Ppt on peptic ulcer drugs kdt based

Reading File

Finding Sources

Reading File

Finding Sources

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Running Command

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty"

Running Command

mkdir -p /home/daytona/workspace/peptic-ulcer-ppt && ls /home/daytona/workspace/peptic-ulcer-ppt

Writing File

~/peptic-ulcer-ppt/build.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Drugs for Peptic Ulcer Disease";

// ─── THEME ───────────────────────────────────────────────────────────────────
const C = {
  deepBlue:   "0D1B2A",   // dominant background
  midBlue:    "1A3A5C",   // card / panel
  accent:     "00B4D8",   // teal accent
  gold:       "F4A261",   // highlight / subheadings
  white:      "FFFFFF",
  lightGray:  "D0E4F0",
  softGreen:  "52B788",
  red:        "E63946",
  yellow:     "FFD166",
  pill:       "1B4F72",   // pill badge bg
};

const FONT  = "Calibri";

// ─── HELPER: Slide header band ────────────────────────────────────────────────
function addHeader(slide, title, subtitle) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 1.05,
    fill: { color: C.midBlue }
  });
  slide.addText(title, {
    x: 0.25, y: 0.08, w: 9.5, h: 0.6,
    fontFace: FONT, fontSize: 24, bold: true, color: C.accent,
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.25, y: 0.62, w: 9.5, h: 0.36,
      fontFace: FONT, fontSize: 13, color: C.lightGray, italic: true,
    });
  }
}

// ─── HELPER: Colored pill badge ───────────────────────────────────────────────
function pill(slide, text, x, y, color) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w: 1.6, h: 0.32,
    fill: { color: color || C.pill },
    line: { color: C.accent, width: 1 },
    rectRadius: 0.1,
  });
  slide.addText(text, {
    x, y, w: 1.6, h: 0.32,
    fontFace: FONT, fontSize: 10, bold: true, color: C.white, align: "center",
  });
}

// ─── HELPER: bullet list box ─────────────────────────────────────────────────
function bulletBox(slide, items, x, y, w, h, opts = {}) {
  const textArr = items.map((item, i) => ({
    text: item,
    options: { bullet: true, breakLine: i < items.length - 1, indentLevel: opts.indent || 0 }
  }));
  slide.addText(textArr, {
    x, y, w, h,
    fontFace: FONT,
    fontSize: opts.fontSize || 13,
    color: opts.color || C.lightGray,
    valign: "top",
    margin: 4,
  });
}

// ─── HELPER: Colored card ─────────────────────────────────────────────────────
function card(slide, x, y, w, h, title, items, titleColor, bgColor) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: bgColor || C.midBlue },
    line: { color: C.accent, width: 1 },
    rectRadius: 0.12,
  });
  slide.addText(title, {
    x: x + 0.12, y: y + 0.08, w: w - 0.24, h: 0.38,
    fontFace: FONT, fontSize: 14, bold: true, color: titleColor || C.gold,
  });
  const txtItems = items.map((t, i) => ({
    text: t, options: { bullet: { type: "bullet" }, breakLine: i < items.length - 1 }
  }));
  slide.addText(txtItems, {
    x: x + 0.12, y: y + 0.5, w: w - 0.24, h: h - 0.58,
    fontFace: FONT, fontSize: 11, color: C.lightGray, valign: "top",
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };

  // Full-width accent band at top
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.accent } });

  // Rx icon area (decorative circle)
  s.addShape(pres.ShapeType.ellipse, {
    x: 3.8, y: 1.0, w: 2.4, h: 2.4,
    fill: { color: C.midBlue },
    line: { color: C.accent, width: 3 },
  });
  s.addText("Rx", {
    x: 3.8, y: 1.4, w: 2.4, h: 1.4,
    fontFace: FONT, fontSize: 60, bold: true, color: C.accent, align: "center",
  });

  s.addText("DRUGS FOR PEPTIC ULCER DISEASE", {
    x: 0.5, y: 3.55, w: 9, h: 0.75,
    fontFace: FONT, fontSize: 30, bold: true, color: C.white, align: "center",
  });
  s.addText("KD Tripathi Classification  |  Pharmacology", {
    x: 0.5, y: 4.28, w: 9, h: 0.4,
    fontFace: FONT, fontSize: 16, color: C.gold, align: "center", italic: true,
  });
  s.addText("Based on Essentials of Medical Pharmacology", {
    x: 0.5, y: 4.72, w: 9, h: 0.35,
    fontFace: FONT, fontSize: 13, color: C.lightGray, align: "center",
  });

  // Bottom accent band
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.33, w: 10, h: 0.3, fill: { color: C.midBlue } });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – PATHOPHYSIOLOGY OVERVIEW
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "Peptic Ulcer Disease – Pathophysiology", "Imbalance between aggressive & defensive mucosal factors");

  // Two columns: Aggressive vs Defensive
  // Left: Aggressive
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.2, w: 4.2, h: 3.8, fill: { color: "3B0A0A" }, line: { color: C.red, width: 1.5 }, rectRadius: 0.12 });
  s.addText("🔴  AGGRESSIVE FACTORS", { x: 0.3, y: 1.2, w: 4.2, h: 0.45, fontFace: FONT, fontSize: 14, bold: true, color: C.red, align: "center" });
  bulletBox(s, [
    "HCl hypersecretion",
    "Pepsin activity",
    "H. pylori infection (gram-negative)",
    "NSAIDs / aspirin (↓PG synthesis)",
    "Bile reflux",
    "Smoking & alcohol",
  ], 0.42, 1.65, 4.0, 3.2, { fontSize: 12, color: C.lightGray });

  // Arrow in middle
  s.addText("⚡ vs", { x: 4.5, y: 2.6, w: 1, h: 0.5, fontFace: FONT, fontSize: 22, bold: true, color: C.yellow, align: "center" });

  // Right: Defensive
  s.addShape(pres.ShapeType.roundRect, { x: 5.5, y: 1.2, w: 4.2, h: 3.8, fill: { color: "0A2B1A" }, line: { color: C.softGreen, width: 1.5 }, rectRadius: 0.12 });
  s.addText("🟢  DEFENSIVE FACTORS", { x: 5.5, y: 1.2, w: 4.2, h: 0.45, fontFace: FONT, fontSize: 14, bold: true, color: C.softGreen, align: "center" });
  bulletBox(s, [
    "Mucus & bicarbonate layer",
    "Prostaglandins (PGE2, PGI2)",
    "Mucosal blood flow",
    "Epithelial restitution",
    "Surface-active phospholipids",
  ], 5.62, 1.65, 4.0, 3.2, { fontSize: 12, color: C.lightGray });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – KDT CLASSIFICATION
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "KDT Classification of Antiulcer Drugs", "KD Tripathi – Essentials of Medical Pharmacology");

  const groups = [
    { label: "1. Antacids",             color: "2E6B8A", items: ["Systemic: Na bicarbonate, NaHCO₃", "Non-systemic: Mg(OH)₂, Al(OH)₃, Mg trisilicate, CaCO₃"] },
    { label: "2. H₂ Blockers",          color: "1B5E4F", items: ["Cimetidine, Ranitidine*", "Famotidine, Nizatidine"] },
    { label: "3. Proton Pump Inhibitors",color: "4A2060", items: ["Omeprazole, Lansoprazole", "Pantoprazole, Rabeprazole", "Esomeprazole, Dexlansoprazole"] },
    { label: "4. Anti-H. pylori",        color: "5A3010", items: ["Triple / Quadruple therapy", "Clarithromycin, Amoxicillin", "Metronidazole, Tetracycline, Bismuth + PPI"] },
    { label: "5. Mucosal Protectives",   color: "1B5220", items: ["Sucralfate, Bismuth subsalicylate", "Misoprostol (PGE₁ analogue)", "Carbenoxolone"] },
    { label: "6. Anticholinergics",      color: "3D1A00", items: ["Pirenzepine (M₁ selective)", "Propantheline (not preferred)"] },
  ];

  const cols = 3;
  const cw = 3.1, ch = 2.0;
  const startX = 0.2, startY = 1.12;
  const gapX = 0.18, gapY = 0.15;

  groups.forEach((g, i) => {
    const col = i % cols;
    const row = Math.floor(i / cols);
    const x = startX + col * (cw + gapX);
    const y = startY + row * (ch + gapY);
    s.addShape(pres.ShapeType.roundRect, { x, y, w: cw, h: ch, fill: { color: g.color }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 });
    s.addText(g.label, { x: x + 0.1, y: y + 0.06, w: cw - 0.2, h: 0.38, fontFace: FONT, fontSize: 12, bold: true, color: C.gold });
    bulletBox(s, g.items, x + 0.1, y + 0.42, cw - 0.2, ch - 0.5, { fontSize: 11, color: C.lightGray });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – ANTACIDS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "1. Antacids", "Weak bases that neutralise gastric HCl  •  First-line symptomatic relief");

