Continuing Professional Development For Pharmacists On Peptic Ulcer Disease

What do you need to learn

This Continuing Professional Development for the role of pharmacist

Reflection:

1. What do you need to learn?

2. How is this learning relevant to the safe and effective practice of pharmacy?

3. Why do you think that this learning may be useful for your future practice?

4. What have you learnt?

5. Give an example of how what you have learned could be applied to patient care in your future role as a pharmacist

6. What have been benefits of these activities to your learning?

According to the given literature review on peptic ulcer disease (PUD), I have come across the clinical manifestations, condition and diagnosis of the disease. This, in particular, includes an understanding of the associated factors in relation to PUD. Therefore, I need to learn about the various effective strategies that need to be implemented for providing proper education and management of risk factors to patients in association with development and recurrence of the peptic ulcer. I need to learn about the suitable methods and steps that need to be taken for encouraging patients to remain abstain from drinking and smoking. I also need to have detailed knowledge regarding the pathophysiology of the disease, which includes understanding the causes and interventions associated with the disease. I need to understand the basic principles of the associated diagnosis process for proper implementation of the various kinds of medical processes associated in relation to PUD. The understanding process also includes knowing the advantage of using endoscopy over other available methods of diagnosis that includes first line therapy and other associated methods that primarily causes bleeding. I also need to acquire knowledge regarding the manifestations of the disease for providing proper support and care to the patient.

Learning of the clinical manifestations, condition and diagnosis of PUD process will help in understanding the rationale regarding the several consequences and factors associated with PUD. The process will also help in understanding the primary cause and the symptoms associated with PUD. This includes a detailed study of the bacterial model H. pylori and its role for causing PUD. The learning will also provide guidelines to develop knowledge regarding the imbalance caused between mechanisms, which protect the epithelium, and agents that attack such as pepsin, NSAIDs and bacteria. The understanding will also help to develop knowledge regarding the role of important factors, which plays a key role in the epithelial defence system. This learning also facilitates in understanding the role prostaglandins in terms of epithelial protection associated with the activities of Cyclooxygenase (COX) enzyme. Thus, in brief, the learning facilitates in understanding the aetiology and epidemiology of PUD. The understanding will help the pharmacists to develop and prescribe small doses of NSAID drugs in order to reduce the chances of developing the peptic ulcer in the future. In association with the safe and effective practice of pharmacy, the learning will also help the pharmacist to understand regarding the various kinds of diagnosis methods associated for safe removal of the ulcer.

How is this learning relevant to the safe and effective practice of pharmacy?

Learning regarding PUD helps the pharmacist to develop knowledge regarding a system of planned and structural design for imparting information which emphasizes on the risk factors influencing the development of the infection and prevention of peptic ulcers. The learning process also imparts knowledge upon the risk factors associated with this particular disease which includes factors like an infection by H. pylori, use of NSAIDs, drinking, cigarette smoking, spicy food, stress which leads to the development of the ulcer. The learning process also plays a key role in understanding the relationship between human beings and the bacteria H. pylori in terms of physiological consequences of the infection produced and the subsequent disease state. The learning will also help in acquiring knowledge regarding the clinical features which primarily includes complications like perforation and bleeding which is a common factor associated with peptic ulcer. Proper knowledge and learning regarding PUD will also help in knowing the primary symptoms that remains associated with the onset of PUD which includes anaemia, loss of appetite, excessive vomiting and other complication and thereby will help the pharmacist to take immediate and effective step. The understanding also helps in implementation of effective diagnostic processes which includes endoscopy and the other related therapies for establishing satisfaction among patients.

In accordance with the present topic, I have learnt that a sore in the inner lining of the upper small intestine or stomach is primarily responsible for causing a peptic ulcer. With the breakdown of the mucosal membrane of the stomach or small intestine, digestive juices containing hydrochloric acid and an enzyme called pepsin, causes potential damage to the intestinal and stomach tissues. Peptic ulcer diseases (PUD) are primarily divided into two main types-1) Gastric ulcers (formed in the stomach), 2) Duodenal ulcers (formed in the upper small intestine).

From the given literature review, I have also learnt that peptic ulcers are caused by several factors. The primary factors include infection with Helicobacter pylori (H. pylori) and use of various kinds of nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, aspirin, ibuprofen etc, which are associated with a breakdown of the protective mucus layer. Although NSAIDs are most commonly used medicine for PUD throughout the world, complications are seen among older people using high doses of NSAIDs. This is because NSAIDs inhibit the rate-limiting enzyme Cyclooxygenase (COX) that plays a key role in synthesizing prostaglandins from arachidonic acid. COX-1 and COX-2 are the two main isoforms of COX. COX-1 stimulates the production of prostaglandins in the gastric mucosa while COX-2 is associated with prostaglandins production in the stomach, liver, kidney and intestines. Inhibition of the enzyme COX-1 in particular by non-selective NSAIDs results in the formation of peptic ulcers.

Furthermore, I have learnt that the primary symptoms associated with PUD include a burning, aching pain between the belly button and the breastbone, loss of appetite, which results in weight loss, nausea, perforation, bleeding, vomiting and bloating.

The present review also emphasizes the fact that peptic ulcers are more common in smokers than in non-smokers. It has been reported that smokers are associated with different kinds of chronic disorders, which includes systematic mastocytosis (abnormal infiltration of the mast cells), pulmonary diseases, renal disorders and cirrhosis.

From the present literature review, I have also learnt that the commonly used clinical practice associated with PUD includes Endoscopy, Radiology, Proton pump inhibitor therapy (PPI), Prophylaxis (particularly applied to individuals associated with NSAIDs).

Learning and understanding of the PUD will help in spreading general awareness among people by evaluating patients requirements, thoughts, beliefs and perspectives for treating the clinical symptoms. The finding will assist me to develop a condition that promotes maintenance of proper health and hygiene as bacterial contamination rapidly spreads through air and water. Individuals shall not be allowed to come in direct contact with the patient diagnosed with the disease. I will be in a unique position to encourage people to remain abstain from drinking and smoking and in the case where it is not possible to cut off the bad habits introduction to other therapies needs to be offered. I will acquire knowledge to make a recommendation for use of small doses of NSAID to slow down the risk of ulcer complications in the future. Furthermore, the present finding will help me in spreading increased awareness among people with O blood group in particular as because the bacteria H. pylori has high affinity to bind specifically to the antigen of blood group ‘O’. Thus, this will further assist me for providing additional education primarily emphasizing the importance of the widely available diagnostic methods for proper administration of the drug therapies.

Activities undertaken during understanding and learning of PUD will help the people to provide proper education regarding the symptoms and course of diagnostic processes. The benefits also includes knowing about the type of ulcer that has been formed. Peptic ulcer depending upon the shape and size is categorized as type 1,2,3,4 and 5 which defines different stages of the ulcer. The activities will also help in providing effective awareness and knowledge regarding the causes of the disease. Activities will also encourage the people to use NSAID at very small doses in order to counter effect the harmful effects NSAID which itself is associated with the development of an ulcer or may be prescribed for using analogues of prostaglandins. The activities will also help in developing ideas regarding various kinds of medical therapies associated in the treatment of ulcer and what methods shall need to be implemented depending upon the shape, size and the course of development of the ulcer. The learning benefits also include the understanding of the treatment that needs to be followed after endoscopy and the choice regarding the first line therapy. This will also benefit in providing knowledge regarding the other diagnostic methods associated in case if patients with PUD are not confirmed with endoscopy.