this is helpful for nursing students

1. CLINICAL TEACHING
ONPROTON PUMP
INHIBITOR
Sneha
MSc 1st year

2. INTRODUCTION
Proton pump inhibitors (PPIs) are the
most widely prescribed class of
medications worldwide. Prescription PPIs
along with availability of over the counter
PPIs, account for approximately 13 billion
dollars in global scales. Due to their
effective acid-suppressing effects, PPIs
are approved for numerous indications.

3. DEFINITION
Proton pump inhibitors (PPIs)
are medicines that work by
reducing the amount of
stomach acid made by glands
in the lining of your stomach.

5. HYDROCHLORIC ACID
PRODUCTION PHYSIOLOGY
 HCL is produced by the parietal cells of stomach.
To begin with, water (H2O) and (CO2) combine
within the parietal cell cytoplasm to produce
carbonic acid (H2CO3). An enzyme called carbonic
anhydrase converts carbonic acid into its
component ions a hydrogen ion (H+) and a
bicorbonate ion (HCO3
-).
 The bicorbonate ion is transported out of the cell
into the blood via a transporter protein called anion
exchanger which transports the bicorbonate ion out
the cell in exchange for a chloride ion (Cl-). This
chloride ion is then transported into the stomach
lumen via a chloride channel.

7. CONTINUE………
 Prior to this, the hydrogen ion that was formed via
the splitting of carbonic acid is transported into the
stomach lumen via the H+- K+ ATPase. This channel
uses ATP energy to exchange potassium ions in the
stomach with hydrogen ions in the parietal cell.
 This results in both hydrogen and chloride ions
being present within the stomach lumen. Their
opposing charges leads them associating with each
other to form hydrochloric acid (HCl).

8. MECHANISM OF ACTION OF
PROTON PUMP INHIBITORS
Proton pump inhibitors act by
irreversibly blocking the
hydrogen/potassium adenosine
triphosphatase enzyme system (the
H+/K+ ATPase, or, more commonly, the
gastric proton pump) of the gastric
parietal cells.

9. PHARMACOKINETICS
Esomeprazole, lansoprazole, and
pantoprazole are available in delayed-
release oral forms and as IV
preparations; rabeprazole,
dexlansoprazole, and omeprazole are
available only in delayed-release oral
forms.

10. CONTINUE…..
Route-Oral
Onset-Varies
Peak-0.5-3.5h
Duration-Varies

11. CONTINUE…..
T 1/2: 30 to 60 mins
Metabolization: Liver
Excretion: Urine and bile

12. EXAMPLES OF PROTON PUMP
INHIBITORS
DRUG DOSAGE AND
ROUTE
OMEPRAZOLE 20-40 mg OD, oral and IV
ESMEPRAZOLE 20-40 mg OD, oral and IV
LANSOPRAZOLE 30mg OD, oral
DEXLANSOPRAZOLE 30-60 mg OD, oral
PANTOPRAZOLE 40 mg OD, oral and IV
RABEPRAZOLE 20 mg OD, oral

13. INDICATIONS
Dyspepsia
Peptic ulcer disease including after
endoscopic treatment for bleeding
As part of Helicobactor pylori
eradication therapy.
Gastroesophageal reflux disease.
Barrett’s esophagus
Eosinophilic esophagitis
Zollinger-Ellison syndrome.

14. CONTRAINDICATIONS AND
CAUTIONS
 These drugs are contraindicated in the presence of
a known allergy to either the drug or the drug
components to prevent hypersensitivity reactions.
 Cautions should be used in pregnant or lactating
women because of the potential for adverse effects
on the fetus or neonate.
 The safety and efficacy of these drugs have not
been established for patients younger than 18
years of age, except for lansoprazole, which is the
proton pump inhibitor of choice if one is needed for
a child.

15. ADVERSE EFFECTS
CNS: headache, dizziness,
vertigo, insomnia.
Skin: rash.
GI: diarrhea, abdominal pain,
nausea,
Respiratory: upper respiratory
infections, cough.

16. SOME OTHER SIDE EFFECTS
 PPIs may increase the risk of clostridium difficile infection of
the colon
 High doses and long term use which is 1 year or longer may
increase the risk of osteoporosis- related fractures of the hip,
wrist, or spine.
 Prolonged use also reduces the absorption of vitamin B12
(cyanocobalamin).
 Long –term use of PPIs has also been associated with low
levels of mangnesium (hypomagnesemia)
 Analysis of patients taking PPIs for long periods of time
showed an increase risk of heart attacks.

18. DRUG INTRACTIONS
 There is a risk of increased serum levels and
increased toxicity of benzodiazepines, warfarin, and
phenytoin if these are combined with thses drugs
patients should be monitored closely.
 Decreased levels of ketoconazole and theophylline
have been reported when combined with these
drugs, leading to loss of effectiveness
 Sucralfate is not absorbed well in the presence of
these drugs, and doses should be spaced at least 30
minutes apart if this combination is used.
 There is an increased risk of cardiovascular events if
proton pump inhibitors are combined with
clopidogrel; this combination should be avoided.

19. NURSING CONSIDERATIONS
 Administer drug before meals to ensure that the patient
does not open, chew, or crush capsules; they should be
swallowed whole to ensure the therapeutic effectiveness of
the drug.
 Provide appropriate safety and comfort measures if CNS
effects occur to prevent patient injury.
 Monitor the patient for diarrhea or constipation in order to
institute an appropriate bowel program as needed.
 Monitor the patient’s nutritional status; use of small frequent
meals may be helpful if GI upset is a problem.
 Encourage patient to avoid alcohol, aspirin products,
ibuprofen, and foods that may increase secretions during
therapy.

21. CONTINUE….
 As drug can interfere with absorption of vitamin B12,
monitor for anemia.
 Urge female patient of child bearing age to use effective
contraception during therapy and to inform their doctor
immediately if she becomes or suspects she may be
pregnant.
 Arrange for medical follow-up if symptoms are not resolved
after 4 to 8 weeks of therapy because serious underlying
conditions could be causing the symptoms.
 Offer support and encouragement to help the patient cope
with the disease and the drug regimen.
 Provide through patient teaching, including the drug name
and prescribed dosage; the importance of taking the drug
whole without opening, chewing, or crushing it; signs and
symptoms of possible adverse effects and measures to
minimize or prevent it.

22. PATIENT TEACHING
 Inform pts that the tablets or capsules should not be
crushed or chewed
 Teach pts taking PPIs for GERD to implement
lifestyle changes, which may decrease the need for
the drug: smoking cessation, decreased alcohol
consumption, weight loss, avoid late night meals
and sleep with HOB elevated
 Teach pt to observe for s/s GI bleeding; black tarry
stools, coffee-ground vomitus, and to call HCP if
they occur
 Inform pts these drugs are meant for short-term use
(limited to 4-8 weeks) and to talk with their HCP to
avoid long-term effects.