  // Mechanism box
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 1.18, w: 9.5, h: 0.58, fill: { color: C.midBlue }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 });
  s.addText("Mechanism: Neutralise HCl → ↑ gastric pH  •  Pepsin inactivated above pH 4  •  Stimulate PG synthesis (Mg, Al salts)", {
    x: 0.35, y: 1.22, w: 9.2, h: 0.5, fontFace: FONT, fontSize: 12, color: C.white,
  });

  const antacids = [
    { name: "Sodium\nBicarbonate", props: ["Rapidly acting", "Systemic – CO₂ gas formed", "Risk: Milk-alkali syndrome", "Not recommended long-term"], color: "2E3A6B" },
    { name: "Magnesium\nHydroxide", props: ["Rapid onset", "Laxative effect", "↑ Mg absorption in renal failure", "Used in combination"], color: "1B5E4F" },
    { name: "Aluminium\nHydroxide", props: ["Slower acting", "Constipation (most common SE)", "Binds phosphate → ↓ phosphate", "Preferred in renal failure (caution)"], color: "4A2060" },
    { name: "Calcium\nCarbonate", props: ["Rapid potent action", "Acid rebound (↑ gastrin)", "Constipation", "Hypercalcaemia risk"], color: "5A3010" },
  ];

  antacids.forEach((a, i) => {
    const x = 0.25 + i * 2.4;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.9, w: 2.28, h: 3.5, fill: { color: a.color }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 });
    s.addText(a.name, { x: x + 0.08, y: 1.92, w: 2.12, h: 0.6, fontFace: FONT, fontSize: 13, bold: true, color: C.gold, align: "center" });
    bulletBox(s, a.props, x + 0.1, y = 2.52, 2.1, 2.8, { fontSize: 11, color: C.lightGray });
  });

  s.addText("Combined antacids (e.g. Digene = Al(OH)₃ + Mg(OH)₂ + Simethicone) minimise individual adverse effects", {
    x: 0.25, y: 5.28, w: 9.5, h: 0.3, fontFace: FONT, fontSize: 11, color: C.yellow, italic: true,
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – H2 RECEPTOR ANTAGONISTS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "2. H₂ Receptor Antagonists (H₂ Blockers)", "Competitive antagonists at gastric parietal cell H₂ receptors");

  // Mechanism diagram (text-based)
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 1.1, w: 9.5, h: 1.25, fill: { color: C.midBlue }, line: { color: C.accent, width: 1.2 }, rectRadius: 0.1 });
  s.addText("MECHANISM", { x: 0.35, y: 1.12, w: 2, h: 0.35, fontFace: FONT, fontSize: 12, bold: true, color: C.accent });
  s.addText("Histamine (via ECL cells) → H₂ receptor on parietal cell → ↑ cAMP → ↑ PKA → H⁺/K⁺-ATPase activation → HCl secretion\nH₂ blockers competitively block H₂ receptors → ↓ basal, nocturnal, food-stimulated acid secretion by ~70%", {
    x: 0.35, y: 1.44, w: 9.3, h: 0.85, fontFace: FONT, fontSize: 12, color: C.lightGray,
  });

  const drugs = [
    { name: "Cimetidine", dose: "400 mg BD / 800 mg HS", features: ["1st H₂ blocker (prototype)", "Inhibits CYP450 (major DDI)", "Anti-androgenic (gynaecomastia)", "Crosses BBB → confusion", "Short t½ (2 h)"], color: "2E3A6B" },
    { name: "Ranitidine*", dose: "150 mg BD / 300 mg HS", features: ["5–10× more potent", "Less CYP inhibition", "No anti-androgenic effect", "*Withdrawn – NDMA contamination"], color: "5A3010" },
    { name: "Famotidine", dose: "20 mg BD / 40 mg HS", features: ["Most potent H₂ blocker", "No CYP inhibition", "No anti-androgenic effect", "Preferred in pregnancy (Cat B)", "Safe in renal failure (adjust dose)"], color: "1B5E4F" },
    { name: "Nizatidine", dose: "150 mg BD / 300 mg HS", features: ["Similar to ranitidine", "No CYP inhibition", "100% oral bioavailability", "Excreted unchanged in urine"], color: "4A2060" },
  ];

  drugs.forEach((d, i) => {
    const x = 0.25 + i * 2.4;
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.45, w: 2.28, h: 3.0, fill: { color: d.color }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 });
    s.addText(d.name, { x: x + 0.08, y: 2.48, w: 2.12, h: 0.38, fontFace: FONT, fontSize: 13, bold: true, color: C.gold, align: "center" });
    s.addText(d.dose, { x: x + 0.08, y: 2.84, w: 2.12, h: 0.28, fontFace: FONT, fontSize: 10, color: C.yellow, align: "center", italic: true });
    bulletBox(s, d.features, x + 0.1, 3.14, 2.1, 2.25, { fontSize: 10, color: C.lightGray });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – PROTON PUMP INHIBITORS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "3. Proton Pump Inhibitors (PPIs)", "Irreversible inhibitors of H⁺/K⁺-ATPase – most potent antisecretory agents");

  // Mechanism
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 1.1, w: 9.5, h: 1.15, fill: { color: C.midBlue }, line: { color: C.accent, width: 1.2 }, rectRadius: 0.1 });
  s.addText("MECHANISM: Prodrugs → activated in acidic canaliculi of parietal cell → sulfenamide derivative → irreversible covalent bond with cysteine residues of H⁺/K⁺-ATPase → blocks the \"final step\" of HCl secretion\n→ ↓ acid by 80–95%  •  Require 2–5 days for full effect  •  Must be taken 30–60 min BEFORE meals  •  Effective against all stimuli", {
    x: 0.35, y: 1.13, w: 9.3, h: 1.05, fontFace: FONT, fontSize: 11.5, color: C.lightGray,
  });

  const ppis = [
    { name: "Omeprazole", dose: "20–40 mg OD", note: "Prototype; CYP2C19 interaction (clopidogrel warning)" },
    { name: "Pantoprazole", dose: "40 mg OD", note: "Least CYP interaction; preferred IV formulation" },
    { name: "Lansoprazole", dose: "15–30 mg OD", note: "Available as ODT; faster absorption" },
    { name: "Rabeprazole", dose: "20 mg OD", note: "Least dependent on CYP2C19; rapid action" },
    { name: "Esomeprazole", dose: "20–40 mg OD", note: "S-isomer of omeprazole; greater bioavailability" },
    { name: "Dexlansoprazole", dose: "30–60 mg OD", note: "Dual delayed-release; prolonged action" },
  ];

  ppis.forEach((p, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * 3.2;
    const y = 2.35 + row * 1.52;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.1, h: 1.4, fill: { color: "1A1A3A" }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 });
    s.addText(p.name, { x: x + 0.1, y: y + 0.06, w: 2.0, h: 0.36, fontFace: FONT, fontSize: 13, bold: true, color: C.gold });
    s.addText(p.dose, { x: x + 2.1, y: y + 0.06, w: 0.9, h: 0.36, fontFace: FONT, fontSize: 11, color: C.yellow, align: "right" });
    s.addText(p.note, { x: x + 0.1, y: y + 0.48, w: 2.9, h: 0.84, fontFace: FONT, fontSize: 10.5, color: C.lightGray });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – PPI ADVERSE EFFECTS & CLINICAL USES
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "PPIs – Adverse Effects & Clinical Uses", "Long-term use risks must be weighed against benefits");

  card(s, 0.25, 1.12, 4.5, 4.35,
    "⚠️  Adverse Effects",
    [
      "Headache, diarrhoea, nausea (common)",
      "Hypomagnesaemia (long-term)",
      "Vitamin B12 deficiency (long-term)",
      "Clostridium difficile infection risk ↑",
      "Fracture risk (↓ Ca absorption)",
      "Fundic gland polyps",
      "Community-acquired pneumonia ↑",
      "Hypergastrinaemia → ECL hyperplasia",
      "Drug interaction: ↓ clopidogrel effect (CYP2C19)",
    ], C.red, "2A1010"
  );

  card(s, 5.05, 1.12, 4.7, 4.35,
    "✅  Clinical Uses",
    [
      "Peptic ulcer disease (gastric & duodenal)",
      "H. pylori eradication (with antibiotics)",
      "GERD / Reflux oesophagitis",
      "Zollinger-Ellison syndrome",
      "NSAID-induced ulcer prophylaxis",
      "Stress ulcer prophylaxis (ICU)",
      "Barrett's oesophagus",
      "Upper GI bleeding (IV pantoprazole)",
      "Dyspepsia",
    ], C.softGreen, "0A2B1A"
  );
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – ANTI-H. PYLORI REGIMENS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "4. Anti-H. pylori Regimens", "Eradication reduces recurrence from 60–100% to <15% per year");

