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How does each of the following drugs work treating ulcers? Give an example of each.
- H2 Antagonists
- Block the histamine 2 receptors on the parietal cells, reduce acid production in the stomach.
- Ranitidine (Zantac�)
- Cimetidine (Tagamet�)
- Famotidine (Pepcid�)
- Nizatidine (Axid�)
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Anticholinergics
- block stimulation of these receptors, Stimulation of these receptors causes acid release.
- Methscopolamine (Pamine�)
- Propantheline (Pro Banthine�)
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H+ Pump Inhibitors
- block the pump which actually moves acid from the parietal cell into the lumen of the GI tract.
- Side Effects: Headache, GI distress, Nausea, vomiting, constipation
- Omeprazole (Prilosec�)
- Lansoprazole (Prevacid�)
- Rabeprazole (AcipHex�)
- Esomeprazole (Nexium�)
- Pantoprazole (Protonix�)
- Dexlansoprazole (Dexilant�)
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Sucralfate (Carafate�)
- Is a glycoprotein which actually binds to ulcerated tissue.
- It dissolves in the stomach and binds to breaks in the gastric mucosa.
- It thus forms a protective barrier from the gastric enzymes and acids, providing an environment in which the ulcer can heal.
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Antacids
- Neutralize acid that is released from the parietal cells
- Al(OH)3, Mg(OH)2, or NaHCO3
- Maalox TC�
- Mylanta Double Strength�
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Antibiotics
- Helicobacter pylori, may be responsible for ulcer
- A common regimen includes an antibiotic, bismuth (Pepto-Bismol�) and an H2 antagonist or proton pump inhibitor.
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Tritec�,
Ranitidine/Bismuth
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Helidac�
Bismuth/Metronidazole/Tetracycline
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Prevpac�
Lansoprazole/Amoxicillin/Clarithromycin
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Reglan�
- Metoclopramide
- Prokinetic agents
- constrict the lower esophageal sphincter thus causing less acid reflux up the esophagus.
- increase the motility of the GI tract, clearing the contents of the stomach more rapidly.
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GERD
- Gastroesophageal Reflux Disease
- In patients with gastroesophageal reflux disease, stomach contents reflux or move back up the esophagus.
- The acid and enzymes contained in the refluxed gastric juice damage the lining of the esophagus.
- Patients with GERD experience pain in the stomach and chest area.
- Antacids
- Histamine 2 (H2) Antagonists
- Proton Pump Inhibitors
- Prokinetic Agents
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Parietal Cell
- produce acid.
- contain both histamine 2 and cholinergic receptors.
- Stimulation of these receptors causes acid release by the parietal cells.
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The causes of ulcers
- Excess stress
- Hypersecretory conditions
- Eating foods that cause irritation or excess acid secretion
- Reduced mucus production
- Helicobacter pylori (bacteria)
- Drugs (analgesics, steroids)
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