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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