This document discusses drug treatment for acid peptic disease. It classifies drugs into those that reduce acid activity like proton pump inhibitors and H2 receptor blockers, mucosal protectants like sucralfate, and prostaglandin analogs like misoprostol. It describes the mechanisms, clinical uses, and adverse effects of representative drugs in each class. Regimens for H. pylori eradication involving combinations of drugs are also outlined.

1. DRUG TREATMENT OF
ACID PEPTIC DISEASE

2. PATHOGENESIS OF ACID PEPTIC DISEASE
DISBALANCE LEADS TO APD
PROTECTIVE
MECHANISMS
ULCER PROMOTING
INFLUENCES INTRINSIC
AND EXTRINSIC

3. CLASSIFICATION OF DRUGS USED IN ACID PEPTIC
DISEASE
A-AGENTS THAT REDUCE ACID ACTIVITY
 PROTON PUMP INHIBITORS
1. OMEPRAZOLE
2. LANSOPERAZOLE
3. PANTOPRAZOLE
4. ESOMEPRAZOLE
 H2 RECEPTOR BLOCKERS
1. CIMETIDINE
2. RANITIDINE
3. FAMOTIDINE

4.  ANTACIDS
1. SODIUM BICARBONATE
2. ALUMINIUM HYDROXIDE
3. ALUMINIUM PHOSPHATE
 ANTI- MUSCARINICS
1. PIRENZEPINE
B-MUCOSAL PROTECTANTS
1. SUCRALFATE
2. BISMUTH SUBSALICYLATE
 C-PROSTAGLANDIN ANALOGS
1. MISOPROSTOL

5. 


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

7. CLINICAL USES
1. GERD—70-80% relief
2. PEPTIC ULCER – H.PYLORI ERADICATION
3. NSAID INDUCED ULCERS
4. PREVENTION OF STRESS ULCERS
5. ZOLLINGER ELLISON SYNDROME
6. NON ULCER DYSPEPSIA
ADVERSE EFFECTS
1. DIARRHEA
2. HEADACHE
3. ABDOMINAL PAIN
4. DECREASED VIT B12 ABSORPTION
5. RESPIRATORY AND ENTERIC INFECTIONS
6. OSTEOPOROSIS

8. REGIMENS FOR H. PYLORI ERADICATION
TRIPPLE REGIEMEN
 OMEPRAZOLE
 METRONIDAZOLE FOR 14 DAYS
 CLARITHROMYCIN
QURADIPLE REGIEMEN
 OMEPRAZOLE
 BISMUTH SUBSALICYLATE
 TETRACYCLINE FOR
 METRONIDAZOLE 14
DAYS

9. H2RECEPTOR BLOCKERS
MECHABISM OF ACTION
MOA –
COMPETITIVE INHIBITIOR OF HISTAMINE ON HISTAMINE
RECEPTORS
 SUPPRESSION OF NOCTURNAL SECRETION – 90%
 SUPPRESSION OF MEAL TIME SECRETION – LESS THAN PPIs
 Famotidine is more potent than Ranitidine

11. CLINICAL USES
1. GERD
2. PEPTIC ULCER
3. NON- ULCER DYSPEPSIA
4. STRESS ULCERS
5. IATROGENIC ULCERS
ADVERSE EFFECTS
1) DIARRHEA
2) HEADACHE
3) FATIGUE
4) MYALGIA
5) CONSTIPATION
6) CIMETIDINE EFFECTS ON TESTOSTERONE, PROLACTIN

12. ANTACIDS –
1. Suspension has more effect than tab
2. Acid neutralizing capacity
SODIUM BICARBONATE
 RAPID ACTION (most rapid)
 A/R: BELCHING, DISTENSION & FLATULENCE—CO2
CALCIUM CARBONATE
 LESS RAPID THAN NaHCO3
 A/R: BELCHING
ALUMINIUM & MAGNESIUM HYDROXIDE
 SLOW IN ACTION BUT MORE COMPLETE NEUTRALIZATION

13. MUCOSAL PROTECTIVE AGENTS
SUCRALFATE – SALT OF SUCROSE WITH SULFATED Al(OH)3
MOA –-
1-It is a tenacious viscous base that is negatively charged and
binds with ulcer crator that is positively charged, protecting
ulcer from effect of HCL
2-STIMULATES SECRETION OF MUCOSAL PGs & HCO3
CLINICAL USES :
STRESS ULCERS
ADVERSE EFFECTS
1. CONSTIPATION DRUG INTERACTIONS

14. MISOPROSTOL
 MOA: ↑ Production of mucus rich in HCO3
 Directly acting on parietal cells and ↓ production of HCL by
acting on EP3 receptors
 USES: Only for NSAIDs associated ulcers
 SIDE EFFECTS:↑ abdominal cramps, diarrhea, ↑ uterine
contractions