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Dyspepsia Case Summary
• Mr Milton (47 y.o.), has used Mylanta regularly. However, over time his dyspepsia has become more frequent
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Tutorial Scenario
• Mr Milton, a regular patient at your pharmacy, has purchased Mylanta off and on for the past few years.
• You have noticed that his purchase have recently become more frequent.
• He is in his late 40’s, slightly over weight he drinks socially and at weekends and takes Perindopril for hypertension, but is otherwise healthy and plays tennis weekly.
• For the past 4 days he has also been taking Voltaren Rapid 25 for a muscle injury.
• As a biology and chemistry teacher he is always interested in how his medications work.
Lectures to Support this Case
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Gut Drugs on Dyspepsia ‐ Dr Hilary Lloyd
Histamines and Antihistamines ‐ A/Prof Jane Hanrahan
Proton Pump Inhibitors 1 & 2 ‐ A/Prof Jane Hanrahan
Dyspepsia 1 & 2 – Dr Beata Bajorek
References to Support this Case
• Lecture notes on H2 antiagonists and PPIs, gastrointestinal drugs and gastrointestinal disorders
• NPS Prescribing Practice Review 25 – Proton Pump Inhibitors: Too much of a good thing?
• NPS Prescribing Practice Review 45 – Proton pump inhibitors: step‐down to symptom control
• L. Olbe, E.Carlsson & P. Lindberg, A Proton‐Pump Inhibitor Expedition: The Case Histories Of Omeprazole And Esomeprazole. Nature Reviews Drug Discovery, 2003, 2, 132‐139.
• G.L. Patrick (2009) 4th edition, An Introduction to Medicinal Chemistry, Oxford, ‐ Chapter 25.
• AMH
Tutorial Scenario Part 2.
• About 3 weeks later Mr Milton visits your pharmacy again
• Although his symptoms improved slightly with Ranitidine, they continued to be troublesome, especially at night
• He has visited his GP who prescribed Esomeprazole (20 mg daily), He also has his regular prescription for Perindopril (4mg daily).
• Mr Milton asks – How does Nexium work and why is it going to be better than what he has been taking?
– Is it OK to take this with my blood pressure tablets
– Can I take it with antacids? Are there any side‐effects? – How long do I need to take it for, the doctor has only given me enough for 1 month?
Learning Outcomes
• Predict the activity of a drug based on a its structure and physicochemical properties ‐‐‐ PPIs
Learning Outcomes
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Demonstrate an understanding of how the physical and chemical properties of a drug determine its pharmacology, toxicology, bioavailability and behaviour in formulations antacids, PPIs, H2‐antagonists etc
Identify typical examples of drugs which are used to restore physiological functions in the gastrointestinal system
Mylanta, Ranitidine, Esomeprazole etc
Describe the mechanism of therapeutic action of a selected drug at the molecular, cellular, organ system and whole body levels
antacids (neutralize acids), PPIs (inhibitor of the H+/K+/ATP‐ase pumps), H2‐antagonists (inhibit histamine at H2 receptors)
Describe the common adverse effects of a selected drug and their mechanism of production
Part 2 activity 5 (What are the possible side‐effects of PPIs?) Learning Outcomes
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Demonstrate an understanding of basic metabolism in relation to drugs and efficacy and safety in relation to the treatment of disease and/or maintenance of health
Voltaran (NSAIDs) contribute to the formation of gastric ulcers
Apply an understanding of the basic and applied sciences to pharmaceutical care in order to optimise health outcomes
Part 2 activity 5 (Why is Esomerprazole better than ranitidine at inhibiting gastric acid release?) Respond to direct product and symptom based requests related to gastrointestinal disorders part 1 pre‐work (symptoms? Treatment?)
Have an awareness of the alarm symptoms related to gastrointestinal disorders
Part 1 pre‐work
Demonstrate an understanding of the clinical and therapeutic principles of treatment and management of gastrointestinal disorders
Role play (give suggestions)