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Gastritis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Proton pump inhibitors reduce acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium).1
Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Pancreatic cancers are considered to be unresectable when they are diagnosed, due to metastases. Based on tumor location, surgery is performed. External beam radiation therapy is often used. Chemotherapy and radiation combinations may be also used. If there are liver or distant metastases, chemotherapy may be used. For moderate to severe pain, oral opioids are administered. Pain control is more important than any concern about addiction. Long-acting preparations are good for chronic pain, and include transdermal oxymorphone, oxycodone, or fentanyl. Exocrine pancreatic insufficiency is treated with oral pancrelipase. Dosage is based on symptoms, the amount of steatorrhea, and dietary fat content. Proton pump inhibitors or H2-blockers may also be required. If diabetes mellitus is present, it must be monitored and controlled with care.
Application of Bioresponsive Polymers in Drug Delivery
Published in Deepa H. Patel, Bioresponsive Polymers, 2020
Manisha Lalan, Deepti Jani, Pratiksha Trivedi, Deepa H. Patel
Poly(methacrylic acid-co-methyl methacrylate) (Eudragit L, S, and F), hydroxypropylmethylcellulose phthalate and HPMC acetate succinate, they have carboxyl groups on the polymer side chains. These polymers are insoluble at low gastric pH but soluble at neutral intestinal pH. There are countless research studies and even significant number of products in the market which are based on such polymers. They are very apt for acid-labile products and offer a cost-effective solution to drug delivery issues. The proton pump inhibitors are a group of drugs which is well known for its acid sensitivity have been extensively investigated for such applications. A number of formulations like enteric-coated tablets, capsules, beads, granules, etc., have been developed. Not even small molecules but large molecules like bovine serum albumin (BSA) has also been encapsulated in such enteric-coated microspheres which displayed negligible drug release at pH 1.0 but ensure unimpeded release at pH 6.8.
Impact of a multifaceted intervention on non-guideline-recommended prescribing of acid suppressive medications for stress ulcer prophylaxis in critically ill patients
Published in Current Medical Research and Opinion, 2023
Furong Han, Chao Zhang, Tong Li, Zhihui Song, Shanshan Xu
An early IV to PO switch can reduce the risk of venous catheter infections, shorten hospitalization stay, and reduce medical expenditure. From the viewpoint of bioavailability, antibiotics, antacids, and antifungal agents are suitable for IV to PO conversion.15. Oral proton pump inhibitors have similar efficacy to intravenous formulations because of their high bioavailability28. Although IV to PO conversion is common in many countries, few clinicians perform IV to PO conversion on patients in China29,30. No research about IV to PO conversion has been studied in ICUs in China. By analyzing data from the pre-intervention period, we observed that 37.1% of ICU patients who received intravenous therapy were not timely converted to oral therapy. The main barrier restricting IV to PO conversion is the wrong concept of physicians that the bioavailability of oral dosage forms is much lower than that of intravenous formulations. In addition, intensivists are surrounded by busy medical work and have no time or consciousness to pay attention to which patients need to switch from intravenous to oral therapy. In our study, the pharmacists collaborated with clinicians to implement the conversion practice to overcome this barrier. Through the implementation of our multifaceted intervention, the rate of patients switching from IV to PO therapy timely was increased by 18.9%.
Diagnostic performance of endoscopy for subsquamous extension of superficial adenocarcinoma of the esophagogastric junction
Published in Scandinavian Journal of Gastroenterology, 2023
Kazunori Takada, Yohei Yabuuchi, Tatsunori Minamide, Yoichi Yamamoto, Masao Yoshida, Yuki Maeda, Noboru Kawata, Kohei Takizawa, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono
All white-light endoscopic images, chromoendoscopy images following dyeing with indigo carmine, and narrow-band images with and without magnifying endoscopy were reviewed. Gastric atrophy (no atrophy, closed type or open type), longitudinal location (tumor center above, on or below the EGJ), circumferential location (anterior wall, right wall, posterior wall, left wall or circumferential), tumor size, macroscopic type (flat type, 0-IIa and 0-IIb; depressed type, 0-IIc and 0-IIa + IIc; and protruded type, 0-I and 0-I + IIa), and the presence of Barrett’s esophagus were evaluated. Gastric atrophy was diagnosed as the presence of a pale color, increased visibility of the mucosal vessels and a loss of the gastric folds [23] and subclassified according to the Kimura-Takemoto classification system [24]. The Helicobacter pylori (H. pylori) infection status was evaluated using H. pylori IgG antibody testing (cut-off value: 10 U/mL). Data on medication with proton pump inhibitor (PPI) were collected. Barrett’s esophagus was defined as an endoscopically-confirmed columnar epithelial metaplasia continuously extending from the stomach to the esophagus [25].
Clinical pharmacology of antiplatelet drugs
Published in Expert Review of Clinical Pharmacology, 2022
Georg Gelbenegger, Bernd Jilma
Proton pump inhibitors (PPI) are known CYP2C19 substrates and show different potency to inhibit CYP2C19 [82]. PPIs are often co-administered with aspirin and P2Y12 inhibitors to prevent gastrointestinal bleeding. Omeprazole, a widely used PPI, is metabolized to hydroxyomeprazole and omeprazole sulfate primarily by CYP2C19 and CYP3A4 [83]. However, it shows a greater affinity for CYP2C19 and therefore has a greater potential for drug-drug interactions mediated by CYP2C19 [84]. Clopidogrel relies heavily on hepatic bioactivation by CYP2C19, and concomitant use with omeprazole has consistently been shown to attenuate the antiplatelet effect of clopidogrel [85–90]. In contrast, pantoprazole does not attenuate clopidogrel responsiveness [91]. A meta-analysis of >150.000 patients indicates that proton pump inhibitor use was associated with an about 30% increase in major cardiovascular events, while gastrointestinal bleeding risk was reduced by about 50% [92].