Peptic ulcer disease

1. Peptic Ulcer Disease

2. 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.

3. PEPTIC ULCER DISEASE
 Group of upper GI disorders
 Defensive factors
 GI upsets

4. TREATMENT GOALS
 Alleviate symptoms
 Promote healing
 Prevent complications
 Prevent recurrences

5. ANTACIDS
 Neutralize stomach acid
 Calcium
• Tums, Rolaids
 Aluminum + Magnesium
• Maalox, Riopan, Mylanta, Gelusil
 Sodium
• Alka-Seltzer
 Magnesium
• Milk of Magnesia

6. 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

7. CONTRAINDICATIONS
 Magnesium
 Renal insufficiency
 Aluminum
 Gastric outlet obstruction
 Sodium
 Hypertension, CHF, sodium restricted
diets

10. INTERACTIONS
 Will inhibit absorption of
 Tetracyclines
 Digoxin
 Phenothiazines
 Captopril
 Isoniazid
 Valium
 Dilantin

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

12. SIDE EFFECTS
Confusion Diarrhea /
Constipation
Hepatitis
Dizziness Headache Anxiety
Hypotension Agranulocytosi
s
Thrombocytope
nia

13. 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

15. PROTON PUMP INHIBITORS
 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)

16. SIDE EFFECTS
 Short term use
 Headache, diarrhea, nausea, vomiting
 Long term use
 Questions about gastric carcinoid
cancer

18. 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

19. 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

20. HELICOBACTER PYLORI
 Standard Therapy
 14-16 days
 Bismuth subsalicylate (Pepto Bismol)
 Metronidazole
 Tetracycline
 Newest Treatment
 Helidac (three antibiotic regimen)

21. 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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