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Proton pump inhibitor (PPIs): Nursing Pharmacology

Notes

Notes

PROTON PUMP INHIBITOR (PPIs)
DRUG NAME
omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium), dexlansoprazole (Dexilant)
CLASS
Proton pump inhibitor (PPIs)
MECHANISM OF ACTION
Inhibit H+/K+-ATPase on parietal cells in the stomach → decrease gastric acid secretion
INDICATIONS
  • Peptic ulcers
  • GERD
  • Zollinger-Ellison syndrome
  • Combination treatment for H. pylori infection
ROUTE(S) OF ADMINISTRATION
  • PO
  • IV
SIDE EFFECTS
  • Headaches, dizziness, fatigue
  • Blurred vision
  • Dry mouth
  • Increased thirst
  • Hiccups
  • Increased or decreased appetite, nausea, abdominal pain, constipation, or diarrhea
  • Skin rash
  • Osteoporosis
  • Decreased absorption of iron, calcium, magnesium, vitamin B12
  • Increased risk of Clostridioides difficile infection, pneumonia
CONTRAINDICATIONS AND CAUTIONS
  • Pregnancy (omeprazole)
  • Drug interactions: digoxin, ketoconazole, warfarin, phenytoin, carbamazepine, diazepam, clopidogre
NURSING CONSIDERATIONS: PROTON PUMP INHIBITOR (PPIs)
ASSESSMENT AND MONITORING
All proton pump inhibitors
  • Baseline assessment
    • Vital signs, neurological status, respiratory status, gastrointestinal status, radiological or endoscopic results, CBC, hepatic function, electrolytes, vitamin B12 level
  • Monitor for therapeutic effect, adverse effects, changes in the client’s condition
CLIENT EDUCATION
All proton pump inhibitors
  • Reason and length of prescribed treatment; follow up with healthcare provider is symptoms don’t resolve
  • Administration
    • Oral: before meals
    • IV: infuse slowly at prescribed rate
  • Do not crush, split or chew; sprinkle granules on one teaspoon applesauce or apple juice (only), mix, swallow immediately, then take several sips of water
  • Increase dietary vitamin B12
  • Avoid alcohol, aspirin, NSAIDs, caffeine, spicy foods
  • Notify healthcare provider about adverse effects
Transcript

Proton pump inhibitors, or PPIs for short, are medications used to treat conditions like peptic ulcers, gastroesophageal reflux disorder or GERD, and Zollinger-Ellison syndrome, which is caused by a gastrin-secreting tumor that leads to excess gastric acid secretion which then results in peptic ulcers.

Proton pump inhibitors are also included in the combination treatment against H. pylori, since they have a weak antibacterial effect.

Now, proton pump inhibitors usually end in “-prazole”, and include medications that are administered orally, like omeprazole, lansoprazole, dexlansoprazole, rabeprazole; as well as medications available intravenously, like pantoprazole and esomeprazole.

Once administered, proton pump inhibitors act on the parietal cells in the stomach by binding to and inhibiting the H+/K+-ATPase or proton pumps.

These pumps are involved in the secretion of gastric acid by exchanging potassium ions from the lumen with hydronium from the cells. As a result, proton pump inhibitors ultimately decrease gastric acid secretion.

Side effects of proton pump inhibitors are uncommon, but can include headaches, dizziness, fatigue, and blurred vision, as well as dry mouth, increased thirst, and hiccups.

In addition, some clients may experience gastrointestinal disturbances, such as increased or decreased appetite, nausea, abdominal pain, constipation, or diarrhea.

Also, prolonged acid suppression can decrease the absorption of iron, calcium, magnesium, and vitamin B12, or cobalamin.

When the gastric juices are less acidic, it also allows ingested pathogens, like Clostridioides difficile, to survive and invade the gastrointestinal tract.

Therefore, clients treated with proton pump inhibitors are more susceptible to gastrointestinal infection; this is also associated with an increased risk of microaspiration and lung colonization, leading to pneumonia. Other side effects may include a skin rash, and osteoporosis.

Now, as far as contraindications go, significant drug interactions should be considered before administering proton pump inhibitors. Specifically, the change in the gastric pH can reduce the absorption of certain medications, such as digoxin and ketoconazole.

Omeprazole can also reduce the rate of elimination of the oral anticoagulant warfarin, as well as anticonvulsants, such as phenytoin and carbamazepine, and benzodiazepines like diazepam, causing them to build up in the body and enhancing their action.

In addition, omeprazole can reduce the activation of the antiplatelet medication clopidogrel. Finally, omeprazole is contraindicated during pregnancy, while the rest are safe to use.

Now, before administering a proton pump inhibitor, be sure to obtain a baseline assessment of your client, including vital signs, neurological status, respiratory status, and gastrointestinal symptoms like diarrhea and constipation; as well as the presence of any abdominal tenderness, distension, rebounding, or guarding.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology: A patient-centered nursing process approach (8th edition)" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference (34th edition)" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination (8th edition)" Saunders (2019)
  5. "Goodman & Gilman's: The Pharmacological Basis of Therapeutics (13e)" McGraw-Hill Education (2018)
  6. "Pantoprazole" MedlinePlus (2021)