1. What signs, symptoms and laboratory values indicate the presence of peptic ulcer disease?
Signs & Symptoms: one-day history of melenic stool, abdominal pain, gradual onset of a localized gnawing epigastric pain that occurred daily, wavered in intensity and increased at night and between meal.
Laboratory value: Low hemoglobin 13.2 g/dl (normal value = 14 – 18 g/dl)
Low hematocrit 40% (normal value = 45 – 52%)
2. What medical problems should be included in the patient’s problem list?
Peptic ulcer disease, hypertension, gastrointestinal bleeding, chronic use of aspirin, constipation, abdominal pain
3. Could any of the problems caused by drug therapy?
Constipation is one of the adverse reactions result from the usage of Procardia XL®, a calcium channel blocker. In addition, it may also due to the Titralac Plus®, which is a calcium carbonate that may cause high calcium content result in constipation.
Abdominal pain, peptic ulcer disease, and gastrointestinal bleeding are some of the adverse reactions result from the usage of Aspirin, a non-steroidal anti-inflammatory agent.
4. What are the desired outcomes for treating this patients PUD?
Promote ulcer healing
Eradicate H. pylori infection (cure)
5.Considering the patient’s presentation, what non-pharmacologic alternatives are available to treat his PUD?
Eliminate or reduce psychological stress, cigarette smoking, alcoholic beverages, and the use of aspirin. Aspirin can be replaced by alternative agents like acetaminophen, a nonacetylated salicylate, or COX-2 selective inhibitor.
6. What pharmacologic alternatives are available to treat duodenal ulcers while waiting for the biopsy result?
Proton pump inhibitors
Omeprazole 20 mg or 40 mg daily
Lansoprazole 30 mg or 60 mg daily
Rabeprazole 20 mg daily
H2 – receptor antagonists
Cimetidine 300 mg QID
400 mg BID
800 mg at bedtime
Famotidine 20 mg BID
40 mg at bedtime
Nizatidine 150 mg BID
Ranitidine 150 mg BID
300 mg at bedtime
7. Design a pharmacotherapeutic regimen for this patient.
Proton pump inhibitor-based three-drug regimen
Omeprazole 20 mg twice daily
Clarithromycin 500 mg twice daily
Amoxicillin 1g twice daily
8. How should the therapy you recommended be monitored for efficacy and adverse effect?
Ulcer pain typically resolves in a few days when NSAIDs are discontinued and within 7 days upon initiation of antiulcer therapy.
Signs and symptoms should be relived after 2 weeks of the pharmacotherapeutic regimen.
Hemoglobin value should be within the normal range
Adverse Effect Monitoring
Omeprazole may cause headache, diarrhea, abdominal pain and others
Clarithromycin may cause abnormal taste, nausea, increase in BUN and others
Amoxicillin may cause anemia, tooth discolouration and others
1. Charles F. Lacy et al. Drug Information Handbook 15th Edition
2. Mary Anne Koda-Kimble et al. Handbook of Applied Therapeutics 8th Edition
3. Barbara G. Wells et al. Pharmacotherapy Handbook 6th Edition