PPIs Flashcards
true or false - following an endoscopic treatment of severe peptic ulcer bleeding, you can give high dose IV PPI to reduce risk of rebleeding and the need for surgery
true
Should you decrease the dose of a PPI in pt who need to continue NSAID treatment after ulcer has healed?
no not normally because symptomatic ulcer deterioration may occur
discuss the use of PPI in pt with CF
can be used in pt with CF to reduce the degradation of pancreatic enzyme supplements
what type of dosage is needed to control excessive secretion of gastric acid in Zollinger-Ellison syndrome
often high doses required
MOA
they inhibit gastric acid secretion by blocking the hydrogen potassium adenosine triphoshatase enzyme system (aka proton pump) of the gastric parietal cell
important safety info, MHRA: very low risk of subacute cutaneous lupus erythematous (SCLE)
- drug includes SCLE can occur weeks, months or even years after exposure to drug
- if pt develops lesions, esp in sun-exposed areas of skin, and it is accompanied by arthralgia advice them to…
- avoid exposing skin to sun
- consider SCLE as possible diagnosis
- consider discontinuing PPI unless it is imperative for a serious acid related condition
- in most cases, symptoms resolve on PPI withdrawal
- topical or systemic steroids may be necessary for treatment only if no signs of remission after a few weeks or months
true or false - a patient who develops SCLE with one PPI may be at risk of the same reaction with another PPI
true
A patient develops some lesions on their hands and face. They also have arthralgia. You look at their PMR and it is as follows
- cetirizine 10mg OD
- omeprazole 20mg OD
- naproxen 250mg TDS PRN
What do you suspect?
Possibly SCLE from PPI, although very rare.
Suspect it is there is lesions on sun exposed areas of skin accompanied by arthalgia.
cautions - what can PPIs do (5)
- increase risk of fractures (esp when used >1yr elderly at high doses)
- increase risk of GI infections including CDI
- mask the symptoms of gastric cancer in adults
- long term treatment can reduce absorption of B12
- pt at risk of osteoporosis
What to do with pt at risk of osteoporosis who are taking PPIs
- maintain adequate intake of calcium and vit D, and if necessary, recieve other preventative therapy
monitoring requirements
consider serum-mg conc before and during prolonged treatment with PPI, esp when used with other drugs that cause hypomagnesaemia or with digoxin
SE of PPIs
- abdominal pain
- constipation
- diarrhoea
- dizziness
- dry mouth
- GI disorders
- insomnia
- nausea, vomiting
- skin reactions
- hypomasgnesaemia (more common after 1 yr treatment, but sometimes occurs after 3 months)
which one is not known to be harmful in P or BF
omeprazole
