Proton pump inhibitors (PPIs): Nursing pharmacology

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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

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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.

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)