A patient is diagnosed with Zollinger-Ellison syndrome. Which of the following would be the most appropriate pharmacotherapy?
The patient in this question was diagnosed with Zollinger-Ellison syndrome. One of the most impoant initial measures in the treatment of this condition is to control the acid hypersecretion. Proton pump inhibitors, such as omeprazole, rabeprazole, pantoprazole, and lansoprazole, are given at a dose of 40-120 mg/day, and titrated to achieve a basal acid output of In standard doses, proton pump inhibitors inhibit 90-98% of 24-hour acid secretion. Proton pump inhibitors undergo rapid first-pass and systemic hepatic metabolism and have negligible renal clearance. Also know: Erythropoietin is a glycoprotein, normally produced in the kidneys, that stimulates stem cells to differentiate into rubriblasts, increases the rate of mitosis, increases the release of reticulocytes from the bone marrow and increases hemoglobin (Hgb) formation. EPO is indicated for the treatment of anemia associated with chronic renal failure, zidovudine therapy, chemotherapy, and for reduction of allogeneic blood transfusions in surgery patients. Famotidine is an H2-antagonist that decreases gastric acid secretion by competitively and reversibly inhibiting histamine receptors on parietal cells. Although famotidine could potentially be used in the treatment of Zollinger-Ellison syndrome, a proton pump inhibitor is a more appropriate treatment measure. Fluorouracil or 5-FU, is an example of an antimetabolite that blocks the methylation reaction of deoxyuridylic acid to thymidylic acid. This results in interference with DNA synthesis, and to a lesser extent, RNA synthesis. 5-FU is indicated for the palliative management of colon rectum, breast, stomach and pancreatic carcinoma. Ref: McQuaid K.R. (2012). Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds),Basic & Clinical Pharmacology, 12e.
Erythropoietin
Famotidine
Fluorouracil
Omeprazole