Ulcer , peptic treatment

H2 Antagonists and the Treatment of Peptic Ulcers. Treatment of peptic ulcers is a complicated and multilevel therapy in which Hj antagonists are very successful and widely used (and abused). Peptic ulcers may affect either the stomach (gastric ulcers, less common overall but more common in people with iatrogenic [i.e., physician-induced] ulcers from the use of nonsteroidal anti-inflammatory drugs [NSAIDs]) or the duodenum (duodenal ulcers). The lining of the stomach or duodenum is attacked by the digestive juices to such an extent that the protective mucous layer on the surface has... 

More important than numerical data are the clinical implications of differences between the two countries. The largest differences have narrowed since the previous study, but important categories in which the U.S. still lagged behind Britain in December 1976 included cardiovascular drugs, peptic ulcer treatment, and central nervous system drugs—including therapies for depression, epilepsy, and migraine. 

Peptic ulcer treatment of Photosensitivity medication-induced Psychiatric symptoms caused by drugs... 

Capsaicin Nonanoyl 4-hydroxy-3-methoxybenzylamide peptic ulcers treatment Guar (Cyanopsis tetragonoloba) gum peptide synthesis... 

Glycyrrhetinic acid is a constituent of licorice that had been used in folk remedies for peptic ulcer disease. For some time, this compound, in the form of carbenoxolone, was tried as a means of peptic ulcer treatment, but its renal toxicity prevented its introduction. 

The sales of antagonists of receptors, eg, diphenhydramine, terfenadine, and astemizole, used in the treatment of allergic diseases, represent 1% of the overall pharmaceutical market, ie, 1.7 biUion (U.S.). antagonists, eg, cimetidine and ranitidine, are effective in peptic ulcer disease and esophageal reflux. Sales represent 3.5% of the world market, ie, 6 biUion (U.S.). agonists or antagonists have not yet found a clear indication. 

Bismuth subsahcylate [14882-18-9] Pepto-Bismol, is a basic salt of varying composition, corresponding approximately to i9-H0CgH4C02(Bi0). Like a number of other insoluble bismuth preparations, it is not currentiy approved in the United States for the treatment of peptic ulcer disease but is under active investigation for this purpose (180). It does appear to be effective for the rehef of mild diarrhea and for the prevention of travelers diarrhea (181). The ready availabiUty of this dmg, however, may lead to its ovemse and result in toxic effects caused by both the saUcylate and bismuth components. It has been suggested that bismuth subsahcylate is somewhat effective in the symptomatic treatment of isosporiasis, a disease caused by the intracellular parasite Isospora belli (182). 

Hydroxy-A, A -bis(hydroxymethyl)-A -methylmethanaminium salts and related types of compounds 19 for prevention and treatment of peptic ulcers and... 

A great many organic quaternary bases can inhibit the action of acetyl choline in organ systems activated by that neurotransmitter and thus possess anticholinergic-antispasmodic activity. One such agent is methantheline bromide (4), used in the treatment of peptic ulcer and as an antispasmodic agent in intestinal disorders. Its synthesis Involves Friedel-Crafts cyclization of o-... 

Very recently, a very bold chemical model for histamine H2-receptors has been proposed using [18]aneN6-3H+ 84), which can chemically recognize histamine, histamine H2-agonists, and histamine H2-antagonists such as cimetidine XII or ranitidine XIII that are currently in world-wide use for treatment of peptic ulcers 85). 

FIGURE 1.7 Key compounds synthesized to eliminate the efficacy (burgundy red) and enhance the affinity (green) of histamine for histamine H2 receptors to make cimetidine, one of the first histamine H2 antagonists of use in the treatment of peptic ulcers. Quotation from James Black [10]. 

Antacids are neutralizing agents. Examples are magnesium hydroxide, magnesium trisylicate and aluminium hydroxide. Prior to the introduction of histamine-H2 receptor antagonists and proton pump inhibitors, they were the standard drugs for the treatment of duodenal/ peptic ulcers. Today their clinical use is limited to the treatment of dyspepsia and the symptomatic relieve for patients with peptic ulcers. 

