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PROTON PUMP INHIBITORS VS 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 DISEASE  peptic 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.

AETIOLOGY  H.PYLORI INFECTION  NSAID INGESTION  STRESS INDUCED  HEREDITY  COMMON ON O BLOOD GROUPS  SMOKING  ALCOHOL  AGE MORE THAN 60 YEARS  CORTICOSTEROIDS

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 INHIBITORS  OMEPRAZOLE  LANSOPRAZOLE  PANTOPRAZOLE  RABEPRAZOLE  ESOMEPRAZOLE

H2 RECEPTOR ANTAGONISTS  CIMETIDINE  RANITIDINE  FAMOTIDINE  ROXATIDINE  LOXATIDINE  NIZATIDINE

PROTON PUMP INHIBITORS: OMEPRAZOLE CLASSIFICATION PHARMACOLOGIC :substituted benzimidazole THERAPEUTIC : gastric acid suppressant MECHANISM OF ACTION  INHIBITS THE ACTIVITY OF PROTON PUMP,H+/K+ AT PASE SECRETORY SURFACE OF GASTRIC PARIETAL CELL.  BLOCKS FORMATION OF GASTRIC ACID

INDICATIONS.ROUTE AND DOSAGE  ACTIVE DUODENAL ULCER 20mg P.O Daily for 4 to 8 weeks  H.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 weeks  ZOLLINGER 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

COUNSELLING  Drug to be taken before meals  Dont crush the capsules BRAND NAMES FORM STRENGTH 1)OMEZ CAP 10,20mg 2)OCID CAP 10,20mg 3)OMEZ INJ 4)OMEZ TAB

40mg 40mg

LANSOPRAZOLE CLASSIFICATION PHARMACOLOGIC :acid pump inhibitor THERAPEUTIC :antiulcerative MECHANISM OF ACTION  INHIBITS THE ACTIVITY OF PROTON PUMP,H+/K+ AT PASE SECRETORY SURFACE OF GASTRIC PARIETAL CELL.  BLOCKS FORMATION OF GASTRIC ACID

INDICATIONS.ROUTE AND DOSAGE  ACTIVE DUODENAL ULCER 15mg P.O once daily for 4 weeks  TREATMENT 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 weeks  H.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 sucralfate  increase theophylline excretion ADVERSE REACTIONS MI, shock , cardio spasm , abnormal liver function tests , head ache , malaise , depression

COUNSELLING  DRUG TO BE TAKEN BEFORE MEALS  DONOT CHEW OR CRUSH  TROUBLE IN SWALLOWING,OPEN THE CAPSULE SPRINKLE THE CONTENTS TO TABLE SPOON AND SWALLOW BRANDS FORM STRENGTH 1)LANS TAB 15,30mg 2)LANPRO TAB 15,30mg

PANTOPRAZOLE  TREATMENT FOR EROSIVE ESOPHAGITIS 40 mg P.O o.d FOR 8 weeks  ZOLLINGER ELLISON SYNDROME Initially 40 mg P.O b.i.d , maximum up to 240mg/day ADVERSE REACTIONS Diarrhea , abdominal pain , pruritus , insomnia , skin rash , dizziness

BRANDS 1)PAN 2) PANTODAC 3)PANTOCID 4)PANSEC 5)PANTOTAB 6)PROPANZ 7)PANCUS 8)PANTAGON 9)PANTIUM

FORM TAB TAB , INJ TAB

STRENGTH 40mg 40 mg 20,40mg

RABEPRAZOLE INDICATIONS.ROUTE AND DOSAGE  GERD 20mg P.O once daily for 4 to 8 weeks  ACTIVE DUODENAL ULCER 20mg P.O once daily for 4 weeks  ZOLLINGER 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 DOSAGE  GERD 20 OR 40 mg P.O once daily for 4 to 8 weeks  TREATMENT FOR EROSIVE ESOPHAGITIS 20mg P.O once daily  H.PYLORI ERADICATION 40mg P.O once daily for 10 days  NSAID RELATED GASTRIC ULCER 20 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 ulcerative MECHANISM OF ACTION  inhibits histamines action at H2 receptor in gastric parietal cells  Reduces basal and nocturnal gastric acid secretion, as well as caused by histamine , food, amino acids..

RANITIDINE HALF LIFE is 2 to 3 hours INDICATIONS.ROUTE AND DOSAGE  ZOLLINGER ELLISON SYNDROME 150 mg P.O b.i.d or 300 mg od h.s 50 mg I.V or I.M q 6 to 8 hours  ACTIVE DUODENAL ULCER 150 mg P.O h.s  PROPHYLAXIS FOR STRESS ULCERS I.V infusion of 150mg in 250 ml solution, at arate of 6.25 mg / hour

 GERD 150mg P.O b.i.d  EROSIVE ESOPHAGITIS 150 mg or 10ml P.O q.i.d  FOR OCCASSIONAL HEARTBURN , ACID INDIGESTION , AND SOUR STOMACH 75 mg once or twice daily or 150 mg o.d INTERACTIONS  Decreased ranitidine absorption with antacids  Increased hypoglycemic effects with glipizide

ADVERSE REACTIONS Granulocytopenia , pancytopenia , thrombocytopenia COUNSELLING  if patient taking single dose take it at bed time  Not to take otc for a period of 2 weeks without mediacal approval BRANDS FORM STRENGTH 1)RANTAC TAB,INJ 150,300mg 2)RANITIN

Thank you

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