Peptic Ulcers

• Cimetidine is an H2 blocker used to treat peptic ulcer disease
• Cimetidine works by blocking the activation of histamine 2 receptors, which causes proton pumps to reduce the amount of acid secreted into the stomach
• Adverse effects of Cimetidine include headaches, dizziness, diarrhea, increased risk of pneumonia, and anti-androgen effects (gynecomastia, reduced libido, erectile dysfunction)
• Cimetidine related ED or gynecomastia is reversible; will go away after stopping the drug
• Cimetidine should be administered at least 1 hour before administering an antacid
• Omeprazole is a proton pump inhibitor that is used to treat gastric ulcers
• Omeprazole works by inhibiting the enzyme that generates stomach acid and inhibiting the proton pump to stop acid production
• Adverse effects of Omeprazole include headache, diarrhea, nausea, vomiting, abdominal pain, constipation, increased risk of pneumonia, osteoporosis, increased risk for fractures, and hypomagnesemia
• Sucralfate is a mucosal protectant used to protect and heal gastric ulcers
• Sucralfate works by undergoing a reaction at a pH less than 4 to turn into a sticky gel; the gel then adheres to ulcers and protects them
• Administer sucralfate on an empty stomach 30 minutes before meals
• The only adverse effect of Sucralfate is constipation
• Antacids help peptic ulcers by neutralizing stomach acid to decrease damage to the gut wall
• Calcium based antacids can cause constipation, while magnesium based antacids can cause diarrhea
• Sodium based antacids can worsen hypertension and heart failure
• Antacids should be avoided or used with caution in patients with kidney disease/failure (will cause fluid-electrolyte imbalance)
• nonpharmacologic treatments for peptic ulcer disease include avoiding tobacco, avoiding alcohol, cutting back on spicy and greasy foods, avoiding NSAIDs, sitting up after eating, weight loss, loose-fitting clothing, and not eating before bed
• Most peptic ulcer drugs may take 4-6 weeks before reaching full effect