Overview Peptic ulcer GERD Diarrhea Constipation Antacid H

Overview - Peptic ulcer, GERD - Diarrhea -Constipation - Antacid - H 2 antagonist - PPI - Cytoprotective - Antispasmodic - Prokinetic agent - Adsorbent - Antibiotic - Antispasmodic - Laxative

Antacid

Antacid Use : . 1บรรเทาอาการปวดแสบทอง จาก GU / DU. 2บรรเทาอาการเจบแสบยอดอก heart burn ใน GERD # ยาเตรยมทม simethicone หรอ alginate ผสม จะสามารถลดการไหลกลบ ของนำยอยได ADR : Na - systemmic alkalosis, HTN, rebound hypersecretion Al, Ca - constipation, hypercalcemia, hypophosphatemia Mg- mild diarrhea, neuromuscular/cardiovascular impairment

H 2 blocker

Proton Pump Inhibitor : PPI

Proton Pump Inhibitor : PPI ประกอบดวย : Omeprazole, Esomeprazole, Lanzoprazole, Rabeprazole , Pantoprazole MOA : react with sulfhydryl group of H+-K+ ATPase enzyme : irreversible : reduce acid secretion - ลดการหลงกรดในกระเพาะอาหารไดอยางสมบรณ - ผลจะยงอยตออก 4 -5 วนหลงหยดยา

Cytoprotective

Prokinetic Agent

Prokinetic agents Domperidone Dose : 10 -20 mg TID ac ADR : HA, dizziness, insomnia, : gynecomastia, serum prolactin increase : hot flash, menstrual irregularity

Prokinetic agents Metoclopramide Dose : 10 -15 mg TID ac ADR : drowsiness, fatigue, HA, somnolence, Parkinson like symptom : AV block, bradycardia : amenorrrhea, galactorrhea, gynecomastia, impotence : visual disturbance D/I : avoid use concomitant with antipsychotic drug “increase level/effect of SSRI, Sertraline, TCA, promethazine” : decrese effect anti-Parkinson’ s agent (dopamine agonist)

Antiflatulence

ภาวะไมสบายในทอง : Dyspepsia : also know as “upset stomach or indigestion” : maybe the first symptom of PU, GU, DU, GERD, IBS : may caused by CCB, Nitrate, Theophylline, Bisphonate, Steroids, NSAIDs Symptoms - Upper abdominal pain - Bloating - Tenderness

ภาวะไมสบายในทอง : Dyspepsia Treatment - H 2 block and/or PPI - Prokinetic - Antiflatulence - Antispasmodic - Lifestyle Modification * In literature review suggested “ antacid and sucralfate found to be no better than placebo”

โรคกระเพาะอาหาร : Peptic ulcer : mucosal erosions at least 0. 5 cm. : may caused by bacteria – Helicobactor pyroli : may caused by Steroids, NSAIDs Classification by region 1. Duodenum : duodenum ulcer 2. Esophageal : esophageal ulcer 3. Stomach : gastric ulcer 4. Meckel’s diverticulum : Meckel’s diverticulum ulcer

โรคกระเพาะอาหาร : Peptic ulcer Caused - H. pyroli - Smoking - Drugs : NSAIDs, Steriods - Caffeine - Behavior : eat, stress, exercise … - Alcohol Symptom - Abdominal pain relating meal time and in the morning - Bloating - N/V/D - Loss of appetite

โรคกระเพาะอาหาร : Peptic ulcer Treatment - H 2 block and/or PPI and/or Antacid - Prokinetic - Antiflatulence - Antispasmodic - Cytoprotective - Antibiotics - Lifestyle Modification

โรคกระเพาะอาหาร : Peptic ulcer Helicobactor pyroli : g (-) flagellate bacteria servive in acidic : Over 80% of people infected with H. pyroli show no symptoms : contacted by saliva : diagnosis by UREASE test, biopsy, histological examination and microbial culture : Treatment – call “Triple therapy” PPIs (Lansoprazole 30 mg BID) + Clarithromycin 500 mg BID + Amoxicillin 1000 mg BID for 7 days

โรคกรดไหลยอน : GERD : also know as “Gastro-Esophageal Reflux Disease ” : caused by changes in the barrier between stomach and esophagus including abnormal relaxation of the lower esophageal sphincter. Symptoms - Heartburn, Regurgitation, Dysphagia (Trouble swallowing) - Chest pain - Increased salivation - Chronic cough

โรคกรดไหลยอน : GERD Treatment - H 2 block and/or PPI and/or Antacid - Prokinetic - Antiflatulence - Antispasmodic - Cytoprotective - Alginic acid (Gaviscon®) : may coat the mucosa as well as increase p. H and decrease reflux - Lifestyle Modification

Irritation Bowel Syndrome (IBS) : โรคลำไสแปรปรวน Classification 1. Diarrhea predominant : IBS-D 2. Comstipation predominant : IBS-C 3. Pain-Predominant or IBS with Alternating stool pattern : IBS-A Caused Unknown but have several hypothesis : Post-infection, Prolong fever, Anxiety, Depression

Constipation Treatment 1. Non-Pharmacological Treatment 2. 1 Bulk forming 2. 2 Osmotic/Saline 2. 3 Stimulant laxative 2. 4 Stool softener(Surfactant) 2. 5 Lubricant laxative 2. 6 อนๆ เชน ยาสวนทวาร

Irritation Bowel Syndrome (IBS) : โรคลำไสแปรปรวน Symptoms - Abdominal pain - Diarrhea or Constipation - Bloating - Gastroesophageal reflux - Abdominal distention

Irritation Bowel Syndrome (IBS) : โรคลำไสแปรปรวน Treatment - Laxative or Antidiarrheal agent - Antidepressant - Prokinetic - Antiflatulence - Antispasmodic - Lifestyle Modification

NSAIDs Non-Steroidal Anti -Inflammatory Drugs

NSAIDs Non-selective Specific COX 2 Inh. nabumetone, meloxicam, nimesulide Carboxylic acids Salicylic acid aspirin celecoxib, etoricoxib Enolic acid pyrazolone Acetic acid diclofenac indomethacin Propionic acid Fenamic acid ibuprofen naproxen Mefenamic acid phenylbutazone oxicam piroxicam

NSAIDs DOSE สำหรบลดอาการปวด อกเสบกลามเนอและขอ : aspirin 300 -600 mg. q 4 -6 hr. Max 4 g/day – : diclofenac – 25 -50 mg TID Max 150 mg/day : indomethacin – 25 -50 mg TID Max 200 mg/day : ibuprofen – 400 -800 mg TQID Max 3. 2 g/day : naproxen – initial 500 mg then 250 mg q 4 hr. Max 1250 mg/day : mefenamic acid - initial 500 mg then 250 mg q 4 hr. : piroxicam – 10 mg BID or 20 mg OD Max 40 mg/day

NSAIDs DOSE สำหรบลดอาการปวด อกเสบกลามเนอและขอ : nabumetone 1 – g. OD or BID Max 2 g/day : meloxicam – 7. 5 -15 mg OD Max 15 mg/day : celecoxib – 200 mg BID : etoricoxib – 60 -120 mg OD