names such<br>as indigestion, dyspepsia, pyrosis, etc.<br>87<br>Zollinger-Ellison syndrome is caused a tumor of gastrin secreting cells of pancreas<br>characterized by excessive secretion of gastrin that stimulates gastric acid secretion.<br>The disorders can be treated by drugs, which are able to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Neutralize gastric acid (HCl) e.g. magnesium hydroxide<\/li>\n\n\n\n<li>Reduce gastric acid secretione.g. cimetidine<\/li>\n\n\n\n<li>Enhance mucosal defences e.g sucralfate<\/li>\n\n\n\n<li>Exert antimicrobial action against H.pylori e.g. clarithromycin<br>The effective therapeutic approach of ucler is based on the adage:<br>\u201cno acid, no ulcer\u201d<br>Anti \u2013 ulcer drugs: drugs used in the prevention and treatment of peptic ulcer disease act mainly<br>to decrease cell-destructive effects, increase cell \u2013 protective effects or both.<br><strong>A: Gastric acid neutralizers (antacids)<\/strong><br>Antacids are alkaline substances (weak bases) that neutralize gastric acid (hydrochloric acid)<br>They react with hydrochloric acid in the stomach to produce neutral or less acidic or poorly<br>absorbed salts and raise the PH of stomach secretion, and above PH of 4, pepsin is inactive.<br>Antacids are divided into systemic and nonsystemic<br>Systemic, e.g. sodium bicarbonate are absorbed into body fluids and may alter acid \u2013 base<br>balance. It can be used in the treatment of metabolic acidosis.<br>Non systemic, do not alter acid \u2013 base balance significantly. They are used as gastric antacids;<br>and include aluminium, magnesium and calcium compounds e.g. (Al(OH)3, MgS2O3 , Mg(OH)2,<br>CaCO3)<br>\u0083 Gastric antacids differ in their potency, in onset of action, duration of action and adverse<br>effects produced.<\/li>\n\n\n\n<li>Magnesium compounds have a relatively high neutralizing capacity, rapid onset of action,<br>cause diarrhoea and hypermagnesemia.<\/li>\n\n\n\n<li>Aluminium compounds generally have a low neutralizing capacity, slow onset of action but<br>long duration of action and may cause constipation.<br>Calcium compounds are effective and have a rapid onset of action but may cause<br>hypersecretion of acid (acid &#8211; rebound) and milk-alkali syndrome (hence rarely used in peptic<br>ulcer disease). All gastric antacids act chemically although some like magnesium trisiolicate can<br>also act physically.<br><br>The most commonly used antacids, are mixtures of aluminium hydroxide and magnesium<br>hydroxide (e.g. Gelusil, Maalox etc).<br>Antacids act primarily in the stomach and are used to prevent and treat peptic ulcer. They are<br>also used in the treatment of Reflux esophagitis and Gastritis<br><strong>B. Gastric acid secretion inhibitors (antisecretory drugs):<\/strong><br>HCl is secreted by parietal cells of the gastric mucosa which contain receptors for acetylcholine,<br>histamine and gastrin that stimulate the secretion.<br>Fi<br>F<br>Fig 6.1 Endogenous acid secretagogues.<br>Antagonists of acetylcholine, histamine and gastrin inhibit acid secretion.<br><strong>Antisecretory drugs include:<\/strong><\/li>\n\n\n\n<li>H2-receptors blocking agents such as cimetidine, ranitidine, famotidine, nizatidine.<br>Cimetidine is the proto type of the group.<br>89<br><strong>Cimetidine dosage<\/strong>: PO 400mg 2 times\/day, with meals and at bed time, or 800mg once daily<br>at bed time for 6-8 weeks.<br>Prophylaxis of recurrent ulcer, PO 400mg at bed time. High doses are used in the treatment of<br>Zollinger-Ellison syndrome.<br>Common adverse effects: muscular pain, headache, dizziness,<br>anti- androgenic effects at high doses such as impotence,gynecomastia,menstrual irregularities.<br>Drug interactions may occur when it is co-adminstered with warfarin, theophylline, phenytoin,<br>etc. and and the effects of the latter drugs is enhanced because of inhibition of the metabolism<br>of them.<br>Proton pump inhibitors such as, <strong>omeprazole, lansoprazole, etc<\/strong>. inhibit H+ -K+<br>-ATPase(proton<br>pump) which is the common terminal step in aa the three secretagogues to release hydrogen<br>ion into the gastric lumen.<br><strong>Omeprazole dosage: &#8211;<\/strong> gastritis, gastroesophageal reflux disease, PO 20mg\/day for 4-8 weeks;<br>zollinger-Ellison syndrome, PO 60mg once daily initially -120mg\/day.<br>Peptic ulcer disease, PO 10-60mg\/day. Adverse effects include headache, diarrhea and<br>nausea.<br>Anticholinergic agents such as pirenzepine, dicyclomine<br>Major clinical indication is prevention &amp; treatment of peptic ulcer disease, Zollinger Ellison<br>syndrome, reflux esophagitis.<br>Anticholinegic drugs are not used alone in the treatment of peptic ulcer. However, they are<br>combined with <strong>H2-antagonists to further decrease acid secretion, <\/strong>with antacids to delay<br>gastric empting and thereby prolong acid \u2013 neutralizing effects, or with any anti-ulcer drug for<br>antispasmodic effect in abdominal pain.<br><strong>C. Cytoprotective (mucosal protective) agents<\/strong>.<br>Locally active agents help to heal gastric and duodenal ulcers by forming a protective barrier<br>between the ulcers and gastric acid, pepsin, and bile salts.<\/li>\n\n\n\n<li>They do not alter the secretion of gastric acid. These drugs include sucralfate and colloid<\/li>\n\n\n\n<li><br><strong>bismuth compounds.<\/strong> (e.g. tripotassium, dicitratobismuthate)<br><\/li>\n\n\n\n<li>Colloidal bismuth compounds additionally exert bactericidal action against H.pylori<br>Other drugs that can to eradicate H.pylori such as amoxicillin, metronidazole, clarithromycin<br>and tetracycline are included in the anti-ulcer treatment regimens.<\/li>\n\n\n\n<li>Protaglandins have both antisecretory and mucosal protective effects.<br>Example: <strong>Misoprostol<\/strong>&#8211; used for prevention of NSAID \u2013 induced ulcer.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Acid-peptic disease includes peptic ulcer (gastric and duodenal), gastroesophageal reflux andZollinger \u2013 Ellison syndrome.Peptic \u2013 ulcer disease is thought to result from an imbalance between cell \u2013 destructive effectsof hydrochloric acid and pepsin and cell-protective effects of mucus and bicarbonate on theother side. Pepsin is a proteolyic enzyme activated in gastric acid, also can digest [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":6507,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[694],"tags":[],"class_list":["post-6599","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drugs-used-in-gastrointestinal-diseases-miad-for-pharmacology"],"jetpack_featured_media_url":"https:\/\/workhouse.sweetdishy.com\/wp-content\/uploads\/2024\/11\/6432053-1.png","_links":{"self":[{"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/posts\/6599","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/comments?post=6599"}],"version-history":[{"count":1,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/posts\/6599\/revisions"}],"predecessor-version":[{"id":6600,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/posts\/6599\/revisions\/6600"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/media\/6507"}],"wp:attachment":[{"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/media?parent=6599"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/categories?post=6599"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/workhouse.sweetdishy.com\/index.php\/wp-json\/wp\/v2\/tags?post=6599"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}