A case presentation on
Peptic ulcer






Name
: xyz
Age
: 28 yrs
Gender
: female
Admission : 12.12.13
Discharge : 15.12.13
Chief complaints :
-Severe epigastric pain
(worse at night , between meals)
-occasional mild cramping sensation

Patient medical history :
-Asthma (exercise induced)
-Allergic rhinitis
-Menstrual migraine

Surgical history :
-Tonsillectomy ;Adenoidectomy

Drugs being used :
- She used OTC antacids without maximal relief
•
•
Family history:
- mother is hypertensive
Social history:
-drinks diet colas 1-2/ per day
Physical Examination:
on examination
CVS :
B.P
: 120/70 mm Hg
heart rate : 82
Resp.sys :
Respiratory rate :14 breaths per min.
Nose ,ear , throat :
sinuses mildly tender
nose - mildly congested
fair amount of clear discharge
bilaterally ; turbinates pale pink , mildly swollen
Abdomen : mild epigastric tenderness
LAB INVESTIGATIONS
:
Complete blood picture :
Parameter :
Result value
Normal range :
Hemoglobin
13.4 gm%
11-16.5 gm%
Hematocrit
41 vol%
35-50 vol%
Leukocyte count
8000 cells/cumm
4000-11000 cells/cumm
MCV
88 fL
76-96 fL
Serology findings : positive for Helicobacter pylori
Final diagnosis
Peptic ulcer secondary to Helicobacter
pylori infection
 Allergic rhinitis
 Exercise induced asthma
 Menstrual migraine

Treatment chart
S
.No.
Generic name of Brand
drug
name
Dose
1.
Sumatriptan
50mg
SOS
Oral
2.
Clarithromycin
500mg
B.D
Oral
3.
Metronidazole
500mg
B.D
Oral
4.
Omeprazole
Almac d
20mg
B.D
Oral
5.
Albuterol
Salamol,
asmol ,
aerolin
90mcg
1-2 puffs
MDI
6.
Levonorgestrel /EE
Levonelle,
plan B
0.15/0.33
mg
O.D
Oral
7.
Loratadine
10mg
O.D
Oral
Biaxin ,Infex,
Klacid
Frequenc
y
Route
Subjective findings
Epigastric pain at night and during meals
 Occasionally mild cramping sensation

Objective findings
Sinuses mildly tendered
 Nose is mildly congested and bilaterally
pale pink color in color and swollen
 Presence of H.pylori .

Assessment
•
No test was conducted to check the
progesterone and estrogen level.
•
Levonorgestrel : patients with conditions that may
be adversely affected by fluid accumulation, such as
asthma, epilepsy, migraine, and cardiovascular or renal
dysfunction.
•
Sumatriptan : Large doses of sumatriptan can cause
sulfhemoglobinemia, a rare condition in which the blood
changes from red to greenish-black.
PLAN



Levonogestrel can be replaced with another drug or should be observed for exacerbation of their condition
during estrogen therapy.
A combination therapy can be used to treat peptic ulcer , to reduce the number of drugs, this will improve
the medication adherence.
Pharmacoeconomics of the drugs should considered while prescribing.
Generic name
Brand name
bismuth sub citrate potassium and metronidazole and tetracycline
Pylera
bismuth subsalicylate and metronidazole and tetracycline
Helidac
lansoprazole (a PPI) and amoxicillin and clarithromycin
Prevpac
omeprazole (a PPI) and amoxicillin and clarithromycin
Monitoring parameters
Sumatriptan doses have to be monitored.
 Hormone(progesterone and estrogen)
levels have to be monitored.
 Blood pressure has to be monitored.

Life style modifications

A nutritious and balanced diet should be taken.

Diet colas should be avoided(As the patient has a social history of
taking one diet cola daily)

Spicy and hot food should be avoided.

Take medication without fail.

Do not take any OTC medication without consulting the physician.

Antibiotics prescribed should be taken for 7 days without fail.

Non pharmacological methods to maintain BP.

If the pain continues even after the therapy is continued, refer the
physician
.
Thank you
Made by : Triveni
Roll no. : 12T31T0029
PHARM-D 3rd year