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Peptic Ulcer Disease PHARMACY ech opicsTM BY ICHP Home-Study Continuing Pharmacy Education MODULES for Nationally Certified Pharmacy Technicians OCTOBER 2010 VOLUME 15 NUMBER 4 PEPTIC ULCER DISEASE THIS MODULE MUST BE SUCCESSFULLY COMPLETED BY OCTOBER 31, 2012 Pharmacy Tech TopicsTM is provided as a free service TO RECEIVE CPE CREDIT to all Pharmacy Technician Members of the American Society of Health-System Pharmacists. Peptic Ulcer Disease Pharmacy Tech Topics™ VOLUME 15 ISSUE 4 OCTOBER 2010 PEPTIC ULCER DISEASE EDITOR: Patricia M. Wegner, PharmD, FASHP DESIGN EDITOR: Barbara J. Yahn Pharmacy Tech Topics™ (USPS No. 014-766) is published quarterly for $50 per year by the Illinois Council of Health-System Pharmacists, 4055 N. Perryville Road, Loves Park, IL 61111-8653. Phone (815) 227-9292. Periodicals Postage Paid at Rockford, IL and additional mailing offices. POSTMASTER: Send address changes to: Pharmacy Tech Topics,™ c/o ICHP, 4055 N. Perryville Road, Loves Park, IL 61111-8653 Copyright OCTOBER 2010 All contents ! 2010 Illinois Council of Health-System Pharmacists unless otherwise noted. All rights reserved. Pharmacy Tech Topics™ is a trademark of the Illinois Council of Health-System Pharmacists. This module is accredited for 2.5 contact hours of continuing pharmacy education and is recognized by the Pharmacy Technician Certification Board (PTCB). LEARNING OBJECTIVES Upon completion of this module, the subscriber will be able to: 1. Describe the pathophysiology of peptic ulcer disease. 2. List the risk factors for developing peptic ulcer disease and the symptoms of peptic ulcer disease. 3. Identify the medications used for the initial therapy and maintenance therapy of peptic ulcer disease. 4. Recognize the appropriate dosage of medications used for peptic ulcer disease. 5. Explain the importance of patient adherence to the treatment plan for peptic ulcer disease. Accreditation: Pharmacy Tech TopicsTM Modules are accredited for Continuing Pharmacy Education (CPE) credits by the Illinois Council of Health-System Pharmacists. The Illinois Council of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. !2010 Illinois Council of Health-System Pharmacists. Pharmacy Tech TopicsTM is a trademark of the Illinois Council of Health-System Pharmacists. The intended audience is pharmacy technicians. This module will provide 2.5 hours of continuing pharmacy education credit for certified pharmacy technicians. ACPE Universal Activity Number: 121-000-10-004-H01-T Type of Activity: Knowledge Validation Dates: 10/01/10 to 10/31/12 3 PHARMACY TECH TOPICSTM — OCTOBER 2010 Pharmacy Tech TopicsTM RENEWAL information for 2011 found on page 25 of this module. Renew Now for 2011! Pharmacy Tech TopicsTM OCTOBER 2010 FACULTY DISCLOSURE It is the policy of the Illinois Council of Health-System Pharmacists (ICHP) to insure balance and objectivity in all its individually or jointly presented continuing pharmacy education programs. All faculty participating in any ICHP continuing pharmacy education programs are expected to disclose any real or apparent conflict(s) of interest that may have any bearing on the subject matter of the continuing pharmacy education program. Disclosure pertains to relationships with any pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter of the topic. The intent of disclosure is not to prevent the use of faculty with a potential conflict of interest from authoring a publication but to let the readers know about the relationship prior to participation in the continuing pharmacy education activity. It is intended to identify financial interests and affiliations so that, with full disclosure of the facts, the readers may form their own judgments about the content of the learning activity. Dr. Sneha Srivastava’s submission has been peer reviewed with consideration and knowledge of these potential conflicts and it has been found to be balanced and objective. The author has no real or apparent conflict(s) of interest that may have any bearing on the subject matter of this continuing pharmacy education program. NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The author and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the author nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this module is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. 