Pharmacology B

Pharmacology B
Lin, I-Yao
A 43y/o male CEO of a multinational
company experienced severe burning
pain one and a half hour after a
sumptuous lunch. This is
accompanied by mild nausea and
vomiting. He was given a glass of milk
and some cookies which apparently
provided some relief.
Diagnosis: Peptic ulcer of duodenum
Ulcer of the distal stomach and proximal
duodenum caused by gastric secretions
(hydrochloric acid and pepsin) and
impaired mucosal defenses.
It’s associate with Helicobacter pylori
which increased hydrochloric acid
secretion, and inadequate mucosal
defense against gastric acid.
1. Using aspirin medicine
2. Drinking alcohol excessively
3. Smoking cigarettes and using tobacco
4. Others.
Sign and symptoms:
1. Nausea and vomiting.
2. Weight loss
3. Fatigue
4. Heartburn, indigestion, belching.
5. Vomiting blood
6. Bloody or dark tarry stools
Lab examination:
Gesophagogastroduodenoscopy (EGD) .
Take biopsy to test for H, pylori.
Stool guaiac to test for blood in the stool.
Schilling test to check for anemia.
Treatment approaches include:
Eradicating the H. pylori infection.
Reducing secretion of gastric acid or
neutralizing the acid after it is released.
Providing agents that protect the gastric
mucosa from damage.
Treatment - medication
NaHCO3, Mg(OH)2, Al(OH)3.
<Acid secretion reducers>
Proton-Pump inhibitors: Omprazole, Lansoprazole.
H2 – Antagonists: Cimetidine, Ranitidine.
<Mucosal strengtheners>
Sucralfate, Bismuth chelate, Prostaglandins
<H. pylori eradication>
Omprazole + Clarithromycin + Amoxillin/ Metronidazole
-weak base that react with gastric HCl to
form salt and water
-reduce gastric acidity
-reduce pepsin activity
Side effect:
NaHCO3-systemic alkalosis
Mg(OH)2-diarrhea, hyper magmesemia
Al(OH)3-constipation, hypophosphatemia
<Acid secretion reducers>
1. Proton-Pump inhibitors: Omprazole, Lansoprazole.
-inhibits gastric parietal cell proton pump H+/K+ ATPase,
dercease gastric acid secretion.
2. H2 – Antagonists:
-blocker H2-receptor and reduce cAMP which inhibit gastric
acid secretion.
Side effect:
Cimetidine-confusion, reversible gynecomastia.
The H2-receptor antagonist can’t combined with PPI
inhibitor which the H2-receptor antagonist even inhibit
<Mucosal strengtheners>
1. Sucralfate
-selective binding to necrotic ulcer tissre and act as barrier
to acid, pepsin, bile.
-requires acid pH to be activated, there fore should not be
used with antacid, H2 antagonist or proton pump
2. Bismuth chelate
-binds and ulcer tissue, coat it and protectit from acid and
3. Prostaglandins
-inhibits secretion of HCl and stimulates secretion of
mucus and bicarbonate (cytoprotective effect).
Non pharmacology:
 Avoid food and drink that seems to cause
more severe symptoms such as spicy
foods, coffee and possibly alcohol.
 stop smoking.
 Should be lose excess weight if