2. PPIs

Question 1

MOA of proton pump inhibitors

Answer 1

PPIs block gastric acid secretion by irreversibly binding to the gastric H+/K+ ATPase pump in parietal cells, shutting down the proton pump

Question 2

omeprazole (brand, dosing)

available as tablet (OTC), capsule, packet suspension

Answer 2

PriLOSEC, PriLOSEC OTC, First-Omeprazole, Omeprazole+Syrspend SF Alka suspension compounding kits
20 mg daily

Question 3

omeprazole + sodium bicarbonate (brand, dosing)

available as capsule, packet

Answer 3

Zegerid

20 mg daily (dosing based on omeprazole component)

Question 4

pantoprazole (brand, dosing)

available as tablet, injection, packet

Answer 4

Protonix

40 mg daily

Question 5

lansoprazole (brand, dosing)

available as soluble tablet, capsule (OTC), suspension

Answer 5

Prevacid, Prevacid SoluTab, Prevacid 24H-OTC, First-Lansoprazole suspension compounding kit
15-30 mg daily

Question 6

dexlansoprazole (brand, dosing)

available as capsule

Answer 6

Dexilant

30-60 mg daily

Question 7

esomeprazole magnesium (brand, dosing)

available as capsule, injection, packet

Answer 7

NexIUM, NeXIUM IV

20-330 mg daily

Question 8

esomeprazole strontium (brand, dosing)

available as capsule

Answer 8

NOT generic Nexium; used for same indications as esomeprazole, not approved for infants/children

strontium 24.65 mg capsule = 20 mg esomeprazole base
strontium 49.3 mg capsule = 40 mg esomeprazole base

Question 9

esomeprazole + naproxen 375 or 500 mg (brand, dosing)

Answer 9

Vimovo

20-40 mg daily (esomeprazole base)

Question 10

rabeprazole (brand, dosing)

available as tablet, capsule sprinkle

Answer 10

AcipHex

20 mg daily

Question 11

PPI warnings (6)

Answer 11

–C. diff-associated diarrhea (CDAD)
–osteoporosis-related fractures (especially with long-term use)
–pneumonia in hospitalized pts
–hypomagnesemia with long-term use
–potential for B12 deficiency with prolonged use (≥2 yrs)
–acute interstitial nephritis (hypersensitivity rxn)

Question 12

PPI SEs

Answer 12

HA, N/D (mild and infrequent)

Question 13

PPIs are the most _____ agents for severe disease/symptoms

Answer 13

effective

Question 14

All PPIs have _____ efficacy

Answer 14

similar

although a pt may respond better to one agent over another

Question 15

PPIs are pregnancy category ___ (name 3) and ___ (name 3)

Answer 15

B: dexlansoprazole, lansoprazole, pantoprazole
C: esomeprazole, omeprazole, rabeprazole

Question 16

Which 2 PPIs are available as IVs?

Answer 16

pantoprazole, esomeprazole

Question 17

PPI tablets or capsules should not be crushed, cut or chewed; however the capsule formulation of 5 PPIs can be opened (not crushed) and mixed in apple sauce or acidic juice if pt can’t swallow a pill or for NG tube delivery. Name those 5 PPIs.

Answer 17

–dexlansoprazole
–esomeprazole
–lansoprazole
–omeprazole
–rabeprazole

Question 18

Zegerid dosing considerations (3)

Answer 18

–the 20 mg and 40 mg have the same Na bicarb content
–two 20 mg capsules ≠ 40 mg capsule
–caution on patients on a Na-restricted diet; each capsule has 300 mg NA

Question 19

Suspension kits contain pre-measured _____ drug, suspension liquid (with _____) and mixing tools; available in different sizes/strengths.

Answer 19

powdered

flavoring

Question 20

PPI DDI: drugs that require an acidic gut for absorption with have decreased absorption and _____-______ products could dissolve and release prematurely.

Answer 20

enteric-coated

Question 21

PPI DDI: use caution when PPIs are administered with (7)

Answer 21

–atazanavir
–bisphosphonates
–itraconazole
–ketoconazole
–ledipasvir
–mesalamine
–many tyrosine kinase inhibitors

Question 22

PPI DDI: avoid these drugs due to decreased absorption (9)

Answer 22

–some oral cephalosporins (cefditoren, cefpodoxime, cefuroxime)
–delavirdine
–rilpivirine
–dasatinib
–erlotinib
–pazopanib
–posaconazole oral suspension
–Atelvia formulation of risedronate
–St. John's wort

Question 23

PPI DDI: PPIs inhibit 2C19, increasing levels of (8)

Answer 23

–nelfinavir
–methotrexate
–phenytoin
–raltegravir
–saquinavir
–tacrolimus
–voriconazole
–warfarin

Question 24

PPI DDI: PPIs inhibit 2C19, possibly decreasing the effectiveness of _____; if it must be used, avoid these 2 PPIs _____ & ______

Answer 24

clopidogrel

omeprazole, esomeprazole

Question 25

Prevacid SoluTab considerations (2)

Answer 25

–contains phenylalanine, so do not use in pts w/ phenylketonuria (PKU)
–do not swallow whole; place on tongue and allow to dissolve with or without water, then swallow

Question 26

PPIs [do/don’t] provide immediate relief for heartburn and acid symptoms.

Answer 26

don’t

needs to be taken everyday as prescribed for relief

Question 27

If taking PPI long-term, ensure that ____ and vitamin __ intake is optimal.

Answer 27

calcium, D

recommend calcium citrate for improved absorption in basic pH

Question 28

If planning to discontinue PPI, consider ____ to avoid _____ _____.

Answer 28

tapering

acid rebound

Question 29

Treatment with a PPI for more than ____ days requires a consultation with a healthcare provider.

Answer 29

14