Peptic Ulcer Drugs Classification Therapeutic Utility

Peptic ulcer disease (PUD) occurs with a break in the lining of the stomach, first part of the small intestine or occasionally the lower oesophagus. Common causes include the bacteria, Helicobacter Pylori and non-steroidal anti-inflammatory drugs (NSAIDs). Classification of PUD 1. Esophagus 2. Stomach 3.Ulcers 4.Duodenum 5.Mucosa 6.Submucosa 7.Muscle Differential Diagnosis • Gastritis • Stomach cancer • Pancreatitis • Hepatic congestion • Cholecystitis • Inferior myocardial infarction Classify the drugs used in treatment of peptic ulcer For the treatment of peptic ulcers, the main objective of pharmacotherapy is to eradicate Helicobacter Pylori infection and to reduce morbidity. This is to prevent complications in patients with peptic ulcers. Acid suppression is the general pharmacologic principle of medical management when treating acute bleeding from peptic ulcers by using Histamine II receptor antagonists (H2RAs) and Proton Pump Inhibitors (PPIs). Both these classes are available in oral and intravenous preparations. Discontinuation of NSAIDs is necessary if it is clinically possible. For those patients who have to continue with their NASAIDs, the maintenance of PPI is always recommended so that recurrences are prevented even after the eradication of Helicobacter Pylori. Explain their mechanism of action and their therapeutic utility The recommended primary therapy for treatment of peptic ulcers and helicobacter pylori infection is the proton pump inhibitor (PPI). It is combined with antacids and an anesthetic like viscous lidocaine or an antispasmodic may also be used as a symptomatic therapy. If the helicobacter pylori eradication is not achieved despite repeat treatment, then anti-secretory therapy is recommended. The patients are possibly suffering with the Zollinger-Ellison Syndrome as a secondary cause of duodenal ulcer. This is a disorder in which severe peptic ulceration is found due to edema or hyperplasia of islet of pancrease that secrete gastrin resulting in hyperchlorhydria. Classification of PPIs:- • Omeprazole (Prilosec) – It decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump. It will decrease the incidence of NSAID-induced peptic ulcers and it can be used to help prevent peptic ulcers in long term NSAID users at high risk. Omeprazole and Domperidone Omeprazole and Domperidone contain a proton pump inhibitor and anti-dopaminergic agent, prescribed for ulcers, indigestion and acid stomach. Same trade names. • Lansoprazole (Prevacid) – It decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump. It is given with clarithromycin and amoxicillin or metronidazole if the patient is allergic to penicillin. • Rabeprazole (Aciphex) – It decreases gastric acid by inhibiting the parietal cell H+/K+ ATP pump. It is used for a short term treatment of two months and elief of symptomatic erosive gastroesophageal reflux disease. If patients are not healed in this time, then an additional treatment of two months is prescribed. • Esomeprazole (Nexium) – This is an S-isomer of Omeprazole. It inhibits gastric acid secretion by inhibiting the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells. It is used in severe cases. • Pantoprazole (Protonix)- It suppresses gastric acid secretion by inhibiting H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cells. Pantoprazole Pantoprazole is a proton-pump inhibitor, prescribed for gastro-oesophageal reflux disease (GERD), ulcers, Zollinger-Ellison Syndrome, and erosive oesophagitis. It decreases the amount of acid made in the stomach. Trade Names - Pandom | Acidwel | Azpan - DM | Histamine II Blocker Treatment Classification:- • Cimetidine (Tagamet) – It can be used as primary therapy to heal peptic ulcers that are not associated with helicobacter pylori infection. The duration of treatment is two months. • Famotidine (Pepcid) – This inhibits histamine at H2 receptor of gastric parietal cells effectively resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentrations. Famotidine is a histamine (H2-receptor antagonist), prescribed for ulcer. Trade Names - Famoflam (20 mg) | Acidosh (20 mg) | Blocacid (20 mg) | • • Nizatidine (Axid) – This inhibits histamine at H2 receptor of gastric parietal cells resulting in reduced gastric acid secretion, gastric volume and hydrogen ion concentrations. • Ranitidine (Zantac) – This inhibits histamine stimulation of the H2 receptor in gastric parietal cells and reduces gastric acid secretion, gastric volume and hydrogen ion concentrations. Ranitidine and famotidine, which are both H2 receptor antagonists, provide relief of peptic ulcers, heartburn and indigestion. They decrease the amount of acid in the stomach helping with healing of ulcers. When Helicobacter Pylori infection is present, the most effective treatments are combinations of two antibiotics (e.g. clarithromycin, amoxicillin, tetracycline, metronidazole) and a proton-pump inhibitor (PPI), sometimes together with a bismuth compound. This is acid reducing medication. Ranitidine is an antacid, anti-reflux agent and anti-ulcerant, prescribed for peptic ulcer. Trade Names - Giran | Intac | Acispas | Ani -Spa Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before endoscopy is undertaken. People who are taking non-steroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (misoprostol) in order to help prevent peptic ulcers. Classification of Drugs for Peptic Ulcers Aluminum Hydroxide and Magnesium Hydroxide Aluminum Hydroxide and Magnesium Hydroxide contains antacids, prescribed for preventing ulcers, heartburn relief, acid indigestion and stomach upsets. Aluminum Hydroxide and Magnesium Hydroxide neutralizes acid in the stomach. Trade Names - Aludrox | Dizicum | Glycopyrrolate Glycopyrrolate is a muscarinic anticholinergic agent, prescribed for peptic ulcer in combination with other medicines and also used in anesthesia as preoperative medication. It reduces acid and saliva secretions. Trade Names - Camolate (0.2 mg) | Glyco P (0.2 mg) | Vagolate (0.2 mg) | Lafutidine Lafutidine is an antacid, prescribed for ulcer. Trade Names - Laciloc (10mg) | Lafaxid (10mg) | Lafutax (10 mg) | Mepenzolate Mepenzolate is an anti-muscarinic agent, prescribed for the treatment of peptic ulcer combined with other medication. It decreases acid secretion in the stomach and control intestinal spasms. Trade Names – A Kare and Mifenac. Misoprostol Misoprostol is a synthetic prostaglandin; prescribed for ulcer, labor induction, induced abortion, miscarriage, postpartum hemorrhage (blood loss during birth) and other gynecological uses. Trade Names – Misonac and Safeguard Oxyphenonium Oxyphenonium is an anti-muscarinic agent, prescribed for peptic ulcer and it prevents muscle spasm in the gastrointestinal tract. Trade Names - Alupromate D | Oxyphenonium Bromide | Ulpane | Pirenzepine Pirenzepine is an antacid, prescribed for peptic ulcer. Trade Name – Same. Propantheline Propantheline is an anti-muscarinic agent, prescribed for peptic ulcer, and urinary incontinence. Trade Names - Pepler | Probanthine | Sere Banthine | Ulsedin |