Peptic Ulcer Disease

OBJECTIVES Discuss peptic ulcer disease. Describe what factors contribute to peptic

ulcer disease. Discuss the treatment goal for peptic

ulcer disease. Discuss the role of medications in the

treatment of peptic ulcer disease. Describe other interventions to

compliment drug therapy.

PEPTIC ULCER DISEASE Group of upper GI disorders Defensive factors GI upsets

TREATMENT GOALS Alleviate symptoms Promote healing Prevent complications Prevent recurrences

ANTACIDS

Neutralize stomach acid Calcium

• Tums, Rolaids Aluminum + Magnesium

• Maalox, Riopan, Mylanta, Gelusil Sodium

• Alka-Seltzer Magnesium

• Milk of Magnesia

SIDE EFFECTS Magnesium

Diarrhea, dehydration, hypermagnesmia, renal stones

Aluminum Constipation, intestinal impaction, anorexia,

weakness Calcium

Constipation, rebound hyperacidity, metabolic alkalosis, hypercalcemia, renal stones, fecal impaction

Sodium Systemic alkalosis, sodium overload

CONTRAINDICATIONS Magnesium

Renal insufficiency Aluminum

Gastric outlet obstruction Sodium

Hypertension, CHF, sodium restricted diets

INTERACTIONS Will inhibit absorption of

Tetracyclines Digoxin Phenothiazines Captopril Isoniazid Valium Dilantin

H2 ANTAGONISTS Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid)

SIDE EFFECTS

Confusion Diarrhea / Constipation

Hepatitis

Dizziness Headache Anxiety

Hypotension Agranulocytosis

Thrombocytopenia

INTERACTIONS Cimetidine (Tagamet) will inhibit drug

metabolizing enzymes and increase plasma concentrations for:

Benzodiazepines Coumadin Theophylline Caffeine Oral hypoglycemics Dilantin Tricyclic antidepressants Flagyl Propranolol Tegretol

PROTON PUMP INHIBITORS Omeprazole (Prilosec) Lansoprazole (Prevacid)

SIDE EFFECTS Short term use

Headache, diarrhea, nausea, vomiting Long term use

Questions about gastric carcinoid cancer

SULCRALFATE - CARAFATE Viscous gel Adheres to ulcerated tissue and

protects it from acid / pepsin Minor side effect is constipation No major side effects May impede absorption of some

drugs

MISOPROSTIL Prostaglandin analog that replaces

prostaglandins lost in stomach as result of NSAID therapy

Only indicated for NSAID induced ulceration

Side effects include diarrhea and abdominal pain

HELICOBACTER PYLORI Standard Therapy

14-16 days Bismuth subsalicylate (Pepto Bismol) Metronidazole Tetracycline

Newest Treatment Helidac (three antibiotic regimen)

NON-DRUG THERAPY Diet plays only a minor role in ulcer

management. No conclusive evidence that caffeine

containing beverages promote ulcer formation or interfere with recovery.

Thought that alcohol can be harmful to lining of stomach

Beneficial to eat 5-6 small meals a day instead of 3 large ones to decrease fluctuations in gastric pH.

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