Post on 13-Mar-2015
transcript
WELCOME
PROTON PUMP INHIBITORSVS
H2 RECEPTOR ANTAGONISTS
SYMPTOMS OF GASTROINTESTINAL DYSFUNCTION
• symptoms can arise from GI dysfunction. Common GI symptoms include heartburn, abdominal pain, dyspepsia, nausea , vomiting, diarrhoea , constipation, and gastrointestinal bleeding.
• Signs and symptoms of malabsorption, hepatitis, and GI infection are also commonly seen.
PEPTIC ULCER DISEASEpeptic ulcer is an abnormal area of mucosa
which has been damaged by the pepsin and hydrochloric acid of gastric juice.
consequent inflammation of the underlying and surrounding tissues.
most ulcers occurs in duodenum or in the stomach ,where ph is sufficiently low.
AETIOLOGYH.PYLORI INFECTION NSAID INGESTIONSTRESS INDUCEDHEREDITYCOMMON ON O BLOOD GROUPSSMOKING ALCOHOLAGE MORE THAN 60 YEARSCORTICOSTEROIDS
GASTROESOPHAGEAL REFLUX DISEASE• Gastroesophageal reflux disease (GERD) is a
common medical disorder for symptoms, such as heartburn , dysphagia or bleeding.
• Endoscopy is used to evaluate mucosal damage from gastroesophageal reflux disease (GERD)
• key factor in the development of GERD is the retrograde movement of acid or other noxious substances from the stomach into the oesophagus.
ZOLLINGER-ELLISON SYNDROME• ZES is characterized by gastric acid hyper
secretion and recurrent peptic ulceration that results from a gastrin-producing tumour (gastrinoma).
• 90% of gastrinomas are located in the region of the pancreas, the most common site being the duodenum.
• Malignant gastrinomas occur in 30% to 50% of patients, with metastases to regional lymph
nodes, liver, spleen, and bone.
PROTON PUMP INHIBITORSOMEPRAZOLELANSOPRAZOLEPANTOPRAZOLERABEPRAZOLEESOMEPRAZOLE
H2 RECEPTOR ANTAGONISTSCIMETIDINERANITIDINEFAMOTIDINEROXATIDINELOXATIDINE NIZATIDINE
PROTON PUMP INHIBITORS:
OMEPRAZOLE
CLASSIFICATION
PHARMACOLOGIC :substituted benzimidazole
THERAPEUTIC : gastric acid suppressant
MECHANISM OF ACTIONINHIBITS THE ACTIVITY OF PROTON
PUMP,H+/K+ AT PASE – SECRETORY SURFACE OF GASTRIC PARIETAL CELL.
BLOCKS FORMATION OF GASTRIC ACID
INDICATIONS.ROUTE AND DOSAGEACTIVE DUODENAL ULCER
20mg P.O Daily for 4 to 8 weeksH.PYLORI ERADICATION
Triple therapy
omeprazole :20mg
clarithromycin/ tinidazole :500mg/750mg
amoxicillin :1000mg
P.O b.i.d for 10 days
Brand name: omez Hp kit / Hp kit
Dual therapy
Omeprazole :40mg
Clarithromycin: 500mg
P.O t.i.d for 14 days,then 14 days of omeprazole 20mg daily o.d
GERD
20mg P.O daily for 4 to 8 weeksZOLLINGER ELLISON SYNDROME
Initial dose:60mg P.O daily , upto 120 mg t.i.d for 4 to 8 weeks
GASTRIC ULCER
40 mg P.O , o.d for 4 to 8 weeks
EXCRETION: by kidneys , half life is half to 1 hour
INTERACTIONS
Impaired elimination with diazepam, phenytoin, propanolol, theophylline and warfarin
ADVERSE REACTIONS
Head ache, dizziness , abdominal pain , constipation , serum gastrin levels rise in most patients during first week of therapy
COUNSELLINGDrug to be taken before mealsDon’t crush the capsules
BRAND NAMES FORM STRENGTH
1)OMEZ CAP 10,20mg
2)OCID CAP 10,20mg
3)OMEZ INJ 40mg
4)OMEZ TAB 40mg
LANSOPRAZOLE
CLASSIFICATION
PHARMACOLOGIC :acid pump inhibitor
THERAPEUTIC :antiulcerative
MECHANISM OF ACTIONINHIBITS THE ACTIVITY OF PROTON
PUMP,H+/K+ AT PASE – SECRETORY SURFACE OF GASTRIC PARIETAL CELL.
