Jaira-D

Rabeprazole 20mg & Domperidone 30mg Capsules

Pantoprazole significantly interferes with antiplatelet effect of clopidogrel:

Result of a pilot randomized trial-2013

Maria Serena Parri a,*,Jacopo Gianetti a, Ana Dushpanova c, Francesca Della Pina c, Claudia Saracini b, Rossella Marcucci b, Betti Giusti b, Sergio Berti a

This is the first documentation in a randomized trial, after correction for the bias of CYP2C19*2 polymorphism, that pantoprazole increases the ADP- MA in patients treated with dual antiplatelet therapy

  • Int J Cardiol .2013 Sep 1;167(5):2177-81.
  • International journal of cardiology IF -3.471

Differential Diagnosis 2-Acute Coronary Ischemia

  • Family history
  • Hypertension
    Stress (can it develop cardiopathy)
  • Pain reported at the subxiphiod area; was found to have tenderness in that area of palpation,
  • The symptoms associated with myocardial infraction are highly variable and seldom report the classic characteristic and location if disease
  • Use of cocaine may precipitate acute myocardial infraction, coronary atheroscle plaque disruption, vasospasm , spontaneous coronary artery dissection.
  • The history of pain after eating , the insidious onset and abrupt worsening of symptoms and the reproductible pain on palpation.
  • The ST on ECG din not clearly indicate a “current of injury” pattern
  • Test for the troponin I was negative.

Differential Diagnosis 3-Aortic Dissection

  • Hypertension could be a reflection of stress or clinically significant pain but also indicate underlying vascular mortic disease.
  • Rare in young patients.
  • Post prandial onset of symptoms
  • The development of arotic dissection is more common preceded by a provisional such as lifting of heavy weight followed by the abrupt onset of severe (“tearing) pain in the interscapular ,chest ,or abdominal region .
  • No symmetric pulses ,bruits, and diastolic murmur) on clinical eaxamination.

Differential Diagnosis 1-Pericardial Disease

    • In a patient with acute chest pan, the presence of PR-segment deprssions in some leads (II, III, and aVF)and an elevated PR segment in lead a VR may be indicative of acute pericarditis.
    • Pericarditis may develop after exposure to infectious illness.(Wife had respiratory illness).
    • Pericarditic chest pain may have an abrupt onset.
    • The pain is not typivally exacerbated by eating and is often positional in nature, and these features are consistent with with the pain that this patient described
    • A pericardial fiction rub was not identified on examination
    • Aspirin had not lessened the pain.

 

FIGURE 1 Satisfactory relief of day time heartburn and regurgitation (in patients who had both heartburn and regurgitation)

Interventions in the Hospital

  • Aspirin,
  • Clopidogrel,
  • Intravenous morphine sulphate,
  • Lorazepam,
  • Esomeprazole, Rabeprazole
  • Glipzide +Metformin,
  • Aluminum hydroxide-diphenhydramine-Iidocaine-magnesium Hydroxide, and
  • Intravenous infusion of heparin and nitroglycerin were administered

Differential Diagnosis 4-Acute Vascular Disease

  • Acute mesenteric ischemia ? severe pain in the subxiphoid area after food.
  • Use of narcotic drugs –no findingson examination to suggest peripheral embolization
  • Blood amylase and lipase levels were not elevated.
  • Fibromuscular dysplasia in the renal arteries could lead to hypertension in a young patient; but history & examination did not support this diagnosis.
  • Spulmonary embolism? Pain is not pleuritic in nature , No tachycardia, No hypoxemia.

“Rabeprazle effectively prevented gastric mucosal damage induced by dual therapy with LDA(Low Dose Aspirin) and clopidogrel, especially in H pylorinagative CYP2V19 intermediate matebolizers (IMs), and poor metabolizers (PMs), without attenuation of the antiplatelet effects of clopidogrel or LDA”

 

Summary of evidence for efficacy of treatment pproaches for functional dyspepsian

Co Rx of Amitriptyline in functional dyspepsia is effective and safer with Rabeprazole

In a double blind trail, imipramine 25mg daily for 8 weeks on 83 functional dyspepsia patients, there was a significant improvement in quality of life (American J of Gastro 2016;111:217-224)