Peptic Ulcer Disorder

Agressive Factors

H. Pylori (most common)

NSAIDS

Acid

Pepsin

Smoking

(PUD)

Treatment for H. pylori

Antiulcer Drugs

Histamine2-Receptor Antagonists

Suppress HCL acid secretion

(Tagamet, Zantac, Pepcid)

Antiulcer Drugs

Proton Pump Inhibitors

Suppress gastric acid secretion

(Prilosec)

Antiulcer Drug

Sucralfate [Carafate]

Creates a protective barrier against acid and pepsin

Adverse effect - constipation

Antiulcer Drugs

Antacids

Neutralize stomach acids

Enhance mucosal protecation by stimulating prostaglandins

Can contain excess Na and exacerbate hypertension and heart failure in certain patients

The effect of diet on ulcer relief?

Diet plays a minor role.

Change in eating pattern may be beneficial. Eating 5-6 small meals instead of 3 large ones will reduce fluctuations in intragastric pH

Laxatives

Used to ease or stimulate defacation

soften the stool, increase stool volume, hasten fecal passage through the intestine, facilitate evacuation from the rectum

Bulk forming Laxative

Effects similar to fiber

soften stool and increase fecal bulk

(Metamucil)

Surfactant Laxative

lower surface tension, which helps water penetrate the feces

(Colace)

Stimulant Laxative

Increases amount of water and electrolytes ini the intestinal lumen

stimulates intestinal motility

(Dulcolax)

Osmotic Laxative

draws water into the intestinal lumen

causes fecal mass to soften and swell,stimulating peristalsis

(Lactulose, Magnesium & Sodium Salts)

Antiemetics

blocks receptors located on vagal neurons in upper GI tract

To suppress nausea and vomitting

(Zofran)

Scopolamine

For motion sickness

suppress nerve impulses going from inner ear to vomiting center

most effective when given prophylactically

Lomotil

antidiarrheal

most serious complication from diarrhea is dehydration and eletrolyte depletion

opiods decrease intestinal motility and transit, allowing more time for fluids and electrolytes to be reabsorbed

Tricyclic antidepressants

inflammatory bowel disease

Prokinetic Agents

(Reglan)

increase the tone and motility of the GI tract

use for GERD

Glaucoma

visual field loss secondary to optic nerve damage

Glaucoma

Beta-adrenergic blocking agents

decrease aqueous humor production

(Timolol)

Glaucoma

Alpha2-adrenergic agonists

increases aqueous humor outflow, decreases production also

(Brimonidine)

Cycloplegic

paralyze ciliary muscles

(atropine)

Mydriatics

dilate the pupils

used for introcular surgery

Mydriatics

dilate the pupil (sympatetic)

Miotics

constricpt pupils (parasympathetic)

Topical glucocorticoids

to relieve inflammation and itching in: contact dermatits, psoriasis and Eczema

use a thin layer because is a steroid which thins the skin

do not use occlusive dressings

Keratolytic Agents

promote shedding horny layer of skin

benzoyl peroxide

salicylic acid - warts, corns

Sulfur- acne, dandruff, psoriasis

Treatment for Acne

cleansing

benzoyle peroxide

Antibiotics (cleocin, zithromax)

Accutane

last resort for severe acne

side effects: nosebleeds, inflammation, suicide  

Category X, teratongenic

Otitis Media

inflammation and fluid in the middle ear

High dose Amoxicillin

Can wait and observe symptoms rather than giving antibiotic right away to see if patient can resolve, prevents resisance

Otitis Externa

inflammation of the external auditory canal

Usual cause is bacterial infection

Most cases respond to topical drugs, keep ear as dry as possible

Migraines

females>males

nausea/vomiting, sensitivity to light, sound

throbbing head pain of moderate to severe intensity

pain lasts 4-72 hours

Migraine

neurovascular disorder that involves dilation and inflammation of intracrainal blood vessels

Migraine Treatment

aspirin, acetaminophen, ibuprofen and other NSAIDS (typically combined with coffee) can provide relief of mild to moderate migraines

Excedrin Migraine (acetaminophen, aspirin, coffee)

Migraine Treatment

Ergotamine

drug of choice for stopping an ongoing migraine attack

should not be taken long term due to risk of dependence

Category X drug

Migraine treatment

DHE

(Dihydroergotamine)

parenertal formula (SQ, IM, IV) or nasal spray

used for migraines and cluster headaches

similar actions to ergotamine, but no physical dependence