LAM Extra for General Practicioners - 2009;1(02)

LAM Extra for General Practicioners

APRIL 21, 2009

[USE OF DRUGS FOR GASTRIC ACID REDUCTION IN GENERAL PRACTICE]

HAJNAL Ferenc

[In order to facilitate (general) practitioner’s therapeutic decisions, this overview reviews advantages and disadvantages of three drug classes used for acid reduction, as to antacids, histamine 2-receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). The possibilities and mechanisms of gastric acid reduction are detailed. This can be achieved either by neutralization of gastric acid by systemic or non-systemic antacids, or by inhibiting acid secretion by H2RAs and PPIs. PPIs are the strongest acid reducing agents indispensable in gastro-esophageal reflux disease (GERD), eradication therapy for Helicobacter pylori ulcers and Zollinger- Ellison syndrome, and they are first choice in non-steroidal anti-inflammatory drug (NSAID) induced gastropathy, epigastric pain syndrome, and functional upper GI dyspepsia. Nonetheless, antacids and H2RAs are faster in relieving pain in the latter pain syndrome and in acute heartburn. Contraindications and adverse effects of these three drug classes are also detailed. The author has concluded that physicians’ up-to-date awareness of these compounds’ pharmacological properties contributes to their ability to tailor acid reduction therapy to patients’ individual needs. Refreshing and expanding this knowledge will finally benefit patients seen in everyday practice.]

LAM Extra for General Practicioners

APRIL 21, 2009

[THE IMPORTANCE OF THE RECOGNITION AND TREATMENT OF LIPID METABOLISM DISORDERS IN THE SECONDARY PREVENTION OF CEREBROVASCULAR DISEASES]

FOLYOVICH András, HORVÁTH Eszter

[The high world prevalence of cerebrovascular diseases, and the particularly bad morbidity rates of Hungary are well known. The physiological properties of the brain make stroke prevention outstandingly important. Effective prevention will be reflected in the reduction of the late complications that are otherwise common and expensive to treat. Because of the common simultaneous development of stroke, cardiovascular and peripheral vascular diseases, overall vascular disease prevention is preferred, even if the various vascular diseases manifest in different degrees in a patient. Hungarian data also indicate the high risk of recurrence of cerebrovascular diseases, therefore, the importance of secondary prevention is obvious. Large international studies have proven the strokepreventing effect, and, by a pleiotropic drug action, additional benefits, of the efficient treatment of blood lipid disorders. Consensus conferences in recent years defined clear and even stricter lipid-lowering target values, mostly to be reached by “double inhibition”, bile acid binding resins, fibrates and nicotinic acid derivatives, beside the most common statin treatment. Neurological and stroke departments and clinics play a pivotal role in vascular prevention.]