  // Diagnosis box
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 1.1, w: 9.5, h: 0.55, fill: { color: C.midBlue }, line: { color: C.accent, width: 1 }, rectRadius: 0.1 });
  s.addText("Diagnosis: Endoscopic biopsy (CLO test) | Urea Breath Test (UBT) | Stool Antigen Test | Serology (IgG)", {
    x: 0.35, y: 1.14, w: 9.2, h: 0.45, fontFace: FONT, fontSize: 12, color: C.white,
  });

  const regimens = [
    {
      title: "Triple Therapy (14 days)",
      color: "1B3A5C",
      borderColor: C.accent,
      items: [
        "PPI (standard dose BD)",
        "+ Clarithromycin 500 mg BD",
        "+ Amoxicillin 1 g BD",
        "  (or Metronidazole 400 mg BD if penicillin allergy)",
        "Eradication: ~80%",
        "Use when clarithromycin resistance <15%",
      ],
    },
    {
      title: "Bismuth Quadruple Therapy (14 days)  ★ 1st Line",
      color: "1B3A1B",
      borderColor: C.softGreen,
      items: [
        "PPI (standard dose BD)",
        "+ Bismuth subsalicylate 525 mg QID",
        "+ Metronidazole 500 mg TID",
        "+ Tetracycline 500 mg QID",
        "Eradication: >90%",
        "Preferred where clarithromycin resistance is high",
      ],
    },
    {
      title: "Concomitant / Sequential (alternative)",
      color: "3D1A00",
      borderColor: C.gold,
      items: [
        "PPI + Clarithromycin",
        "+ Amoxicillin + Metronidazole",
        "All drugs given together × 10–14 days",
        "Overcomes metronidazole resistance",
        "Levofloxacin-based: salvage therapy",
      ],
    },
  ];

  regimens.forEach((r, i) => {
    const x = 0.25 + i * 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.75, w: 3.15, h: 3.75, fill: { color: r.color }, line: { color: r.borderColor, width: 1.5 }, rectRadius: 0.12 });
    s.addText(r.title, { x: x + 0.1, y: 1.78, w: 2.95, h: 0.52, fontFace: FONT, fontSize: 12, bold: true, color: C.gold });
    bulletBox(s, r.items, x + 0.1, 2.32, 2.95, 3.1, { fontSize: 11, color: C.lightGray });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – MUCOSAL PROTECTIVE AGENTS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "5. Mucosal Protective Agents", "Enhance defensive factors without significantly reducing acid secretion");

  const agents = [
    {
      name: "Sucralfate", color: "1B5E4F",
      moa: "Polymerises in acid pH → viscous paste → coats ulcer base → barrier against acid/pepsin/bile; also stimulates PG, binds EGF",
      dose: "1 g QID (1 h before meals & HS)",
      use: "Duodenal ulcer, stress ulcer prophylaxis",
      se: "Constipation, ↓ absorption of other drugs (give 2h apart)",
      note: "Requires acid for activation — avoid PPIs simultaneously",
    },
    {
      name: "Misoprostol", color: "4A2060",
      moa: "PGE₁ analogue → ↑ mucus & bicarbonate secretion, ↑ mucosal blood flow, ↓ acid secretion (via IP₃/cAMP in parietal cell)",
      dose: "200 μg QID with food",
      use: "NSAID-induced ulcer prophylaxis, gastric ulcer",
      se: "Diarrhoea (most common), abdominal cramps, uterine contractions",
      note: "Contraindicated in pregnancy (abortifacient – PGE₁)",
    },
    {
      name: "Bismuth Compounds", color: "5A3010",
      moa: "Coat ulcer, inhibit H. pylori (disrupts cell wall), ↑ PG, stimulate mucus & HCO₃, bind to pepsin",
      dose: "Bismuth subsalicylate 525 mg QID",
      use: "H. pylori eradication (quadruple therapy); traveller's diarrhoea",
      se: "Black stools & tongue (bismuth sulfide), nausea",
      note: "Not to be confused with bismuth toxicity at high doses",
    },
    {
      name: "Carbenoxolone", color: "2E3A6B",
      moa: "Synthetic derivative of glycyrrhetinic acid → ↑ mucus synthesis & secretion, ↑ mucosal PGs, ↑ epithelial life span",
      dose: "100 mg TID (before meals)",
      use: "Gastric ulcer (less used now)",
      se: "Sodium & water retention (aldosterone-like), hypertension, hypokalaemia",
      note: "Largely replaced by PPIs",
    },
  ];

  agents.forEach((a, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.9;
    const y = 1.12 + row * 2.35;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.72, h: 2.25, fill: { color: a.color }, line: { color: C.accent, width: 1 }, rectRadius: 0.12 });
    s.addText(a.name, { x: x + 0.12, y: y + 0.06, w: 3.5, h: 0.38, fontFace: FONT, fontSize: 14, bold: true, color: C.gold });
    s.addText(a.dose, { x: x + 3.5, y: y + 0.06, w: 1.1, h: 0.38, fontFace: FONT, fontSize: 10, color: C.yellow, align: "right", italic: true });
    const details = [
      { text: "MOA: ", options: { bold: true, color: C.accent, breakLine: false } },
      { text: a.moa, options: { color: C.lightGray, breakLine: true } },
      { text: "Use: ", options: { bold: true, color: C.accent, breakLine: false } },
      { text: a.use, options: { color: C.lightGray, breakLine: true } },
      { text: "SE: ", options: { bold: true, color: C.red, breakLine: false } },
      { text: a.se, options: { color: C.lightGray, breakLine: true } },
      { text: "⚠ ", options: { bold: true, color: C.yellow, breakLine: false } },
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  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – ANTICHOLINERGICS / OTHER DRUGS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "6. Other Drugs – Anticholinergics & Miscellaneous", "Adjuncts in peptic ulcer management");

  card(s, 0.25, 1.12, 4.6, 4.3,
    "Anticholinergics",
    [
      "Pirenzepine (M₁ selective) – preferred",
      " Dose: 50 mg BD, before meals",
      " ↓ Acid secretion by blocking M₁ on ECL/ganglion cells",
      " SE: Dry mouth, blurred vision (mild – M₂/M₃ spared)",
      "",
      "Non-selective (Propantheline, Atropine)",
      " Block all muscarinic receptors",
      " High SE: dry mouth, constipation, urinary retention, tachycardia",
      " Now rarely used for ulcers",
    ], C.gold, "2E1A00"
  );

  card(s, 5.1, 1.12, 4.6, 4.3,
    "Miscellaneous Agents",
    [
      "Vonoprazan (Potassium-Competitive Acid Blocker)",
      " K⁺-competitive, reversible; faster onset than PPIs",
      " Not pH-dependent activation; effective even at night",
      "",
      "Rebamipide",
      " ↑ Prostaglandins, scavenges free radicals",
      " Used in Asia for mucosal healing",
      "",
      "Prokinetics (Domperidone, Metoclopramide)",
      " Adjuncts in GERD to ↑ gastric emptying & LES tone",
    ], C.accent, "0A1A2A"
  );
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – DRUG COMPARISON TABLE
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "Comparative Overview", "H₂ Blockers vs PPIs vs Antacids");

  const rows = [
    ["Parameter",          "Antacids",         "H₂ Blockers",         "PPIs"],
    ["Mechanism",          "Neutralise HCl",   "Block H₂ receptor",   "Block H⁺/K⁺-ATPase"],
    ["Acid reduction",     "Transient",        "~70%",                "80–95%"],
    ["Onset",              "Immediate",        "30–60 min",           "1–4 days (full effect)"],
    ["Duration",           "1–2 h",            "6–12 h",              "24 h (irreversible)"],
    ["H. pylori use",      "No",               "No",                  "Yes (cornerstone)"],
    ["Pregnancy",          "Safe (Ca, Mg)",    "Famotidine (Cat B)",  "Omeprazole (Cat C)"],
    ["Key ADR",            "Acid rebound",     "Cimetidine – DDI",    "↓B12, hypoMg"],
  ];

  const colColors = [C.midBlue, "2E3A6B", "1B5E4F", "4A2060"];
  const colW = [2.5, 2.4, 2.4, 2.4];
  const rowH = 0.48;
  const startX = 0.25, startY = 1.1;

