4.

3 PEPTIC ULCER DISEASE

Table 4.3a: FREQUENCY & PERCENTAGE WISE DISTRIBUTION OF
MEDICATIONS IN
MEDICATION HISTORIES OF PUD

DRUG CATEGORY GENERIC DRUGS FREQUENCY PERCENTAGE

ANTIBIOTICS
MACROLIDE Clarithromycin 4 10
QUINOLONES Ciprofloxacin 2 5
PENICILLIN Amoxicillin 4 10
PROTON PUMP Omeprazole 4 10
INHIBITOR Esomeprazole 2 5
H2-BLOCKER ranitidine 2 5
TRICYCLIC Dothiepen 1 3
ANTIDEPRESSENT
LAXATIVE Lactulose 4 10
SAMATOSTATIN octreotide 2 5
ANALOGUE
ANTI-DOPAMINERGIC Metoclopramide 5 13
Domperidone 1 3
BETA BLOCKER propranolol 1 3
ANTI HEOMRRAGHIC Vitamin k 1 3
BLOOD PLASMA haemaccel 3 8
SUBSTITUE
CYTOPROTECTIVE Sucralfate 1 3
AGENT
MULTIVITAMIN 1 3
DIURETICS
Potassium sparing diuretics spironolactone 1 3
Loop diuretics frusemide 1 3
MISCELLENIOUS Topical steroid 1 3
Allupurinol 1 3
TOTAL DRUGS=42

Figure 4.3a

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PERCENTAGE WISE PRESENTATION OF MEDICATIONS IN
MEDICTAION HISTORIES OF PUD

Topical steroid
2%
Frusemide
2%

Spironolactone Allupurinol
2% 2%
Clarithromycin
Multivitamin 10%
Ciprofloxacin
2%
5%
Sucralfate
2%
Haemaccel Amoxicillin
7% 10%

Vitamin k
2%
Propranolol
2%
Domperidone Omeprazole
2% 10%

Metoclopramide
12% Esomeprazole
5%

Ranitidine
Octreotide
Dothiepen 5%
5%
Lactulose 2%
10%

DISSCUSION OF PHARMACOTHERAPY

75
In 6 peptic ulcer disease cases 66% were reported as H Pylori induced and 33% as
NSAID induced as the H Pylori prevalence exceeds by geographic location,
socioeconomic conditions and ethnicity. 50% of reported 6 cases of peptic ulcer
disease were comorrbid with cirrhosis as the Cirrhotic have an increased risk of
developing gastric or duodenal ulcers
(Berardi RR, Welage LS.2005).
In the 6 PUD cases therapy was initiated with PPI-based three-drug regimen that is
amoxicillin, clarithromycin, Omeprazole/Esomeprazole. The frequency of use of
these drugs in 6 cases were amoxicillin 4(10% of all drugs used), clarithromycin
4(10% of all drugs used), Omeprazole 4(10% of all drugs used) and Esomeprazole
2(5% of all drugs used).use of this HP eradication regime is associated with higher
eradication rates and less antimicrobial resistance. (Feldman Mark. 2005).
The Omeprazole used in peptic ulcer cases were 10% of all drugs used and
Esomeprazole 5% of all drugs used because Omeprazole used in duodenal ulcers for
healing, maintain healing, for eradication of HP and prevention of re-bleed where as
the Esomeprazole used in hp eradication, although the drug interaction and ADRs are
less than Omeprazole. (Li XQ, Andersson TB, Weidolf Lars, et al.2003)
Among all H2 blocker Ranitidine was used majorly 2(5% of all drugs used)
Metoclopramide is given in 5(13% of all drugs used) for the symptomatic relief,
tricyclic antidepressant 1(dothiepen 3% of all drugs used), and haemaccel 3(plasma
substitute 8% of all drugs used).

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Table 4.3a: FREQUENCY & PERCENTAGE WISE DISTRIBUTION OF
ETIOLOGY IN MEDICATION HISTORIES OF PEPTIC ULCER DISEASE

ETIOLOGY FREQUENCY %AGE

PUD H PYLORI 4 66%
PUD NSAID INDUCED 2 33%

Table 4.3b: FREQUENCY & PERCENTAGE WISE DISTRIBUTION OF

COMORRBID PEPTIC ULCER DISEASE
DISEASE FREQUENCY %AGE
PEPTIC ULCER(ONLY) 3 50%
PEPTIC ULCER COMORBID 3 50%
CONDITION
(PUD WITH CIRRHOSIS)
TOTAL CASES=6

Table 4.3c: FREQUENCY & PERCENTAGE WISE DISTRIBUTION OF

DRPs IN MEDICATION HISTORIES OF PEPTIC ULCER DISEASE
DRUG RELATED FREQUENCY PRCENTAGE
PROBLEM
Improper drug selection 1 3
Excessive dosage 3 8
Drug interaction 3 8
Non compliance 2 5
Requiring dose adjustment 3 8
in hepatic impairment
Cost related problem 22 57
Miscellaneous problem 4 11
Total problems=38

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Figure 4.3a: PERCENTAGE WISE PRESENTATION OF DRUG
RELATED PROBLEMS IN MEDICATION HISTORIES OF
PEPTIC ULCER DISEASE
Improper drug
Miscellaneous selection Excessive dosage
problems 3% 8%
11%

Drug interactions
8%

Non compliance
5%

Requiring dose
adjustment in
hepatic impairment
8%

Cost related
problems
57%

DISCUSSION OF DRPs

Among 6 patients of peptic ulcer disease total 38 drug related problems were
identified. The most common drug related problem was cost related problem that
were 22(57% of DRP) and problems requiring dose adjustment in hepatic
impairment were 3(8% of DRP) and excessive dosage 3(8% of DRP), that requires
Omeprazole to be reduced to 20mg daily in cirrhotic patient. Drug interaction were
3(8% of DRP) that was of significant rating 3 and delayed onset with minor severity
and suspected documentation for which no special action was needed. Improper drug
selection 1(3% of DRP) Allupurinol was prescribed for joint pain where as
Nimusilde or Celecoxib is the drug of choice for joint pain. other DRP were non
compliance 2(5% of DRP) and miscellaneous 4(11% of DRP) that comprises
Counselling problems, in case of quinolone administration no counselling has been
done about milk intake along with ciprofloxacin intake because it has interaction
with milk of significant rating-2(onset rapid, severity moderate and suspected
documentation).proper counselling should be done to patient to avoid milk intake
but if milk can not be avoided lengthen the intake of milk and drug as much as
possible.
status of alternative efficacious and cost effective drugs were listed in each case, so
in order to promote rationalization of drug therapy patient socioeconomic status
should be considered before prescribing the drugs. Patient education about the drug
therapy should be done to avoid compliance problem.

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