Esomeprazole Magnesium (Gastric Antisecretory)

Question 1

What is the brand name of Esomeprazole Magnesium?

Answer 1

Nexium

Question 2

What dosages strengths are available for Nexium capsules, delayed release?

Answer 2

20mg & 40mg

Question 3

What strengths are available for Esomeprazole granules for oral suspension?

Answer 3

10mg, 20mg, 40mg

Question 4

What strengths are available for Nexium powder for injection, freeze dried?

Answer 4

20mg & 40mg

Question 5

What dosage of Nexium is used when indicated for the short-term treatment of erosive esophagitis (oral only)?

Answer 5

20 to 40mg daily for 4-8 weeks

Question 6

What dosage of Esomeprazole Magnesium is used for the treatment of symptomatic GERD? (in patients over the age of 1)

Answer 6

20mg QD for 4-8 weeks

Question 7

What dose of Nexium is used for the maintenance of healing of erosive esophagitis and gastric ulcers?

Answer 7

20mg given once daily

Question 8

What is the dose of Nexium used to treat an infection of H. Pylori

Answer 8

Esomeprazole 40mg QD
Clarithromycin 500mg QD
Amoxicillin 1000mg BID

all for 10 days

Question 9

What dose of Nexium is used to reduce occurrences of gastric ulcers associated with NSAID use in patients >60 years old?

Answer 9

20-40mg QD for up to 6 months

Question 10

What dose of Esomeprazole is used to treat GERDD with a history of erosive esophagitis when oral therapy is not appropriate?

Answer 10

20-40mg IV over at least 3 hours or continuously infused over 10-30 minutes

Question 11

What dose of Nexium should be used to treat pathological hypersecretory conditions including Zollinger-Ellison syndrome?

Answer 11

40mg BID

Question 12

What should the providers monitor while their patient is taking Esomeprazole Magnesium?

Answer 12

Magnesium Levels

Bone Mineral Density

Question 13

What is the mechanism of action for Nexium?

Answer 13

It is a proton pump inhibitor (PPI) that surpasses the H+/K+ ATPase enzyme system at the secretory surface of the gastric parietal cell.

Question 14

What are the possible drug interactions for Esomeprazole Magnesium?

Answer 14

• Increases plasma levels of diazepam
• Since this drug acts to increase the pH of the gastric acid, drugs that depend on the normal stomach pH may be affected (Ketoconazole, digoxin, cyanocobalamin, ampicillin esters, iron salts)
• May decrease the plasma levels of atazanavir
• Antacids may be used concomitantly
• Voriconazole may increase the levels of Nexium
• Nexium may inhibit the metabolism of cilostazole
• May prevent the conversion of clopidogrel to its active metabolite

Question 15

What are the contraindications of Nexium?

Answer 15

• Animal studies have shown a dose-related increase risk for gastric carcinoid tumors with long-term use of omeprazole or esomeprazole (the enantiomer).
• The levels of the drug needed to product tumors far exceed the normal daily dose (up to 352 times the human dose)
• Symptomatic response to therapy with esomeprazole does not preclude the presence of gastric malignancy.
• There have been rare cases of severe dermatologic reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiform, in patients using esomeprazole
• Pregnancy Category B

Question 16

What are the adverse effects of Nexium?

Answer 16

Headache, diarrhea/constipation, nausea, flatulence, abdominal pain, & dry mouth

Question 17

What should the RPh tell the patient about Esomeprazole Magnesium?

Answer 17

• Take this drug at least 1 hours prior to eating
• Swallow capsules whole, or carefully empty the contents by opening the capsule and sprinting the enteric-coated granules over one tsp of applesauce. Injest this mixture without chewing.
• Granules should be mixed with one tbsp of water, stirred, left for 2-3 minutes, then taken orally. Water can be added to the container a second time if any medication is remaining. Take w/I 30 minutes of mixing
• Antacids MAY be taken at the same time
• If a dose is missed, take ASAP. If time is closer to next dose, skip the missed dose. Do NOT double doses