4 Peptic Ulcer Disease Meet the Author Sneha Srivastava, PharmD Sneha Srivastava, PharmD is an Assistant Professor of Pharmacy Practice at Chicago State University College of Pharmacy. Dr. Srivastava received her Doctor of Pharmacy degree in 2004 from the Ernest Mario School of Pharmacy at Rutgers University. She also completed a Pharmacy Practice Residency and then an Ambulatory Care Specialty Residency at the University of Illinois at Chicago. She served on the faculty of the University of Connecticut School of Pharmacy in Storrs, CT from 2006-2008. Dr. Srivastava’s clinical interests include diabetes, hypertension, hyperlipidemia, HIV/AIDS, and tobacco dependence, ambulatory and community care, as well as patient education and outreach. Her research interests include medication adherence and health psychology in conjunction with the aforementioned disease states as well as the scholarship of teaching. PEPTIC ULCER DISEASE INTRODUCTION Figure 1. Diagram of the stomach Peptic ulcer disease (PUD) is defined as erosions in the gastrointestinal tract secondary to mucosal damage often caused by pepsin and gastric acid secretion.1 The erosions penetrate the muscularis mucosa and usually occur in the stomach, pylorus, duodenum, jejunum, ileum, and near Meckel’s diverticula; erosions and gastritis usually do not penetrate the mucosa as deep. Helicobacter pylori (H. pylori) associated, nonsteroidal anti-inflammatory drug (NSAID)- induced and stress ulcers are the most common form of peptic ulcers. The stomach and duodenum are the most common places for NSAID-induced and H. pylori ulcers to occur while stress ulcers more often occur in the 2 critically ill patient’s stomach. Peptic ulcer Reprinted with permission from the National Digestive Diseases disease has a 60 to 100% rate of ulcers Information Clearinghouse. reoccurring within one year of initial ulcer. http://digestive.niddk.nih.gov/ddiseases/pubs/pepticulcers_ez/index.htm 5 PHARMACY TECH TOPICSTM — OCTOBER 2010 Epidemiology anatomy and physiology of the alimentary canal, also know as the gastrointestinal (GI) tract, in There are many theories about the etiology particular the parts of the GI tract that may be of peptic ulcers because of the shift in the affected by the ulcers. The GI tract includes the patterns of gastritis. The first description of a mouth, pharynx, esophagus, stomach, small gastric ulcer was made in 1835 and in the intestine, and large intestine. The process of beginning, gastric ulcers were found mostly in digestion begins with mastication, where food is young females. In the 1900s, duodenal ulcers chewed and mixed with saliva followed by became more prevalent and the total number of deglutition, the act of swallowing. The food ulcers diagnosed increased as well. Theories passes through the pharynx and esophagus state that environmental factors such as better prior to reaching the stomach, where gastric transportation and refrigeration of food, leading digestion transforms it to chyme, a liquid or to the use of fewer preservatives, especially salt, semiliquid consistency, by way of peristalsis or caused the shift in patterns. Also, the more muscular contractions. Chyme then travels developed countries have a lower incidence of through the duodenum on its way to the H. pylori because of better hygiene.3 small intestine. Simultaneously, the mucous The annual incidence of peptic ulcers is 0.1 membrane of the stomach is secreting gastric to 0.3%, increasing to 1% in patients with juice produced by both the sight of food and H. pylori. The lifetime prevalence is 5 to 10% irritation on the mucous membrane due to the (versus 10 to 20% in patients with H. pylori). In presence of food in the stomach. Gastric juice, a western countries, the occurrence of ulcers is thin colorless liquid with a normal acidity level of similar in both sexes (although duodenal ulcers 0.02%, contains hydrochloric acid, pepsinogen, were twice as common in men in the past); while rennin, water, ammonium, calcium, potassium, in Asian
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