  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const x = startX + colW.slice(0, ci).reduce((a, b) => a + b, 0);
      const y = startY + ri * rowH;
      const isHeader = ri === 0;
      const isRowLabel = ci === 0;
      s.addShape(pres.ShapeType.rect, {
        x, y, w: colW[ci], h: rowH,
        fill: { color: isHeader ? C.accent : (isRowLabel ? "1A2A3A" : colColors[ci]) },
        line: { color: C.deepBlue, width: 1 },
      });
      s.addText(cell, {
        x: x + 0.08, y, w: colW[ci] - 0.16, h: rowH,
        fontFace: FONT,
        fontSize: isHeader ? 13 : 11,
        bold: isHeader || isRowLabel,
        color: isHeader ? C.deepBlue : C.lightGray,
        valign: "middle",
      });
    });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – NSAID-INDUCED ULCER & SPECIAL SITUATIONS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "NSAID-Induced Ulcer & Special Situations", "Prevention and management strategies");

  card(s, 0.25, 1.12, 4.6, 4.3,
    "NSAID-Induced Ulcer",
    [
      "NSAIDs inhibit COX-1 → ↓ PGE₂ / PGI₂",
      " → ↓ Mucus & bicarbonate",
      " → ↓ Mucosal blood flow",
      " → Direct mucosal damage",
      "",
      "Prevention options:",
      " • Misoprostol 200 μg QID (PGE₁ analogue)",
      " • PPI (omeprazole/pantoprazole) – preferred",
      " • Switch to COX-2 selective NSAID",
      "",
      "If H. pylori present: eradicate first",
    ], C.gold, "2A1A00"
  );

  card(s, 5.1, 1.12, 4.6, 4.3,
    "Special Clinical Scenarios",
    [
      "Zollinger-Ellison Syndrome:",
      " High-dose PPI (omeprazole 60–360 mg/day)",
      "",
      "Stress Ulcer Prophylaxis (ICU):",
      " IV pantoprazole or sucralfate",
      "",
      "Upper GI Bleeding:",
      " IV PPI bolus then infusion (pantoprazole 80 mg + 8 mg/h)",
      "",
      "Pregnancy:",
      " Antacids (1st line), Sucralfate (safe), Famotidine (if needed)",
      " Avoid misoprostol (abortifacient)",
      "",
      "Paediatrics:",
      " Omeprazole / Lansoprazole (age-appropriate dosing)",
    ], C.accent, "0A1A2A"
  );
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – DRUG INTERACTIONS & KEY POINTS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "Key Drug Interactions & High-Yield Points", "Important for exams and clinical practice");

  card(s, 0.25, 1.12, 4.6, 4.3,
    "⚠️  Drug Interactions",
    [
      "Cimetidine (major CYP inhibitor):",
      " ↑ Warfarin, phenytoin, theophylline, lidocaine levels",
      "",
      "PPIs + Clopidogrel:",
      " Omeprazole inhibits CYP2C19 → ↓ clopidogrel activation",
      " Use pantoprazole/rabeprazole instead",
      "",
      "Antacids:",
      " Chelate fluoroquinolones, tetracyclines, iron",
      " Give 2 h apart from other drugs",
      "",
      "Sucralfate:",
      " Adsorbs many drugs — give 2 h before other drugs",
    ], C.red, "2A0808"
  );

  card(s, 5.1, 1.12, 4.6, 4.3,
    "📌  High-Yield Memory Points",
    [
      "PPIs = most potent & first-line antisecretory drugs",
      "Cimetidine = 1st H₂ blocker, most DDIs",
      "Famotidine = most potent H₂ blocker",
      "Misoprostol = only drug contraindicated in pregnancy",
      "Sucralfate needs acid for action → avoid with PPIs",
      "Carbenoxolone → aldosterone-like SE",
      "Pirenzepine = selective M₁ blocker",
      "Ranitidine withdrawn (NDMA)",
      "Quadruple therapy = >90% H. pylori eradication",
      "PPI + Clarithromycin + Amoxicillin = triple therapy",
    ], C.softGreen, "0A2010"
  );
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – SUMMARY FLOWCHART
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  addHeader(s, "Treatment Algorithm – Peptic Ulcer Disease", "Stepwise approach based on etiology");

  // Flowchart using boxes + arrows (text-based)
  const boxData = [
    { x: 3.5, y: 1.1, w: 3.0, h: 0.55, text: "Confirmed Peptic Ulcer", color: C.accent, textColor: C.deepBlue },
    { x: 0.25, y: 2.15, w: 2.5, h: 0.55, text: "H. pylori +ve", color: "1B5E4F", textColor: C.white },
    { x: 7.25, y: 2.15, w: 2.5, h: 0.55, text: "H. pylori -ve", color: "2E3A6B", textColor: C.white },
    { x: 0.1, y: 3.1, w: 2.8, h: 0.9, text: "Triple/Quadruple\nTherapy × 14 d\n+ PPI", color: "0A2B1A", textColor: C.lightGray },
    { x: 7.1, y: 3.1, w: 2.8, h: 0.9, text: "PPI × 4–8 wks\n(Omeprazole/Pantoprazole)\n+ H₂ blocker if needed", color: "0A1A2B", textColor: C.lightGray },
    { x: 3.5, y: 4.15, w: 3.0, h: 0.6, text: "Confirm Eradication (UBT)\n→ PPI × 4 more weeks", color: "2A1A00", textColor: C.yellow },
    { x: 3.5, y: 5.0, w: 3.0, h: 0.5, text: "Maintenance: Lifestyle + review NSAIDs", color: C.midBlue, textColor: C.lightGray },
  ];

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  // Connecting lines / arrows (text arrows)
  s.addText("↓", { x: 4.7, y: 1.65, w: 0.6, h: 0.5, fontFace: FONT, fontSize: 22, color: C.accent, align: "center" });
  s.addText("↙", { x: 3.5, y: 1.65, w: 1.5, h: 0.5, fontFace: FONT, fontSize: 22, color: C.softGreen, align: "center" });
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  s.addText("↓", { x: 1.2, y: 4.0, w: 0.6, h: 0.35, fontFace: FONT, fontSize: 18, color: C.softGreen, align: "center" });
  s.addText("↓", { x: 8.2, y: 4.0, w: 0.6, h: 0.35, fontFace: FONT, fontSize: 18, color: C.accent, align: "center" });
  s.addText("↓ ↓", { x: 4.5, y: 4.76, w: 1.0, h: 0.3, fontFace: FONT, fontSize: 16, color: C.yellow, align: "center" });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – THANK YOU
// ═════════════════════════════════════════════════════════════════════════════
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  const s = pres.addSlide();
  s.background = { color: C.deepBlue };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.accent } });
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  s.addText("Thank You", { x: 0.5, y: 3.3, w: 9, h: 0.7, fontFace: FONT, fontSize: 40, bold: true, color: C.white, align: "center" });
  s.addText("KD Tripathi – Essentials of Medical Pharmacology", {
    x: 0.5, y: 4.05, w: 9, h: 0.4, fontFace: FONT, fontSize: 15, color: C.gold, align: "center", italic: true,
  });
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    x: 0.5, y: 4.45, w: 9, h: 0.35, fontFace: FONT, fontSize: 12, color: C.lightGray, align: "center",
  });
}

// Write file
pres.writeFile({ fileName: "/home/daytona/workspace/peptic-ulcer-ppt/Peptic_Ulcer_Drugs_KDT.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });

Running Command

cd /home/daytona/workspace/peptic-ulcer-ppt && node build.js 2>&1

Running Command

ls -lh /home/daytona/workspace/peptic-ulcer-ppt/Peptic_Ulcer_Drugs_KDT.pptx

Your PPT is ready! 🎉

Peptic Ulcer Drugs KDT

Presentation · PPTX

📋 What's Inside (15 Slides)

Slide	Content
1	Title Slide – Drugs for Peptic Ulcer Disease (KDT-based)
2	Pathophysiology – Aggressive vs Defensive factors
3	KDT Classification – All 6 groups in color-coded cards
4	Antacids – Systemic vs Non-systemic, 4 drugs compared
5	H₂ Blockers – Mechanism + all 4 drugs (dose, features, SE)
6	Proton Pump Inhibitors – MOA + all 6 PPIs with doses
7	PPI Adverse Effects & Clinical Uses – Long-term risks
8	Anti-H. pylori Regimens – Triple, Quadruple, Concomitant
9	Mucosal Protective Agents – Sucralfate, Misoprostol, Bismuth, Carbenoxolone
10	Anticholinergics & Miscellaneous – Pirenzepine, Vonoprazan, Rebamipide
11	Comparison Table – Antacids vs H₂ Blockers vs PPIs
12	NSAID-Induced Ulcer & Special Situations – Pregnancy, ZES, ICU
13	Drug Interactions & High-Yield Points – Exam essentials
14	Treatment Algorithm Flowchart – H. pylori +ve vs -ve
15	Thank You / References

Design: Deep navy blue theme with teal accents and gold highlights — professional and easy to read.