BLOCKS FORMATION OF GASTRIC ACID
INDICATIONS.ROUTE AND DOSAGEACTIVE DUODENAL ULCER
15mg P.O once daily for 4 weeksTREATMENT FOR EROSIVE ESOPHAGITIS
30 mg P.O once daily up to 8 weeks ZOLLINGER ELLISON SYNDROME
Initially 60 mg once daily increased up to 180 mg/day
TREATMENT FO GASTRIC ULCER
30 mg P.O daily up to 8 weeks
GERD
15 mg P.O daily up to 8 weeksH.PYLORI ERADICATION
DUAL THERAPY
LANSOPRAZOLE : 30mg
AMOXICILLIN :1000mg
Given t.i.d for 14 days
TRIPLE THERAPY
LANSOPRAZOLE : 30mg
AMOXICILLIN :1000mg
CLARITHROMYCIN : 500mg
Given b.d for 10 to 14 days
INTERACTIONS delayed lansoprazole absorption with
sucralfateincrease theophylline excretion
ADVERSE REACTIONS
MI, shock , cardio spasm , abnormal liver function tests , head ache ,
malaise , depression
COUNSELLINGDRUG TO BE TAKEN BEFORE MEALSDONOT CHEW OR CRUSHTROUBLE IN SWALLOWING,OPEN THE
CAPSULE SPRINKLE THE CONTENTS TO TABLE SPOON AND SWALLOW
BRANDS FORM STRENGTH1)LANS TAB 15,30mg2)LANPRO TAB 15,30mg
PANTOPRAZOLETREATMENT FOR EROSIVE ESOPHAGITIS40 mg P.O o.d FOR 8 weeksZOLLINGER ELLISON SYNDROMEInitially 40 mg P.O b.i.d , maximum up to
240mg/dayADVERSE REACTIONSDiarrhea , abdominal pain , pruritus , insomnia ,
skin rash , dizziness
BRANDS FORM STRENGTH1)PAN TAB 40mg2) PANTODAC TAB , INJ 40 mg3)PANTOCID TAB 20,40mg4)PANSEC5)PANTOTAB6)PROPANZ7)PANCUS8)PANTAGON9)PANTIUM
RABEPRAZOLE
INDICATIONS.ROUTE AND DOSAGEGERD
20mg P.O once daily for 4 to 8 weeksACTIVE DUODENAL ULCER
20mg P.O once daily for 4 weeksZOLLINGER ELLISON SYNDROME
60 mg P.O daily increased to 100 mg P.O once daily or 60 mg P.O twice daily
ADVERSE REACTIONS
Seizures , cardial infarction , pancreatitis , sinus bradycardia , allergic reactions
INTERACTIONS
Inhibit cyclosporine metabolism
BRANDS FORM STRENGTH
1)RABIUM TAB,INJ 20mg
2)RABLET
3)RABELOC
4)REKOOL
ESOMEPRAZOLE
INDICATIONS.ROUTE AND DOSAGEGERD20 OR 40 mg P.O once daily for 4 to 8 weeksTREATMENT FOR EROSIVE ESOPHAGITIS20mg P.O once daily H.PYLORI ERADICATION40mg P.O once daily for 10 daysNSAID RELATED GASTRIC ULCER20 or 40 mg once daily up to 6 months
ADVERSE REACTIONS
Nausea , voumitting , flushing , head ache confusion , drowsiness , dry mouth
PRECAUTIONS
Reduce dosage in case of severe hepatic insufficiency
BRANDS FORM STRENGTH
1)SOMPRAZ TAB 20,40mg
2)NEXPRO
3)NEKSIUM INJ 40mg
4)RACIPER
H2 RECEPTOR ANTAGONISTS
CLASSIFICATION
PHARMACOLOGIC : H2 receptor antagonists
THERAPEUTIC : anti ulcerativeMECHANISM OF ACTIONinhibits histamines action at H2 receptor in
gastric parietal cellsReduces basal and nocturnal gastric acid
secretion, as well as caused by histamine , food, amino acids…..
RANITIDINEHALF LIFE is 2 to 3 hoursINDICATIONS.ROUTE AND DOSAGEZOLLINGER ELLISON SYNDROME150 mg P.O b.i.d or 300 mg od h.s50 mg I.V or I.M q 6 to 8 hoursACTIVE DUODENAL ULCER 150 mg P.O h.sPROPHYLAXIS FOR STRESS ULCERSI.V infusion of 150mg in 250 ml solution, at arate
of 6.25 mg / hour
GERD150mg P.O b.i.dEROSIVE ESOPHAGITIS150 mg or 10ml P.O q.i.dFOR OCCASSIONAL HEARTBURN , ACID
INDIGESTION , AND SOUR STOMACH75 mg once or twice daily or 150 mg o.dINTERACTIONSDecreased ranitidine absorption with antacidsIncreased hypoglycemic effects with glipizide
ADVERSE REACTIONS Granulocytopenia , pancytopenia ,
thrombocytopeniaCOUNSELLINGif patient taking single dose take it at bed timeNot to take otc for a period of 2 weeks
without mediacal approvalBRANDS FORM STRENGTH1)RANTAC TAB,INJ 150,300mg2)RANITIN
Thank you
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