17.09 Proton Pump Inhibitors

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Overview

  1. Indication
    1. Gastroesophageal Reflux Disease
    2. Stress Gastritis
      1. Often hospitilized patients
    3. Dyspepsia
  2. Mechanism of action
    1. Irreversibly block hydrogen-potassium ATP pump or Gastic Proton Pump
      1. Decreases hydrogen ion concentration
      2. Decreases 99% of stomach acid secretion

Nursing Care

Overview

  1. PPI’s are used widely in hospital
  2. Have fewer side effects than Histamine 2 Receptor Antagonists
  3. Examples
    1. Omeprazole
    2. Pantoprazole
    3. Lansoprazole
    4. Esmoprazole

Assessment

  1. Assess for Side Effects
    1. Headaches
    2. Nausea
    3. Diarrhea
    4. Constipation
    5. Abdominal pain
    6. Fatigue
    7. Dizziness
  2. When on PPI for a long time…
    1. Depression
    2. Rhabdomyolysis
      1. Breakdown of muscle tissue
      2. Elevated creatinine
    3. Bone fractures

Therapeutic Management

  1. Administration
    1. Give on 1 hour before or after a meal for optimal absorption.
    2. Space away from other medications
      1. Stomach will be alkaline affecting absorption of other medications
  2. Monitor
    1. Creatinine

Nursing Concepts

  1. Pharmacology
    1. PPI’s are often prescribed to treat reflux and prevent stress gastritis.

Patient Education

  1. Inform patients that they should take PPI’s 1 hour before or 2 hours after a meal.

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Video Transcript

Proton Pump Inhibitors. So, we gonna talk about the mechanism of action, indication, side effects, and some of the examples. Let’s take a look at into the mechanism of action first. This drug also called as, this drug also known as a PPIs, in short form. What they do, they do irreversibly blocks Hydrogen-Potassium ATP pump or Gastric proton pump in the stomach. And this is the last step in production of acid in our stomach. So, they decreases the Hydrogen ion concentration, and thereby, decrease acid production in the stomach. This mechanism is pretty simple, it irreversibly blocks the Hydrogen-Potassium pump which is responsible for producing acid in our stomach and that’s how it decreases the acid production. However, this is really really effective mechanism of action by these drugs, it decreases about 99% of acid production. Now, if you have watched the video about the histamine 2 receptor antagonists or blockers, they are also used for the same indications and they also decreases the acid production in our stomach. However, they are not really effective as much as this proton pump inhibitors are. These are actually decreases more acid production for longer time and works really faster than histamine 2 receptor antagonists. And we gonna also talk about the side effect of this drug as well. Side effects of these drugs are considerably low than the histamine 2 receptor antagonists. So, that’s the reason the proton pump inhibitors medication are most, more widely used than histamine 2 antagonists even though they do the same work. Okay.

So, let’s take a look at into the indication. So, as we know, this medication decreases the acid production in our stomach. It can be used in peptic ulcer disease, in GERD (Gastroesophageal Reflex Disease), Stress Gastritis. And I have seen mostly all the patient if it is not contraindicated on proton pump inhibitors when they are in the hospital, because they are gonna get stress gastritis because if you’re in the hospital, if a patient in the hospital is, they’re body is under so much stress, they have many machines running around, unfamiliar noises, kinda, especially if they are in ICU, critical care environment. It makes more stressful and creates more stress on their body. So, when the body is under stress, this is gonna produce more acid. That’s the main reason these medications are used as a prophylactic in those condition in order to prevent the gastritis by increased acid production. And I have seen Pantoprazole medication used most oftenly in hospital settings. There’s Barrett’s esophagus also, and what is it? This is esophagus inflammation due to chronic GERD. Now, in this disease condition, it may lessen the signs and symptoms of this Barrett’s esophagus but it doesn’t actually reverse it because the damage is done already, the inflammation is done already by the GERD. However, this medication significantly reduces the signs and symptoms of this Barrett’s esophagus. Also used in Dyspepsia and Zollinger-Ellison syndrome. This syndrome is gastrin producing tumor in stomach. So, what does this tumor does, it produces more and more gastrin enzyme which is responsible for producing more and more acid. And usually, since this is a tumor, it gonna produce a large amount of gastrin in our stomach. Usually they need like a 2-3 times normal dose of this medication. So, the normal medication dose for let’s say, Pantoprazole is 40 mg that we give as a prophylactic or for all the disease. They may need like 80 – 120 mg, like really high dose in this syndrome, in order to prevent the damage by acid production. So, those are the some indication for this medication.

