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Anti Ulceration and Anti Emetics
Nur Irjawati S. Kawang, S.Si,
Introduction of ulcer
• Etiology
▫ General consideration: No Acid No Ulcer
▫ Main Destroy Factors: ①HCl, ②Pepsin, ③Hp
▫ Protective Barrier: Mucus-HCO3-
• Physiology
▫ HCl: P-cell, H2, M1, G-R, H+-pump
Peptic Ulcer
• The term “peptic ulcer” refers to an ulcer in the
lower Oesophagus, stomach, duodenum
(commonly), jujenum and ileum (rarely)
• Gastric and duodenal ulcers may be acute
or chronic
• Acute ulcer shows no evidence of fibrosis
• Both penetrate the muscularis mucosae
• Erosions do not penetrate the muscularis
Production of Gastric acid
• Secretion of gastric acid, mucus and bicarbonate. The
control of the gastrointestinal tract is through nervous
and humoral mechanisms.
▫ Acid is secreted from gastric parietal cells by a proton pump
(K+/H+ ATPase).
▫ The three endogenous secretagogues for acid are histamine,
acetylcholine and gastrin.
▫ Prostaglandins E2 and I2 inhibit acid, stimulate mucus and
bicarbonate secretion, and dilate mucosal blood vessels.
• The genesis of peptic ulcers involves:
▫ infection of the gastric mucosa with Helicobacter pylori.
▫ an imbalance between the mucosal-damaging (acid, pepsin)
and the mucosal-protecting agents (mucus, bicarbonate,
prostaglandins E2 and I2
Drugs affecting Gastric acid secretion
Caused by Nerveous or
humoral mechanism
Caused by H. Pilory
H-2 Reseptor Antagonist
• Used therapeutically to:
• Promote healing of duodenal and gastric ulcers.
• Provide long-term treatment of pathological GI
hypersecretory conditions.
• Reduce gastric acid production and prevent
stress ulcers.
Unwanted effects are rare
Proton Pump Inhibitors
Indicated for:
Short term treatment of gastric ulcers
Active duodenal ulcers and peptic ulcers (H. pylori)
Erosive esophagitis
Hypersecretory states
Unwanted effects of this class of drugs are uncommon. They
may include headache, diarrhoea (both sometimes severe) and
rashes. Dizziness, somnolence, mental confusion, impotence,
gynaecomastia, and pain in muscles and joints have been
reported. Proton pump inhibitors should be used with caution
in patients with liver disease, or in women who are pregnant or
breast feeding. The use of these drugs may 'mask' the
symptoms of gastric cancer.
Antimuscarinics Drugs
• M1 receptors antagonists :
Pirenzepine, telenzepine (a more potent
analog), reduce gastric acid secretion with
fewer adverse effects than atropine and
• Contraindicated in some gastric ulcers as
they may slow gastric emptying and prolong
the exposure of the ulcer bed to acid.
• Prescribed to relieve pain and promote healing
in peptic ulcer disease.
• Also used to relieve symptoms of acid
indigestion, heart-burn, dyspepsia, or GERD.
• Also used to prevent stress ulcers, GI bleeding,
and hyperphosphatemia in kidney failure.
Mucosal Protective Agents
Sucralfate is a complex of aluminium hydroxide and sulfated
sucrose, which releases aluminium in the presence of acid. The
residual complex carries a strong negative charge and binds to
cationic groups in proteins, glycoproteins, etc. It can form
complex gels with mucus, an action that is thought to decrease
the degradation of mucus by pepsin and to limit the diffusion of
Sucralfate can also inhibit the action of pepsin and stimulate
secretion of mucus, bicarbonate and prostaglandins from the
gastric mucosa. All these actions contribute to its mucosaprotecting action.
Unwanted effects are few, the most common being
constipation, which occurs in up to 15% of patients treated.
Less common effects include dry mouth, nausea, vomiting,
headache and rashes. It should be used with caution in
pregnancy, when breast feeding, or in patients for whom
enteral feeding is in progress
Prostaglandins Analogue
Prostaglandins of the E and I series have a generally
protective action in the gastrointestinal tract, and a
deficiency in endogenous prostaglandin production
(after ingestion of a NSAID, for example) may
contribute to ulcer formation. Misoprostol is a
stable analogue of prostaglandin E1. It is given orally
and is used to promote the healing of ulcers or to
prevent the gastric damage that can occur with
chronic use of NSAIDs.
Unwanted effects include diarrhoea and abdominal
cramps; uterine contractions can also occur, so
the drug should not be given during pregnancy
(unless deliberately to induce a therapeutic abortion
Anti Emetic Drug
What is Emetics ?
What is anti emetic drugs ?