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Peptic Ulcer Disease

 

Questions:

 

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?

      Relieve symptoms

      Promote ulcer healing

      Prevent complications

      Eradicate H. pylori infection (cure)

      Prevent recurrences

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?

      Efficacy Monitoring

      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

 

References:

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


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