Try again

Asking for Preferences

Writing File

~/peptic-ulcer-ppt/build2.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Drugs for Peptic Ulcer Disease – KDT";

// ─── WARM ORANGE/RED ACADEMIC PALETTE ────────────────────────────────────────
const C = {
  cream:      "FFF8F0",   // dominant slide background
  warmWhite:  "FFFFFF",
  darkBrown:  "2C1503",   // text / dominant dark
  rust:       "C0392B",   // primary accent (red)
  orange:     "E67E22",   // secondary accent
  amber:      "F39C12",   // highlight / subheadings
  burntSiena: "A04000",   // card tops / headers
  teal:       "1A7A7A",   // contrast accent
  softGreen:  "27AE60",
  charcoal:   "3D3D3D",
  lightRust:  "F5D5CC",   // card background
  lightAmber: "FEF0D9",   // alt card bg
  midBrown:   "7B3A10",
  darkRed:    "7B0A0A",
  parchment:  "FAF0E0",   // slide bg variant
};

const FONT = "Georgia";
const FONT2 = "Calibri";

// ─── HELPERS ──────────────────────────────────────────────────────────────────

function addHeader(slide, title, sub) {
  // Red diagonal band at top
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  slide.addShape(pres.ShapeType.rect, { x: 0, y: 1.0, w: 10, h: 0.12, fill: { color: C.amber } });
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}

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    fill: { color: bgColor || C.lightAmber },
    line: { color: borderColor || C.orange, width: 1.5 },
    rectRadius: 0.14,
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}

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    options: { bullet: true, breakLine: i < items.length - 1 },
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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.darkBrown };

  // Top decorative bars
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  // Bottom bars
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  // Central circle
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  s.addText("DRUGS FOR PEPTIC ULCER DISEASE", {
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.parchment };
  addHeader(s, "Peptic Ulcer Disease – Pathophysiology", "Imbalance of aggressive vs. defensive mucosal factors");

  // Left: Aggressive
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  bulletBox(s, [
    "HCl hypersecretion (parietal cells)",
    "Pepsin (proteolytic enzyme)",
    "H. pylori infection (gram-negative rod)",
    "NSAIDs & Aspirin → ↓ PG synthesis",
    "Bile salts reflux",
    "Smoking, alcohol",
    "Stress & corticosteroids",
  ], 0.3, 1.82, 4.1, 3.45, { fontSize: 12, color: C.darkRed });

  // VS
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  // Right: Defensive
  s.addShape(pres.ShapeType.roundRect, { x: 5.5, y: 1.25, w: 4.3, h: 4.1, fill: { color: "DFF2E9" }, line: { color: C.softGreen, width: 2 }, rectRadius: 0.14 });
  s.addShape(pres.ShapeType.roundRect, { x: 5.5, y: 1.25, w: 4.3, h: 0.52, fill: { color: C.softGreen }, line: { color: C.softGreen, width: 0 }, rectRadius: 0.14 });
  s.addText("DEFENSIVE FACTORS", { x: 5.6, y: 1.28, w: 4.1, h: 0.42, fontFace: FONT, fontSize: 14, bold: true, color: C.warmWhite });
  bulletBox(s, [
    "Mucus layer (viscous bicarbonate gel)",
    "Bicarbonate secretion (surface cells)",
    "Mucosal blood flow (O₂ & nutrients)",
    "Prostaglandins – PGE₂ & PGI₂",
    "Tight epithelial junctions",
    "Epithelial restitution (rapid repair)",
    "Surface-active phospholipids",
  ], 5.6, 1.82, 4.1, 3.45, { fontSize: 12, color: "1A5C35" });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – KDT CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "KDT Classification of Antiulcer Drugs", "6 major groups — KD Tripathi's Essentials of Medical Pharmacology");

  const groups = [
    { num: "1", title: "Antacids",                 drugs: "Systemic: NaHCO₃\nNon-systemic: Mg(OH)₂, Al(OH)₃\nMg trisilicate, CaCO₃", bg: "FDE8D8", border: C.rust },
    { num: "2", title: "H₂ Blockers",              drugs: "Cimetidine (prototype)\nRanitidine* (withdrawn)\nFamotidine  ·  Nizatidine", bg: "FEF0CC", border: C.amber },
    { num: "3", title: "Proton Pump Inhibitors",   drugs: "Omeprazole, Lansoprazole\nPantoprazole, Rabeprazole\nEsomeprazole, Dexlansoprazole", bg: "F9E4D4", border: C.orange },
    { num: "4", title: "Anti-H. pylori Drugs",     drugs: "Amoxicillin, Clarithromycin\nMetronidazole, Tetracycline\nBismuth compounds + PPI", bg: "D9EFE4", border: C.softGreen },
    { num: "5", title: "Mucosal Protectives",       drugs: "Sucralfate\nMisoprostol (PGE₁ analogue)\nBismuth subsalicylate\nCarbenoxolone", bg: "DDEEF9", border: C.teal },
    { num: "6", title: "Anticholinergics",          drugs: "Pirenzepine (M₁ selective)\nPropantheline (non-selective)\n[adjuncts – rarely used]", bg: "EDE0F5", border: "7B4BA0" },
  ];

  const cw = 3.0, ch = 2.0;
  groups.forEach((g, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * (cw + 0.28);
    const y = 1.2 + row * (ch + 0.18);

    s.addShape(pres.ShapeType.roundRect, { x, y, w: cw, h: ch, fill: { color: g.bg }, line: { color: g.border, width: 2 }, rectRadius: 0.14 });
    // Number badge
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.1, y: y + 0.08, w: 0.42, h: 0.42, fill: { color: g.border }, line: { color: g.border, width: 0 } });
    s.addText(g.num, { x: x + 0.1, y: y + 0.08, w: 0.42, h: 0.42, fontFace: FONT, fontSize: 14, bold: true, color: C.warmWhite, align: "center", valign: "middle" });
    s.addText(g.title, { x: x + 0.6, y: y + 0.1, w: cw - 0.72, h: 0.38, fontFace: FONT, fontSize: 13, bold: true, color: C.darkBrown });
    s.addShape(pres.ShapeType.line, { x: x + 0.1, y: y + 0.56, w: cw - 0.2, h: 0, line: { color: g.border, width: 1, dashType: "dash" } });
    s.addText(g.drugs, { x: x + 0.1, y: y + 0.62, w: cw - 0.2, h: ch - 0.74, fontFace: FONT2, fontSize: 11, color: C.charcoal, valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – ANTACIDS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "1. Antacids", "Weak bases that neutralise HCl  ·  pH rises above 3.5 → pepsin inactivated");

  // Mechanism banner
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 9.6, h: 0.55, fill: { color: C.lightAmber }, line: { color: C.amber, width: 1.5 }, rectRadius: 0.1 });
  s.addText("Mechanism: Neutralise HCl → ↑ gastric pH  |  Pepsin activity ↓ at pH >4  |  Mg & Al salts also stimulate PG synthesis", {
    x: 0.3, y: 1.26, w: 9.4, h: 0.45, fontFace: FONT2, fontSize: 12, color: C.darkBrown,
  });

  const cols = [
    { name: "Sodium\nBicarbonate", dose: "0.6–2 g PRN", props: ["Rapidly acting systemic antacid", "Gas (CO₂) formation — belching", "Milk-alkali syndrome (chronic)", "Systemic alkalosis risk", "Not for long-term use"], bg: "FDE8D8", border: C.rust },
    { name: "Magnesium\nHydroxide", dose: "0.3–1 g PRN", props: ["Rapid potent action", "Non-systemic (poorly absorbed)", "Osmotic laxative effect", "↑ Mg absorbed → toxicity in CRF", "Used in combination antacids"], bg: "FEF0CC", border: C.amber },
    { name: "Aluminium\nHydroxide", dose: "0.6–1 g PRN", props: ["Slower, sustained action", "Non-systemic antacid", "Constipation (most common SE)", "Binds phosphate (used in CRF)", "Adsorbs pepsin & bile salts"], bg: "F9E4D4", border: C.orange },
    { name: "Calcium\nCarbonate", dose: "0.5–2 g PRN", props: ["Most potent & rapid antacid", "Acid rebound (↑ gastrin)", "Constipation", "Hypercalcaemia, nephrolithiasis", "Milk-alkali syndrome"], bg: "DDEEF9", border: C.teal },
  ];

  cols.forEach((c, i) => {
    const x = 0.2 + i * 2.42;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.85, w: 2.32, h: 3.6, fill: { color: c.bg }, line: { color: c.border, width: 1.5 }, rectRadius: 0.12 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.85, w: 2.32, h: 0.7, fill: { color: c.border }, line: { color: c.border, width: 0 }, rectRadius: 0.12 });
    s.addText(c.name, { x: x + 0.08, y: 1.88, w: 2.16, h: 0.62, fontFace: FONT, fontSize: 12.5, bold: true, color: C.warmWhite, align: "center", valign: "middle" });
    s.addText(c.dose, { x: x + 0.08, y: 2.6, w: 2.16, h: 0.28, fontFace: FONT2, fontSize: 10.5, color: C.burntSiena, align: "center", italic: true });
    bulletBox(s, c.props, x + 0.1, 2.92, 2.12, 2.45, { fontSize: 10.5, color: C.charcoal });
  });

  s.addText("Tip: Combination antacids (e.g. Digene = Al(OH)₃ + Mg(OH)₂ + Simethicone) balance constipation vs laxative effects", {
    x: 0.2, y: 5.5, w: 9.6, h: 0.26, fontFace: FONT2, fontSize: 10.5, color: C.burntSiena, italic: true,
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – H2 BLOCKERS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "2. H₂ Receptor Antagonists", "Competitive antagonists at H₂ receptors of parietal cells");

