Report 4 Pharma 2

8/14/2019 Report 4 Pharma 2

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PEPTIC ULCER – is a

broad term for an ulcer

occuring in the esophagus,

stomach or duodenum

within the upper

gastrointestinal (GI) tract.



Peptic ulcers occur when there

is a hypersecretion of hydrochloric acid and pepsin,which erode the GI mucosallining.

PEPSIN- a digestive enzymeis activated at a pH of 2 andthe acid-pepsin complex of



Gastric mucosal barrier

(GMB)- is a thick,

viscous,mucous material

that provides a barrier

between the mucosal lining

and acidic gastric

secretions.



TWO SPHINCTER MUSCLES

•CARDIAC – located at the upper

potion of stomach

•PYLORIC- located at the lower portion of the stomach- acts as

barriers to prevent reflux of acidinto the espophagus and

duodenum.



•ESOPHAGEAL ULCER- results from

reflux of acidic gastric secretions intothe esophagus as a result of a defective

of incompetent cardiac sphincter.

•GASTRIC ULCER- frequently occurs

because of breakdown of the GMB.



DUODENAL ULCER- caused by

hypersecretion of acid fromthe stomach passing into theduodenum because of insufficient buffers toneutralize gastric acid in the

stomach, a defective of incompetent pyloric sphincteror hypermotility of the

stomach.



•GASTROESOPHAGEAL

REFLUX DISEASE•Is inflammation or erosion of

the esophageal mucosacaused by a reflux of gastriccontent from the stomach



•SMOKING AND OBESITY tend

to accelerate the disease process.

•Medical treatment for GERD is

similar to the treatment for pepticulcers. This includes the use of

common antiulcer drugs toneutralize gastric contents and

reduce gastric acid secretion.





•A Proton Pump inhibitors relieves

symptoms faster and maintainshealing better than an H2 blocker.

•

Effective management of GERDkeeps the esophageal mucosa

healed and the client free

symptoms, but GERD is a chronicdisorder that requires continuous

care.



•Inlude mechanicaldisturbances,genetic influences,

bacterial organisms, environmentalfactors and certain drugs.

•Healing of an ulcer takes 4 to 8

weeks.•Complication can occur as the resultof scar tissue.



•Classic symptom of peptic

ulcers is gnawing, aching,pain.

•GASTRIC ULCER, pain occurs

30 minutes to 1.5 hours aftereating.

•DUODENAL ULCER, 2 to 3hours after eating.

•Small frequent meals of

nonirritating food decrease



•With treatment, pain usually subsides in

10 days; however, the healing process maytake 1 to 2 months.

•STRESS ULCER usually follows a

critical situation such as extensive traumaor major surgery (e.g., burns, cardiac

surgery)

•PROPHYLACTIC use of antiulcer drugsdecreases the incidence of stress ulcers.



HELICOBACTER PYLORI – agram negative bacillus , is linked

with the development of pepticulcer and known to cause

gastritis, gastric ulcer, andduodenal ulcer.



•Avoiding tobacco and alcohol can decrease

gastric secretions.•With GERD, nicotine relaxes the lower

esophageal sphincter, permitting gastric

acid reflux. Obesity enhances the problemof GERD; weight loss is helpful in

decreasing symptoms.



•To relieve symptoms of GERD,

the client should raise the head of

the bed, not eat before bedtime,and wear loose-fitting clothing



1. Tranquilizers- which decrease vagal

activity

2. Anticholinergics- decrease acetylcholine by blocking the cholinergic receptors.

3. Antacids – which neutralize gastric acid

4. H2 blockers- block the H2 receptor



5. PPIs , inhibit gastric acid secretion,

regardless of acetylcholine or histamine release.

6. The pepsin inhibitor sucralfate

7.The prostaglandin E1 analogue

misoprostol, which inhibits gastric

acid secretion and protects themucosa.



TRANQUILIZERS

•Have minimal effect in preventing andtreating ulcers; however, they reduce vagal

stimulation and decrease anxiety.

USED IN THE TREATMENT OF

ULCERS

•

chlordiazepoxide (Librium);and•The anticholinergic

clidiniumbromide(Quarzan)





•Dry mouth, decrease secretions,

headache, blurred vision,drowsiness, dizziness, lethargy,

palpitations, bradycardia,

tachycardia, urinary rretention andconstipation.



ANTACIDS

•

Promote ulcer healing by neutralizinghydrochloric acid and reducing pepsin activity;

they do not coat the ulcer.

TWO TYPES OF ANTACIDS

•SYSTEMIC EFFECT

•NONSYSTEMIC EFFECT- composed of

alkaline salt such as aluminum( aluminumhydroxide, aluminum carbonate) and magnesium

(hydroxide, carbonate, trisilicate,phosphate)



•The ideal dosing interval for antacids is 1 to

3 hours after meals and at bedtime.

•ANTACIDS taken on an empty stomach are

effective for 30 to 60 minutes before passing

into the duodenum.

•ANTACIDS containing magnesium salts

are contraindicated in clients with impaired

renal function because of risk of hypermagnesemia.

•Magnesium is primarily excreted by the

kidneys

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Report 4 Pharma 2