EDUCATING THE PATIENT WITH A PEPTIC ULCER The nurse gives the patient with a peptic ulcer a full explanation of Hie treatment regimen, which may include dru and a special diet. The patient is instructed to take the drug exactly as prescribed by file primary health care provider (eg, 30 minutes before meals or between meals) to obtain file desired results. The nurse discusses file importance of diet in file treatment of peptic ulcer and gives a full explanation of file special diet (when ordered). 

Mr. Anthony is prescribed a cholinergic blocking drug for the treatment of peptic ulcer. In planning patient teaching for Mr. A nthony before dismissal from the hospital, determine what information must be included to prevent complications of therapy. 

Specific anticholinergic drug are occasionally used in die medical treatment of peptic ulcer. These drug have been largely replaced by histamine H2 antagonists, which appear to be more effective and have fewer adverse drug reactions. 

Antiflatulents are used for die relief of painful symptoms of excess gas in the digestive tract. These drugs are useful as adjunctive treatment of any condition in which gas retention may be a problem (ie, postoperative gaseous distention, air swallowing, dyspepsia, peptic ulcer, irritable colon, or diverticulosis). In addition to its use for tiie relief of intestinal gas, charcoal may be used in the prevention of nonspecific pruritus associated with kidney dialysis treatment and as an antidote in poisoning. Simethicone is in some antacid products, such as Mylanta liquid and Di-Gel liquid. 

When an anticholinergic drug is prescribed for the treatment of a peptic ulcer, the nurse observes the patient for which of the following adverse effects ... 

Histamine receptors were first divided into two subclasses Hi and H2 by Ash and Schild (1966) on the basis that the then known antihistamines did not inhibit histamine-induced gastric acid secretion. The justification for this subdivision was established some years later when Black (see Black et al. 1972) developed drugs, like cimetidine, that affected only the histamine stimulation of gastric acid secretion and had such a dramatic impact on the treatment of peptic ulcers. A recently developed H2 antagonist zolantidine is the first, however, to show significant brain penetration. A further H3 receptor has now been established. It is predominantly an autoreceptor on histamine nerves but is also found on the terminals of aminergic, cholinergic and peptide neurons. All three receptors are G-protein-coupled but little is known of the intracellular pathway linked to the H3 receptor and unlike Hi and H2 receptors it still remains to be cloned. Activation of Hi receptors stimulates IP3 formation while the H2 receptor is linked to activation of adenylate cyclase. 

Salim, A.S. (1992f). Alopurinol and dimethyl sulphoxide improve treatment outcomes in smokers with peptic ulcer disease. J. Lab. Clin. Med. 119, 702-709. 

Less common causes of peptic ulceration include Zollinger-Ellison syndrome (ZES), cancer chemotherapy, radiation, and vascular insufficiency. ZES is caused by a gastrin-producing tumor called a gastrinoma and results in gastric acid hypersecretion. High-dose oral proton pump inhibitor (PPI) therapy is the initial treatment of choice for ZES intermittent intravenous PPI therapy may be required for any patient in whom oral therapy is contraindicated.1... 

There are certain histologic subtypes of diffuse, aggressive NHL that respond less well to treatment with conventional regimens such as CHOP. Burkitt s lymphoma, lymphoblastic lymphoma, mantel cell lymphoma, and primary CNS lymphoma are examples of disease that benefit from more intensive therapy. Regimens such as hyper-CVAD, which alternate cycles of hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone with high-dose cytarabine and methotrexate, often are substituted for CHOP. Intrathecal therapy with methotrexate is indicated with documented CNS infiltration of tumor or involvement of the sinuses. The recent appreciation of the etiology of Helicobacter pylori in the etiology of peptic ulcer disease and the association between colonization and mucosal-associated lymphoma (MALT) has spurred... 

Brunton, L., Agents for control of gastric acidity and treatment of peptic ulcers, in Goodman and Gilman s The Pharmacological Basis of Therapeutics, 9th ed., Hardman, J.G. and Limbird, L.E., Eds., McGraw-Hill, New York, 1996, chap. 37. 

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