Proton Pump Inhibitors (PPI's) Flashcards
What are some examples of PPI’s?
- Omeprazole
- Lansoprazole
- Esomeprazole
- Pantoprazole
What is the aim of PPI’s?
To suppress gastric acid secretion
How do PPI’s have their effect?
Irreversibly inhibit H+/K+ -ATPase in gastric parietal cells
How can PPI’s be administered?
- PO
- IV
What are the indications for PPI’s?
- GORD
- Gastro-duodenal ulcers
- H.pylori eradication (as part of triple therapy)
- Prophylaxis of ulceration in NSAID and steroid use
- Zollinger-Ellison syndrome
What are the cautions for the use of PPI’s?
- Red flag cancer symptoms
- Risk of osteoporosis
- Hepatic impairment
How should PPI’s be prescribed in hepatic impairment?
- Lower dose
- Renal function monitoring
What monitoring may patients of PPI’s require?
Magnesium levels
How can PPI’s affect magnesium levels?
Can cause hypomagnesaemia between 3 months to 1 year
What drugs does omeprazole interact with?
- Warfarin
- Clopidogrel
Omeprazole decreases efficacy of these drugs
What other drug can PPI’s interact with?
Digoxin
What can PPI’s and digoxin together cause?
Hypomagnesaemia
What are the common side-effects of PPI’s?
- GI disturbances
- Dry mouth
- Headaches
- Fatigue
What are the less common side-effects of PPI’s?
- Increased risk of C.diff
- Increased risk of osteoporosis
What mnemonic can be used to remember the side-effects of PPI’s?
PPI
What does the PPI mnemonic stand for?
- Pain (headache, abdo pain)
- Prone to C.diff and osteoporosis
- Intestinal upset
What counselling should be given to patients on PPI’s?
- Measures to further reduce acidity
- Ensure compliance
- Adequate vit D and calcium intake
- Red flags of gastric cancer
What should the patient be told regarding measures to further reduce acidity?
Explain that drug reduces acidity of stomach and should hopefully ease symptoms, but advise patient to avoid foods and drinks that exacerbate symptoms, to avoid large meals particularly late in evening, and avoid lying down immediately after eating
What should the patient be told regarding compliance with PPIs?
Emphasise the importance of compliance, particularly if this drug has been co-prescribed with other drugs for prophylaxis of ADR
What should be patients be told regarding preventing osteoporosis with PPIs?
Advise patients who are at risk of osteoporosis to maintain an adequate intake of vitamin D and calcium
What should be done in a patient taking a PPI who might struggle to maintain an adequate intake of calcium?
Consider prescribing prophylactic therapy, e.g. bisphosphonates
What should a patient on PPIs be told regarding red flags of cancer?
Inform patients about red flag symptoms of gastric cancer, and tell them to report these to GP. PPIs can mask symptoms of gastric cancer, so it is important to have a high index of suspicion