Let’s take a look at into the side effects. So, this medication can cause headache and as usual, GI side effects, nausea, it can cause diarrhea or constipation, abdominal pain, it can also cause the fatigue and dizziness. These 3 are really serious side effects, and you may see these side effects if a patient or a person on proton pump inhibitor for longer time. Depression. Rhabdomyolysis, which is, if you remember, breaking of muscle tissues. And how do you recognize a, usually if their muscles is gonna be really thin and creatinine, that’s the lab you usually see. The creatinine is gonna be really really high in Rhabdomyolyis. And this medication, long term use can also cause the bone fractures. And another thing to remember as a nurse and often asked in NCLEX as well, is would you give this medication with food? They’ll make a question like that and will be saying like, okay, give this medication with food in order to prevent stomach upset. Usually, most of the medication are given with the food in order to prevent stomach upset done by the medication. However, these are the medication you do not want to give with the food. The reason is, when you give it with the food, it gonna decreases the absorption. And when it decreases the absorption, their effect won’t be adequate. So, that’s why, actually, you give it either 1 hour before or after a meal. So, you wanna space it out at least one hour from meals. And also, another thing, you want to space this medication out from the other medication administration as well. And the reason is, now, if you think about, when you give a medication, it either gonna absorb in the stomach or intestine. In stomach, there’s an acidic environment and in intestine, there is an alkaline. So, let’s say, stomach, there is an acidic environment. And in intestine, it is alkaline. Now, when you give any medication, they gonna either absorb in a acidic environment or alkaline. And they are formulated according to where they want to get the absorption. But when you give this medication, and it’s gonna decreases the acid production in our stomach, it’s gonna alter the stomach pH. So, normal pH of stomach is 3 – 5. Now, when you give this medication, the stomach pH is gonna be higher because it’s gonna be alkaline. The acid production is decreased. So, the medication that supposed to be absorbed in acidic environment, won’t be absorbed in stomach because you just changed the pH of the stomach by giving this medications. And the same as well in intestine, so, if medication is supposed to be absorbed in a alkaline environment, when you change this pH of stomach and make it alkaline, so, that medication instead of going to absorb in intestine, it’s gonna absorb in stomach. So, that’s the reason you don’t want to give this medication with other medication as well because it can alter the absorption of other medication. It can either increase their absorption, can decrease their absorption, can change the site of absorption, so that is the reason you don’t really wanna give this medication with either food or with other medications, okay.

Let’s take a look at some of the examples. The first is Omeprazole, Pantoprazole, Lansoprazole, Esmoprazole. These are the widely used medication. There are many other medication in this category, but the easy way to remember this category is, all ends with -prazole. Okay. So, that’s the easy way to remember this medication, ends with -prazole.

Thanks for watching this video. If you have any questions about proton pump inhibitors, feel free to contact us.

Read more

  • Question 1 of 2

The nurse has received report on 4 clients. All clients have pantoprazole ordered. Which client will need this medication first?

  • Question 2 of 2

The nurse is caring for a client with an intestinal ulcer who takes lansoprazole. The nurse knows to monitor the client for which of the following adverse reactions? Select all that apply.

Module 0 – Pharmacology Course Introduction

Module 3 – Disease Specific Medications

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