• GORD occurs,
acid from the stomach repeatedly flowback into the esophagus -Y recurrent irritation
and damage to esophageal epithelium
• Treatment method Reduction of the gastric acid or neutralize proton pump
inhibitors, H2 receptor blockers and antacids
• Omeprazole —PPI, A prodrugs
• oral PPIs are degraded at low pH levels So, they are given in enteric coated forms -Y
The coating is removed in the alkaline duodenum -Y absorbed and transport into the
parietal cells -Y converted to the active form and binds irreversibly to the proton pump
• Both basal and stimulated gastric acid secretion is reduced.
Metoclopramide— dopamine antagonist
• Metoclopramide is an anti-emetic drug use to treat vomiting following Gl
disorders, drugs, surgery and cancer chemotherapy,radiation, GORD, gastroparesis
in DM.
• It has central as well as peripheral effect.
• Central action via blockage of D2 (dopamine) receptors in chemoreceptor
trigger zone -CTZ
• Peripheral action Stimulate the muscarinic receptors of the Gl tract -Y It
increases the tone of the lower esophageal sphincter
• Relax the pyloric antrum and duodenal cap Increase peristalsis and facilitate
gastric emptying
Omeprazole Metoclopramide
P - pneumonia I. fatigue, drowsiness —common
P- poor calcium absorption 2. extrapyramidal symptoms
I - infections (C.defficile) 3. Hyperprolactinemia
B —B12 deficiency 4. Gynecomastia
U —upset stomach 5. Galactorrhea
R —renal issue 6. disorders of menstruation
P - polyps (gastric)
S Serum magnesiumdepletion
Common— Central action —D2 receptor block inhibit the effect of dopamine
Headache Dopamine suppress secretion of prolactin from the anterior pituitary grand
Abdominal pain Elevated prolactin levels gynecomastia, galactorrhea
Diarrhea
Nausea, vomiting
1) Treat nausea following surgery, drug, radiation therapy
2) Gastroparesis in DM
G resis stomach's ability to empty its contents is delayed -Y
slow digestion
• Long term high blood sugar levels -5 damage vagus nerve -Y
impairing normal muscle contraction delayed gastric emptying
nausea, vomiting, bloating, feeling full quickly, fluctuations in blood
sugar level
Gastroparesis
Delayed gastric Loss of muscles to
emptying move food through
the digestive tract
Possible damage
to vagus nerves
Food stays in the
Closed
stomach too long
sphincter
(bezoars)
' Clopidogrel is an antiplatelet agent.
• Clopidogrel is converted into its active metabolite by the liver cytochrome
P450 system mainly CYP2C19. All PPIs metabolized via the cytochrome P450
system particularly CYP2C19.
• There is a significant decrease of clopidogrel platelet anti-aggregation effect
when it co-administrates with omeprazole. The risk for cardiovascular events
is increased.
• So, it is discouraged to take omeprazole with clopidogrel.
(increase plasma level of— phenytoin, diazepam)
CYP2C19 —metabolize...