  // MOA box
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 9.6, h: 1.0, fill: { color: C.lightAmber }, line: { color: C.amber, width: 1.5 }, rectRadius: 0.1 });
  s.addText("MECHANISM", { x: 0.35, y: 1.25, w: 1.8, h: 0.3, fontFace: FONT, fontSize: 12, bold: true, color: C.rust });
  s.addText("Histamine (from ECL cells) → H₂ receptor on parietal cell → ↑ cAMP → ↑ PKA → activates H⁺/K⁺-ATPase → HCl secretion\nH₂ blockers: Competitively block H₂ receptors → ↓ acid by ~70%  (basal, nocturnal & food-stimulated acid)", {
    x: 0.35, y: 1.52, w: 9.4, h: 0.64, fontFace: FONT2, fontSize: 11.5, color: C.darkBrown,
  });

  const drugs = [
    { name: "Cimetidine", dose: "400 mg BD\nor 800 mg HS", features: ["1st H₂ blocker (prototype)", "Inhibits CYP1A2, 2C9, 2D6, 3A4", "↑ Warfarin, phenytoin, theophylline", "Anti-androgenic: gynaecomastia", "Crosses BBB → confusion (elderly)", "Inhibits tubular creatinine secretion"], bg: C.lightRust, border: C.rust },
    { name: "Ranitidine*", dose: "150 mg BD\nor 300 mg HS", features: ["5–10× more potent than cimetidine", "Minimal CYP inhibition", "No anti-androgenic effects", "➜ Withdrawn (NDMA contamination)", "Famotidine now preferred"], bg: "F5E6C8", border: C.amber },
    { name: "Famotidine", dose: "20 mg BD\nor 40 mg HS", features: ["Most potent H₂ blocker", "No CYP inhibition", "No anti-androgenic effects", "Safe: Pregnancy Cat B", "Dose adjust in renal failure"], bg: "D9F0EC", border: C.teal },
    { name: "Nizatidine", dose: "150 mg BD\nor 300 mg HS", features: ["Similar to ranitidine in potency", "No CYP inhibition", "Highest oral bioavailability (~100%)", "Excreted unchanged in urine", "Least studied of the group"], bg: "E4EEF9", border: "4A7AB0" },
  ];

  drugs.forEach((d, i) => {
    const x = 0.2 + i * 2.42;
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.28, w: 2.32, h: 3.25, fill: { color: d.bg }, line: { color: d.border, width: 1.5 }, rectRadius: 0.12 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.28, w: 2.32, h: 0.62, fill: { color: d.border }, line: { color: d.border, width: 0 }, rectRadius: 0.12 });
    s.addText(d.name, { x: x + 0.08, y: 2.3, w: 2.16, h: 0.38, fontFace: FONT, fontSize: 13, bold: true, color: C.warmWhite, align: "center" });
    s.addText(d.dose, { x: x + 0.08, y: 2.66, w: 2.16, h: 0.36, fontFace: FONT2, fontSize: 9.5, color: C.burntSiena, align: "center", italic: true });
    bulletBox(s, d.features, x + 0.1, 3.05, 2.12, 2.42, { fontSize: 10, color: C.charcoal });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – PPIs MECHANISM & DRUGS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "3. Proton Pump Inhibitors (PPIs)", "Most potent antisecretory drugs  ·  Irreversible H⁺/K⁺-ATPase inhibitors");

  // Mechanism
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 9.6, h: 1.12, fill: { color: C.lightAmber }, line: { color: C.orange, width: 1.5 }, rectRadius: 0.1 });
  s.addText("MECHANISM", { x: 0.35, y: 1.25, w: 1.8, h: 0.3, fontFace: FONT, fontSize: 12, bold: true, color: C.rust });
  s.addText(
    "Prodrugs → absorbed in small intestine → reach parietal cell canaliculi → activated (sulfenamide) at acidic pH → " +
    "irreversible covalent bond with cysteine residues of H⁺/K⁺-ATPase\n" +
    "→ Blocks FINAL COMMON PATHWAY  ·  ↓ HCl by 80–95%  ·  Must be taken 30–60 min BEFORE meals  ·  2–5 days for full effect",
    { x: 0.35, y: 1.52, w: 9.4, h: 0.76, fontFace: FONT2, fontSize: 11.5, color: C.darkBrown }
  );

  const ppis = [
    { name: "Omeprazole",      dose: "20–40 mg OD",  note: "Prototype PPI; inhibits CYP2C19 → clopidogrel interaction (avoid co-use)", bg: "FDE8D8", border: C.rust },
    { name: "Pantoprazole",    dose: "40 mg OD",     note: "Least CYP interaction; IV form available → preferred in GI bleeds", bg: "FEF0CC", border: C.amber },
    { name: "Lansoprazole",    dose: "15–30 mg OD",  note: "ODT (orally disintegrating tablet); faster absorption; also available for paediatrics", bg: "F9E4D4", border: C.orange },
    { name: "Rabeprazole",     dose: "20 mg OD",     note: "Least dependent on CYP2C19 polymorphism; faster onset of action", bg: "D9F0E4", border: C.softGreen },
    { name: "Esomeprazole",    dose: "20–40 mg OD",  note: "S-isomer of omeprazole; greater bioavailability; once-daily dosing", bg: "DDEEF9", border: C.teal },
    { name: "Dexlansoprazole", dose: "30–60 mg OD",  note: "Dual delayed-release; two peak plasma concentrations; prolonged acid control", bg: "EDE0F5", border: "7B4BA0" },
  ];

  ppis.forEach((p, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.2 + col * 3.25;
    const y = 2.42 + row * 1.6;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.12, h: 1.52, fill: { color: p.bg }, line: { color: p.border, width: 1.5 }, rectRadius: 0.12 });
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.12, h: 0.44, fill: { color: p.border }, line: { color: p.border, width: 0 }, rectRadius: 0.12 });
    s.addText(p.name, { x: x + 0.1, y: y + 0.04, w: 2.0, h: 0.36, fontFace: FONT, fontSize: 13, bold: true, color: C.warmWhite });
    s.addText(p.dose, { x: x + 2.0, y: y + 0.04, w: 1.0, h: 0.36, fontFace: FONT2, fontSize: 10, color: C.warmWhite, align: "right", italic: true });
    s.addText(p.note, { x: x + 0.1, y: y + 0.5, w: 2.9, h: 0.95, fontFace: FONT2, fontSize: 10.5, color: C.charcoal, valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – PPIs: ADRs & USES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "PPIs – Adverse Effects & Clinical Uses", "Weigh long-term risks against therapeutic benefits");

  // Adverse effects card
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 4.6, h: 4.25, fill: { color: "FDE8D8" }, line: { color: C.rust, width: 2 }, rectRadius: 0.14 });
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 4.6, h: 0.52, fill: { color: C.rust }, line: { color: C.rust, width: 0 }, rectRadius: 0.14 });
  s.addText("⚠  ADVERSE EFFECTS", { x: 0.32, y: 1.25, w: 4.36, h: 0.44, fontFace: FONT, fontSize: 13.5, bold: true, color: C.warmWhite });
  bulletBox(s, [
    "Headache, diarrhoea, nausea (common)",
    "Hypomagnesaemia → tetany, arrhythmia",
    "Vitamin B12 deficiency (long-term)",
    "C. difficile infection risk ↑",
    "Osteoporosis / fracture risk",
    "Fundic gland polyps",
    "Hypergastrinaemia → ECL cell hyperplasia",
    "Community-acquired pneumonia ↑",
    "CKD risk (long-term use data)",
    "DDI: Omeprazole ↓ clopidogrel (CYP2C19)",
  ], 0.32, 1.78, 4.38, 3.62, { fontSize: 11.5, color: C.darkRed });

