Proton pump inhibitor

Question 1

PPI - examples

Answer 1

omeprazole

lansoprazole

pantoprazole

Question 2

PPI - indications

Answer 2

Prevention and treatment of peptic ulcer disease (PUD)

Symptomatic relief of dyspepsia and GORD

Eradication of H.Pylori infection - part of triple therapy

Question 3

PPI - MOA

Answer 3

PPIs REDUCE GASTRIC ACID SECRETION BY:
- irreversibly inhibiting H+/K+- ATPase in gastric parietal cells

• targets final stage of gastric acid production - therefore suppresses gastric acid production almost entirely

Question 4

PPI - adverse effects (common)

Answer 4

• GI disturbances: constipation, diarrhoea, nausea, vomiting
• headache

Question 5

PPI - what can happen with prolonged (most common after 1 year of treatment) use of PPI?

Answer 5

Hypomagnesaemia

Increased risk of Bone fractures in the elderly

Question 6

PPI - cautions

Answer 6

• PPIs may disguise symptoms of gastro-oesophageal cancer - therefore ensure to rule out alarming symptoms for malignancy prior to treatment
• high dose for prolonged course (especially in elderly) can increase the risk of fracture
• osteoporosis - advise these patients to maintain adequate intake of calcium and vitamin D

Question 7

PPI - interaction

Answer 7

Omeprazole can reduce the antiplatelet effect of clopidogrel by decreasing its activation by cytochrome p450

Alternative PPIs should be used if the patient is also taking clopidogrel such as lansoprazole and pantoprazole