1.Classify drugs used to treat acid peptic diseases.

ANS;
a. Reduction of HCL secretion:
PPI (Proton Pump Inhibitors): Omeprazole, Dexlansoprazole,
Rabeprazole, Lansoprazole, Pantoprazole, Esmoprazole
H2 Blocker: Cimetidine, Ranitidine, Famotidine, Nizatidine, Roxatidine
Anticholinergics: Dicyclomine, Pirenzepine
Prostaglandin analogues: Misoprostol, Enprostil
b. Neutralization of gastric acid: Antacids (Calcium
carbonate, Magnesium hydroxide)
c. Ulcer protective: Sucralfate, Bismuth subsalicylate
d.Anti- H. pylori drugs: Amoxicillin, Tetracycline,
Clarithromycin, Metronidazole

2. List 4 proton pump inhibitors and three H2 blockers

ANS;
Proton Pump inhibitors 3 H2 blockers
- Omeprazole - Cimetidine
- Pantoprazole - Ranitidine
- Lansoprazole - Nizatidine
- Rabeprazole
3. Write MOA of Omeprazole and Ranitidine
ANS;
MOA of Omeprazole:
- irreversible inhibition of proton pump and inhibit gastric
acid secretion.

prodrug---- after absorption, diffused into acidic

environment of canaliculi of parietal cell----get activated
and changed into active form(ionized)-----Active form
binds covalently with H+K+ATPase(proton pump)------
irreversible inactivation of the pump(covalent bond)----
inhibition of HCl secretion.

##Inhibit both fasting and stimulated acid secretion. Imp.

Role in final step of gastric acid secretion (basal and
stimulated)
MOA of Ranitidine:
- competitive inhibition of H2 blocker on parietal cell and
inhibit gastric acid secretion.
## suppress all phases (basal, cephalic and gastric) of acid
secretion; mainly effective in suppressing nocturnal acid
secretion.
4.Differentiate between H2 blockers and Proton Pump
Inhibitors.
ANS;
H2 Blockers PPIs
Onset of Within 1 hr. Can take upto 4
action days to take
effect.

Duration of Lasts about 9-12 hrs. Lasts 24 hrs upto

action 3days.

Mechanis Block the histamine Shut down the

m of action receptors in parietal cells proton pump in
to decrease the amount of these cells and
acid produced (although preventing the
there are other stimuli so acid from being
that some acid is still secreted into the
produced). stomach.
Block one of the first Block final step in
stimuli for acid the pathway of
production. acid secretion in
the stomach.
Efficacy Lesser acid suppression. Greater acid
suppression. This
is due to the fact
that other
 stimuli, in
addition to
histamine 2,
stimulate acid
production in the
stomach and H2-
blockers only
block histamine
2.
Examples Cimetidine, Ranitidine, Omeprazole, Dex
Famotidine, Nizatidine lansoprazole,
Rabeprazole,
Lansoprazole
Common Ranitidine Pantoprazole
dosages 150 mg PO BID 20mg PO daily.

5. Why are PPI given once daily in morning?

ANS;
There is empty stomach in the early morning. Food
decreases absorption of PPIs. Therefore, PPIs are usually taken
in empty stomach in the morning followed 30-60 minutes later
by meal to increase absorption and to activate proton pump
making PPs more susceptible to it that maintains or increases
the efficacy of drug.
Now, the dosage timing in the morning better than other timing
like evening or nighttime can be understood with the following
fact. Intra gastric pH presents a circadian mode. Most acid is
produced in the morning time period compared to the late
night time. So, after a good night sleep of 8 hours, stomach is
empty of food and has a pH around 4. Following a lunch intra-
gastric pH increases for the next few hours.  As we know, for
the PPIs to become activated low intra gastric PH is essential.
Thus, morning dosing is the most important is as it is the first
meal of the day that stimulates the largest number of proton
pumps to be turned on.

6. Why are PPI given in empty stomach?

ANS;
Food decreases absorption of PPIs. Therefore, PPIs are usually
taken in empty stomach followed 30-60 minutes later by meal
to increase absorption and to activate proton pump making PPs
more susceptible to it that maintains or increases the efficacy
of drug.

7.Omeprazole is used in bleeding peptic ulcer. Why?

ANS;
Omeprazole as a proton pump inhibitor is powerful acid
suppressing agent. It inhibits all phases of gastric acid secretion.
It has important role in blocking final step in the pathway of
acid secretion in the stomach while H2 blockers block one of
the first stimuli for acid production leaving the fact that other
stimuli, in addition to histamine 2, stimulate acid production in
the stomach. It is also superior to H2 blockers with the fact
that its onset of action is rapid and cause faster ulcer healing.
Bleeding is helped as a neutral pH facilitates platelet
aggregation. Thus, it is more efficacious and is well tolerated.
Hence, omeprazole is used in bleeding peptic ulcer.

8. What advice do you give to the patients to maximize

the effects of proton pump inhibitors?
ANS;
- Take the drug in empty stomach once daily in the morning
and take meal 30-60 minutes later.
- Don’t chew or crush the tablet/capsule inside mouth.