  // Clinical uses card
  s.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 1.22, w: 4.6, h: 4.25, fill: { color: "D9F2E4" }, line: { color: C.softGreen, width: 2 }, rectRadius: 0.14 });
  s.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 1.22, w: 4.6, h: 0.52, fill: { color: C.softGreen }, line: { color: C.softGreen, width: 0 }, rectRadius: 0.14 });
  s.addText("✔  CLINICAL USES", { x: 5.32, y: 1.25, w: 4.36, h: 0.44, fontFace: FONT, fontSize: 13.5, bold: true, color: C.warmWhite });
  bulletBox(s, [
    "Peptic ulcer disease (duodenal & gastric)",
    "H. pylori eradication (cornerstone drug)",
    "GERD / Reflux oesophagitis",
    "Zollinger-Ellison syndrome (high-dose)",
    "NSAID-induced ulcer prophylaxis",
    "Stress ulcer prophylaxis (ICU)",
    "Barrett's oesophagus",
    "Upper GI bleeding (IV pantoprazole)",
    "Non-ulcer dyspepsia",
    "Laryngopharyngeal reflux",
  ], 5.32, 1.78, 4.38, 3.62, { fontSize: 11.5, color: "1A5C35" });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – ANTI-H. PYLORI
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "4. Anti-H. pylori Regimens", "Eradication → recurrence ↓ from 60–100% to <15%/year");

  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 9.6, h: 0.48, fill: { color: C.lightAmber }, line: { color: C.amber, width: 1 }, rectRadius: 0.1 });
  s.addText("Diagnosis: Endoscopic CLO test | Urea Breath Test (UBT) | Stool Antigen Test | Serology (IgG — low specificity)", {
    x: 0.3, y: 1.26, w: 9.4, h: 0.38, fontFace: FONT2, fontSize: 12, color: C.darkBrown,
  });

  const regs = [
    {
      title: "Triple Therapy  (×14 days)",
      border: C.teal, bg: "DDEEF9",
      lines: [
        "PPI (standard dose) BD",
        "+ Clarithromycin 500 mg BD",
        "+ Amoxicillin 1 g BD",
        "  (or Metronidazole 400 mg BD if PCN allergy)",
        "Eradication rate: ~80%",
        "Use where clarithromycin resistance <15%",
        "Prior macrolide exposure → avoid",
      ],
    },
    {
      title: "Bismuth Quadruple  (×14 days)  ★ 1st Line",
      border: C.softGreen, bg: "D9F2E4",
      lines: [
        "PPI (standard dose) BD",
        "+ Bismuth subsalicylate 525 mg QID",
        "+ Metronidazole 500 mg TID",
        "+ Tetracycline 500 mg QID",
        "Eradication rate: >90%",
        "Preferred where clarithromycin resistance is high",
        "First-line per ACG/AGA guidelines",
      ],
    },
    {
      title: "Salvage / Levofloxacin Therapy",
      border: C.orange, bg: "F9EED8",
      lines: [
        "PPI + Levofloxacin 500 mg OD",
        "+ Amoxicillin 1 g BD × 14 days",
        "After failed first-line treatment",
        "Concomitant therapy: PPI + Clarithromycin",
        "  + Amoxicillin + Metronidazole × 10–14 d",
        "Rifabutin-based: last resort",
      ],
    },
  ];

  regs.forEach((r, i) => {
    const x = 0.2 + i * 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.78, w: 3.12, h: 3.75, fill: { color: r.bg }, line: { color: r.border, width: 2 }, rectRadius: 0.14 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.78, w: 3.12, h: 0.56, fill: { color: r.border }, line: { color: r.border, width: 0 }, rectRadius: 0.14 });
    s.addText(r.title, { x: x + 0.1, y: 1.81, w: 2.92, h: 0.48, fontFace: FONT, fontSize: 12, bold: true, color: C.warmWhite });
    bulletBox(s, r.lines, x + 0.12, 2.38, 2.9, 3.08, { fontSize: 11, color: C.charcoal });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – MUCOSAL PROTECTIVE AGENTS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "5. Mucosal Protective Agents", "Enhance defensive factors — no significant acid reduction");

  const agents = [
    {
      name: "Sucralfate", dose: "1 g QID (1 h before meals & HS)", bg: "FDE8D8", border: C.rust,
      moa: "In acid pH → polymerises → viscous paste → coats ulcer crater → barrier vs acid/pepsin/bile; stimulates PG, binds EGF",
      use: "Duodenal ulcer, stress ulcer prophylaxis",
      se: "Constipation; adsorbs other drugs (give 2 h apart)",
      note: "Needs acid for activation — avoid simultaneous PPIs",
    },
    {
      name: "Misoprostol", dose: "200 μg QID with meals", bg: "FEF0CC", border: C.amber,
      moa: "PGE₁ analogue → Gs-coupled → ↑ mucus & HCO₃ secretion, ↑ mucosal blood flow, ↓ acid secretion (inhibits H⁺/K⁺-ATPase via ↓ cAMP)",
      use: "NSAID-induced ulcer prophylaxis; gastric ulcer",
      se: "Diarrhoea (most common), abdominal cramps, uterine contractions",
      note: "⚠ Contraindicated in pregnancy — potent abortifacient",
    },
    {
      name: "Bismuth Subsalicylate", dose: "525 mg QID", bg: "D9F2E4", border: C.softGreen,
      moa: "Coats ulcer surface; kills H. pylori (disrupts cell wall & inhibits urease); ↑ mucus & PG; binds pepsin",
      use: "H. pylori eradication (quadruple); traveller's diarrhoea",
      se: "Black stools & tongue (bismuth sulphide — harmless), nausea",
      note: "Salicylate component — avoid in aspirin allergy / children (Reye's)",
    },
    {
      name: "Carbenoxolone", dose: "100 mg TID before meals", bg: "DDEEF9", border: C.teal,
      moa: "Liquorice derivative → ↑ mucus quality & quantity, ↑ mucosal PGs, prolongs surface cell lifespan",
      use: "Gastric ulcer (now largely obsolete)",
      se: "Na & water retention (aldosterone-like), hypertension, hypokalaemia, oedema",
      note: "Replaced by PPIs; use with aldosterone antagonist (spironolactone)",
    },
  ];

  agents.forEach((a, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.2 + col * 4.95;
    const y = 1.2 + row * 2.35;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.75, h: 2.25, fill: { color: a.bg }, line: { color: a.border, width: 1.5 }, rectRadius: 0.14 });
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.75, h: 0.48, fill: { color: a.border }, line: { color: a.border, width: 0 }, rectRadius: 0.14 });
    s.addText(a.name, { x: x + 0.12, y: y + 0.05, w: 2.8, h: 0.38, fontFace: FONT, fontSize: 13, bold: true, color: C.warmWhite });
    s.addText(a.dose, { x: x + 2.88, y: y + 0.05, w: 1.78, h: 0.38, fontFace: FONT2, fontSize: 9.5, color: C.warmWhite, align: "right", italic: true });
    const detail = [
      { text: "MOA: ", options: { bold: true, color: C.rust, breakLine: false } },
      { text: a.moa, options: { color: C.charcoal, breakLine: true } },
      { text: "Use: ", options: { bold: true, color: C.burntSiena, breakLine: false } },
      { text: a.use, options: { color: C.charcoal, breakLine: true } },
      { text: "SE: ", options: { bold: true, color: C.rust, breakLine: false } },
      { text: a.se, options: { color: C.charcoal, breakLine: true } },
      { text: "⚠ ", options: { bold: true, color: C.amber, breakLine: false } },
      { text: a.note, options: { color: C.midBrown, italic: true } },
    ];
    s.addText(detail, { x: x + 0.12, y: y + 0.52, w: 4.52, h: 1.65, fontFace: FONT2, fontSize: 10, valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – ANTICHOLINERGICS & MISC
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "6. Anticholinergics & Miscellaneous Drugs", "Adjuncts — largely replaced by PPIs");

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    "Pirenzepine (M₁ SELECTIVE — preferred)",
    "  Dose: 50 mg BD before meals",
    "  Blocks M₁ on ECL cells & ganglion cells",
    "  ↓ Acid secretion; spares M₂ (heart) & M₃ (glands)",
    "  SE: dry mouth, blurred vision (mild)",
    "",
    "Propantheline (Non-selective)",
    "  Blocks all muscarinic receptors",
    "  SE: dry mouth, urinary retention,",
    "  constipation, tachycardia (severe)",
    "  ✘ Largely abandoned for ulcer therapy",
  ], 0.32, 1.78, 4.38, 3.65, { fontSize: 11, color: C.darkRed });

