Pharmacology Third Year

1. Peptic Ulcer
Any disruption in the surface epithelium of
the gastric & duodenal mucosa. It occurs
due to an imbalance between defensive
factors & aggressive factors. Duodenal ulcer
is 4 times more common than gastric ulcer.

2. Causes
A- Overproduction of gastric HCL
B- H. pylori
C- Risk factors like smoking, stress, NSAIDs etc

3. Pathophysiology
There is inflammation of the mucosa.The H.
pylori produce ammonia which further
increase inflammation & thus the acid &
H. Pylori help each other to increase
inflammation.

4. Treatment of peptic ulcer.
1- To neutralize the acid, antacids are given.
e.g. Sodiumbicarbonate (systemic antacid) &
salts of allominium, calcium & magnesium
(non-systemic antacid)
2- Drugs to reduce gastric acid secretion e.g
cont.

5. a. H2 receptor antagonists
-Cimetidine
-Ranitidine
-Nizatidine
-Famotidine
b. Proton pump inhibitors
-Omeprazole
-Lanzoprazole
-Pantoprazole
-Rabiprazole
cont.

6. c. Anticholinergic ( M1-blocker)
e.g pirenzepine
3-Mucosal protective like bismuth chelate
e.g sucralfate (Ulsanic)
4- Antibiotics e.g Amoxicillin,Clarithromicin
to kill H. pylori.

7. Cimetidine
It blocks the H2 receptors in the parietal cells
& thus decrease the over production of gastric
HCl.

8. Clinical uses
a. Peptic ulcer
b. Reflux esophagitis
c. Non- ulcer dyspepsia
d. Before anaesthesea (Decrease acid)

9. Adverse effects
a. CNS: Confuion, hallucination, Agitation specially
when given i.v.
b. Endocrine effects
Inhibits binding of dihydrotestosterone to
androgen receptors,increase serum prolactin level
& cause loss of libido,gynaecomastea & impotance
in male.This occur due to prolong use or high
dose.It also increase serum prolactin level.The rest
of H2 blockers have no such effect.
c. Can cause bradyardia & hypotension

10. Prescription for peptic ulcer
a. Omeprazole caps. 20 mg PO OD for one &
a half month.
b. Amoxacillin caps. 500 mg POTDS for 7 days
c. Metronidazole tabs. 400 mg PO TDS for
7days.

11. Drug interactions
It acts as enzyme inhibitor for many drugs like
erythromycin, warfarin, propranolol etc &
thus should not be used with these drugs or
their dose should be reduced.
Cautions: Should not be used in renal
impairment, pregnancy & lactation