4ANTIMICROBIAL Amoxicillin Metronidazole Tetracycline Clarithromycin Triple therapy: PPI + Metronidazole or amoxicillin + clarithromycin Quadruple therapy: Bismuth sub + metronidazole + tetracycline + PPI or H ₂- receptor antagonist
5 ADJUNCT MANAGEMENT REST, RELIEVE STRESS STOP/REDUCE SMOKING/DRINKING Inclination of the bed head at 45 degrees DIET – NON-IRRITATING – FREQUENT
Regulation of gastric acid secretion Gastric acid secretion by parietal cells of the gastric mucosa is stimulated by acetylcholine, histamine and gastrin. The binding of AcH, gastrin and histamine to their various receptors results in the activation of protein kinases which in turn stimulates the H ⁺ /K ⁺-ATPase proton pump to secrete hydrogen ions in exchange for K⁺ into the lumen of the stomach Gastrin and AcH act by inducing an ↑ in calcium level While receptor binding of prostaglandin E₂ and somatostatin inhibits adenylyl cyclase 6
9 Mech Of Action:H2 receptor antagonists competitively inhibits the binding of histamine on H2 receptors located on gastric parietal cell, thereby preventing acid secretion into the stomach lumen. It also inhibits gastric acid secretion induced by gastrin.
11 Side effects : Headache, diarrhea, Mental confusion, muscular pain, dizziness ( ALSO GYNACOMASTIA,GALACTORRHEA and REDUCED SPERM COUNT WITH CIMETIDINE)
Drug interaction: ↓ absorption of drugs that require acidic medium for absorption e.g., ketoconazole, vit B12 Cimetidine is a P450 inhibitor and ↑es activity of drugs that are metabolized via P450 12
16 PROSTAGLANDINS MISOPROSTOL(PGE1) These inhibit the secretion of Hcl by stimulate production of mucus and bicarbonate ( Cytoprotective effect). Only used for NSAID induced ulcers. Not used commonly for others. CI: DURING PREGNANCY
21 SUCRALFATE Mech Of Action: Complex of polyaluminum hydroxide and sulfated sucrose sulfate which binds proteins in normal and ulcerated mucosa forming a gel that acts as a physical barrier that impairs diffusion of HCl and degradation of mucus by acid and pepsin. USES: Duodenal ulcer
22 COLLOID BISMUTH SALTS May inhibit pepsin activity Increase secretion of mucus Forms a gel that coats and protects the ulcer crater by preventing the diffusion of acid.
23 ANTACIDS DRUGS Al(OH)3 Mg (OH )2 NaHCO3 COMMON SIDE EFFECT – MAY AFFECT ABSORPTION OF MANY OTHER DRUGS Azoles, floroquinolones, tetracyclines, warfarin, quinidine SIDE EFFECT CONSTIPATION DIARRHOEA SYSTEMIC ALKALOSIS, belching & flatulence
24 Anti-Emesis Drugs Why do we vomit?! Stimulation of the “Vomiting Centers”, “chemoreceptor trigger zone” and vestibular system (which functions mainly in motion sickness).
25 EMESIS/VOMITING RECEPTORS INVOLVED DOPAMINE – DA2 SEROTONIN- 5 HT3 Histamine- H1-receptor via the vestibular system Muscarinic: via the vestibular system
Antiemetic agents for motion sickness Anti histamines: diphenhydramine, dimenhydrinate, meclizine Anti muscarinic: Works via blockade of the vestibular system which gives afferent input to the vomiting center e.g., scopolamine 27
28 **ONDANSETRON** POWERFUL CENTRAL ACTING ANTIEMETIC COSTLY CONTROLS VOMITING POSTOP AND IN PT’S UNDERGOING CANCER CHEM.. SE; HEADACHE DIARRHEA