  // Right: Miscellaneous
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    "Vonoprazan (P-CAB)",
    "  Potassium-competitive acid blocker",
    "  Reversible K⁺-competitive inhibition of H⁺/K⁺-ATPase",
    "  Not pH-dependent for activation (unlike PPIs)",
    "  Faster onset; effective day-1; controls nocturnal acid",
    "",
    "Rebamipide",
    "  ↑ PG synthesis, scavenges ROS, enhances mucin",
    "  Used adjunctively in Asia",
    "",
    "Prokinetics (Domperidone, Metoclopramide)",
    "  Adjuncts in GERD: ↑ LES tone, ↑ gastric emptying",
  ], 5.32, 1.78, 4.38, 3.65, { fontSize: 11, color: "0A3040" });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – COMPARISON TABLE
// ═══════════════════════════════════════════════════════════════════════════
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  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "Comparative Overview", "Antacids  ·  H₂ Blockers  ·  PPIs — at a glance");

  const rows = [
    ["Parameter",          "Antacids",             "H₂ Blockers",          "PPIs"],
    ["Mechanism",          "Neutralise HCl",       "Block H₂ receptor",    "Irreversible H⁺/K⁺-ATPase block"],
    ["Acid reduction",     "Transient ↓",          "~70%",                 "80–95%"],
    ["Onset",              "Immediate",            "30–60 min",            "1–4 days (full effect)"],
    ["Duration",           "1–2 hours",            "6–12 hours",           "24 h (irreversible enzyme)"],
    ["H. pylori use",      "No",                   "No",                   "Yes (cornerstone)"],
    ["GERD first-line",    "Symptomatic only",     "Mild GERD",            "Moderate–Severe GERD"],
    ["Pregnancy",          "Mg, Ca, Al (safe)",    "Famotidine (Cat B)",   "Omeprazole (Cat C)"],
    ["Key ADR",            "Acid rebound (CaCO₃)", "Cimetidine DDIs",      "↓B12, hypoMg, C. diff"],
  ];

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        x, y, w: colW[ci], h: rowH,
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        fontSize: isHdr ? 13 : 11,
        bold: isHdr || isLabel,
        color: isHdr ? C.warmWhite : C.charcoal,
        valign: "middle",
        wrap: true,
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    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 – NSAID ULCER & SPECIAL SITUATIONS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "NSAID-Induced Ulcer & Special Situations", "Prevention strategies and high-risk scenarios");

  // NSAID
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    "NSAIDs inhibit COX-1 → ↓ PGE₂ / PGI₂",
    "→ ↓ Mucus & bicarbonate secretion",
    "→ ↓ Mucosal blood flow",
    "→ Direct mucosal damage (acidic NSAIDs)",
    "",
    "Prevention / Management:",
    "• PPI (omeprazole / pantoprazole) — PREFERRED",
    "• Misoprostol 200 μg QID (FDA approved)",
    "• Switch to COX-2 selective NSAID (celecoxib)",
    "• H₂ blocker (less effective than PPI)",
    "• If H. pylori +ve: eradicate first",
    "• Lowest effective NSAID dose for shortest duration",
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  // Special situations
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    "Zollinger-Ellison Syndrome:",
    " High-dose PPI (60–360 mg omeprazole/day)",
    "",
    "Stress Ulcer (ICU): IV pantoprazole / sucralfate",
    "",
    "Upper GI Bleeding:",
    " IV PPI bolus 80 mg then 8 mg/h infusion × 72 h",
    "",
    "Pregnancy:",
    " Antacids (1st line) → Sucralfate → Famotidine",
    " Avoid misoprostol (abortifacient)",
    "",
    "Paediatrics: Omeprazole / Lansoprazole ODT",
    "",
    "Renal failure: Famotidine (dose-adjust); avoid Mg antacid",
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 – DRUG INTERACTIONS & HIGH-YIELD
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "Drug Interactions & High-Yield Exam Points", "Clinically significant interactions to remember");

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  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 1.22, w: 4.6, h: 0.52, fill: { color: C.rust }, line: { color: C.rust, width: 0 }, rectRadius: 0.14 });
  s.addText("⚠  Drug Interactions", { x: 0.32, y: 1.25, w: 4.36, h: 0.44, fontFace: FONT, fontSize: 13.5, bold: true, color: C.warmWhite });
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    "Cimetidine (CYP inhibitor):",
    " ↑ Warfarin, phenytoin, theophylline,",
    " lidocaine, diazepam, propranolol",
    "",
    "PPI + Clopidogrel:",
    " Omeprazole inhibits CYP2C19 → ↓ clopidogrel",
    " Use pantoprazole / rabeprazole instead",
    "",
    "Antacids + Other Drugs:",
    " Chelate fluoroquinolones, tetracyclines, iron",
    " Separate by at least 2 hours",
    "",
    "Sucralfate: adsorbs drugs — give 2 h before",
    "Misoprostol: potentiates oxytocics",
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    "PPIs = most potent antisecretory drugs (1st line)",
    "Cimetidine = 1st H₂ blocker; most drug interactions",
    "Famotidine = most potent H₂ blocker",
    "Omeprazole = prototype PPI (CYP2C19 DDI)",
    "Pantoprazole = safest PPI (fewest DDIs); IV available",
    "Misoprostol = contraindicated in pregnancy",
    "Sucralfate = needs acid; give apart from other drugs",
    "Carbenoxolone → aldosterone-like effects",
    "Pirenzepine = selective M₁ blocker",
    "Ranitidine = withdrawn (NDMA contamination)",
    "Quadruple therapy → >90% H. pylori eradication",
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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 – TREATMENT ALGORITHM
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.cream };
  addHeader(s, "Treatment Algorithm – Peptic Ulcer Disease", "Tailored approach based on etiology");

  // Central diagnosis box
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  s.addText("Confirmed Peptic Ulcer", { x: 3.3, y: 1.18, w: 3.4, h: 0.58, fontFace: FONT, fontSize: 13, bold: true, color: C.warmWhite, align: "center", valign: "middle" });

  // Arrow down
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  // Test box
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  s.addText("Test for H. pylori  (UBT / Stool Ag / Biopsy)", { x: 2.8, y: 2.06, w: 4.4, h: 0.52, fontFace: FONT2, fontSize: 12, bold: true, color: C.darkBrown, align: "center", valign: "middle" });

  // Branches
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  s.addText("▶  NEGATIVE", { x: 7.3, y: 2.62, w: 2.3, h: 0.36, fontFace: FONT2, fontSize: 12, bold: true, color: C.teal });

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  s.addText("PPI × 4–8 weeks (omeprazole/pantoprazole)\n+ H₂ blocker (if PPI not tolerated)\nIf NSAID-induced: add misoprostol or stop NSAID\nReview contributing factors (NSAIDs, smoking)", { x: 5.82, y: 3.04, w: 3.86, h: 1.52, fontFace: FONT2, fontSize: 11.5, color: "0A2B4A" });

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  s.addText("Maintenance:  Lifestyle modification  ·  Avoid NSAIDs  ·  Stop smoking  ·  Reduce alcohol", { x: 2.52, y: 4.76, w: 4.96, h: 0.62, fontFace: FONT2, fontSize: 11.5, color: C.darkBrown, align: "center", valign: "middle" });
  s.addText("▲          ▲", { x: 3.0, y: 4.56, w: 4.0, h: 0.22, fontSize: 14, color: C.orange, align: "center" });
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 – SUMMARY & THANK YOU
// ═══════════════════════════════════════════════════════════════════════════
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    ["1. Antacids",              "Neutralise HCl; symptomatic relief; NaHCO₃ (systemic), Al/Mg/Ca salts (non-systemic)"],
    ["2. H₂ Blockers",          "~70% acid ↓; Cimetidine (DDI risk); Famotidine (most potent, safest)"],
    ["3. PPIs",                  "80–95% acid ↓; irreversible; most potent; cornerstone of PUD & GERD therapy"],
    ["4. Anti-H. pylori",        "Quadruple (>90% eradication) or Triple therapy with PPI backbone"],
    ["5. Mucosal Protectives",   "Sucralfate (coat), Misoprostol (PGE₁), Bismuth, Carbenoxolone (↑mucus)"],
    ["6. Anticholinergics",      "Pirenzepine (M₁ selective); mostly obsolete; replaced by PPIs"],
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  s.addText("Reference: KD Tripathi — Essentials of Medical Pharmacology (8th Ed.)", {
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// ─── WRITE FILE ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/peptic-ulcer-ppt/Peptic_Ulcer_Drugs_KDT_v2.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });

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