GIT
22. Write the Drug treatment of peptic ulcer disease? (10 Marks)
Answer:
Classification Drugs
Reduction of Gastric Acid Secretion
H2 Antihistamines Cimetidine, Ranitidine, Famotidine, Roxatidine
Proton Pump Inhibitors Omeprazole, Esomeprazole, Lansoprazole,
Pantoprazole, Rabeprazole, Dexrabeprazole
Anticholinergic Drugs Pirenzepine, Propantheline, Oxyphenonium
Prostaglandin Analogue Misoprostol
Neutralization of Gastric Acid (Antacids)
Systemic Sodium bicarbonate, Sodium citrate
Magnesium hydroxide, Magnesium trisilicate,
Nonsystemic Aluminium hydroxide gel, Magaldrate, Calcium
carbonate
Ulcer Protectives Sucralfate, Colloidal Bismuth Subcitrate (CBS)
Amoxicillin, Clarithromycin, Metronidazole,
Anti-H. pylori Drugs
Tinidazole, Tetracycline
1. Reduction of Gastric Acid Secretion:
Mechanism of Action: These medications reduce gastric acid secretion by inhibiting
proton pumps or histamine H2 receptors in the stomach lining.
Uses: They are prescribed to manage conditions such as gastroesophageal reflux
disease (GERD), peptic ulcers, and Zollinger-Ellison syndrome.
Adverse Effects: Common side effects include headaches, diarrhea, constipation,
and an increased risk of infections like Clostridium difficile. H2 antihistamines may
interact with other medications due to their impact on liver enzymes. Prolonged use
of proton pump inhibitors may lead to decreased absorption of certain nutrients,
such as calcium and magnesium.
2. Neutralization of Gastric Acid (Antacids):
Mechanism of Action: Antacids directly neutralize excess stomach acid, raising the
pH level in the stomach.
Uses: They provide rapid relief from heartburn and indigestion symptoms.
Adverse Effects: Common adverse effects include diarrhea or constipation,
depending on the type of antacid used. Some antacids may interact with other
medications, affecting their absorption.
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3. Ulcer Protectives (Sucralfate, Colloidal Bismuth Subcitrate - CBS):
Mechanism of Action: These drugs form a protective barrier over ulcers or irritated
areas in the stomach lining, shielding them from corrosive stomach acid.
Uses: They are prescribed for treating peptic ulcers and facilitating the healing
process.
Adverse Effects: Typically mild adverse effects may include constipation and,
in rare cases with sucralfate, aluminum toxicity. CBS may lead to temporary
darkening of the tongue and stools.
4. Anti-H. pylori Drugs:
Mechanism of Action: These medications target Helicobacter pylori bacteria, a
contributor to peptic ulcers, by either directly killing the bacteria or inhibiting its
growth.
Uses: They are administered in combination with other drugs to eradicate H.
pylori infections, reducing the risk of ulcer recurrence.
Adverse Effects: Adverse effects vary depending on the specific drug but may
encompass gastrointestinal symptoms like nausea, diarrhea, and a metallic taste
in the mouth. Although rare, allergic reactions can occur with some antibiotics.
5. pylori Eradication Therapy:
Treatment for eradicating Helicobacter pylori (H. pylori) infection is essential for
all patients who test positive.
Here are the first-line options for H. pylori eradication therapy:
Clarithromycin Triple Therapy:
Recommended in regions with low clarithromycin resistance (<15%).
Standard or double-dose PPIs twice daily (e.g., omeprazole).
Combined with clarithromycin and amoxicillin or metronidazole.
Treatment duration: 14 days.
Clarithromycin-Based Concomitant Therapy:
Suitable when clarithromycin resistance is not a significant concern.
Standard-dose PPIs twice daily (e.g., omeprazole).
Combined with clarithromycin, amoxicillin, and metronidazole or tinidazole.
Treatment duration: 10–14 days.
Bismuth Quadruple Therapy:
Preferred in regions with high clarithromycin resistance (≥15%).
Standard-dose PPIs twice daily (e.g., omeprazole).
Combined with bismuth (e.g., bismuth subcitrate or bismuth subsalicylate),
tetracycline, and metronidazole.
Treatment duration: 10–14 days.
Reference: Essentials of medical pharmacology, KDT 7th Edition, Page No. 651-58
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GIT
23. Write a short note on Antiemetics. (5 Marks)
Answer: Antiemetics are drugs used to prevent or suppress vomiting.
Classification Drugs
Anticholinergics Hyoscine, Dicyclomine
H1 antihistaminics Promethazine, Diphenhydramine, Dimenhydrinate,
Doxylamine, Meclozine (Meclizine), Cinnarizine
Neuroleptics (D2 Chlorpromazine, Triflupromazine, Prochlorperazine
blockers)
Prokinetic drugs Metoclopramide, Domperidone, Cisapride, Mosapride,
Itopride
5-HT3 antagonists Ondansetron, Granisetron, Palonosetron, Ramosetron
NK1 receptor Aprepitant, Fosaprepitant
antagonists
Dexamethasone, Benzodiazepines, Dronabinol,
Adjuvant antiemetics
Nabilone, Haloperidol, etc.
ANTICHOLINERGICS
Mechanism of action: Anticholinergics block the action of the neurotransmitter
acetylcholine in the central and peripheral nervous systems. They inhibit muscarinic
receptors, leading to decreased smooth muscle contractions and reduced secretions.
Uses: Anticholinergics are used to treat conditions involving excessive cholinergic
activity, such as gastrointestinal spasms and motion sickness.
H1 ANTIHISTAMINES
Mechanism of action: H1 antihistamines block the action of histamine at H1
receptors, thereby reducing allergic reactions and symptoms such as itching,
sneezing, and runny nose.
Uses: These drugs are commonly used to relieve allergy symptoms, motion sickness,
and as sleep aids due to their sedative effects.
NEUROLEPTICS (D2 BLOCKERS)
Mechanism of action: Neuroleptics, also known as antipsychotics, primarily block
dopamine D2 receptors in the brain. This reduces excessive dopamine activity and
helps control psychotic symptoms.
Uses: They are used to manage schizophrenia, bipolar disorder, and other psychotic
disorders.
PROKINETIC DRUGS
Mechanism of action: Prokinetic drugs enhance gastrointestinal motility and transit
by stimulating or mimicking the action of neurotransmitters like dopamine and
serotonin in the gut.
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Uses: These drugs are used to treat conditions such as gastroesophageal reflux
disease (GERD), gastroparesis, and functional dyspepsia.
5-HT3 ANTAGONISTS
Mechanism of action: 5-HT3 antagonists block serotonin (5-HT3) receptors in the
gut and the central nervous system, reducing nausea and vomiting signals.
Uses: They are used in chemotherapy-induced and postoperative nausea and
vomiting prevention, as well as in managing nausea associated with radiation
therapy.
NK1 RECEPTOR ANTAGONISTS
Mechanism of action: NK1 receptor antagonists block the action of substance P,
a neurotransmitter involved in the vomiting reflex, thereby reducing nausea and
vomiting.
Uses: These drugs are used in combination with other antiemetics to prevent
nausea and vomiting associated with chemotherapy and postoperative settings.
ADJUVANT ANTIEMETICS
Mechanism of action: These drugs have various mechanisms of action, including
anti-inflammatory and sedative properties, making them useful in managing
different causes of nausea and vomiting.
Uses: They are often used in combination with other antiemetic classes to provide
comprehensive relief from nausea and vomiting in various clinical situations,
including chemotherapy, surgery, and palliative care.
Reference: Essentials of medical pharmacology, KDT 7th Edition, Page No. 387, 662-70
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