Proton Pump Inhibitors (PPIs) Flashcards
What is the clinical indication of PPIs such as omeprazole, lansoprazole and esomeprazole?
- Prevention and treatment for peptic ulcer disease, including NSAIDS-associated ulcers
- Treatment of gastro-esophageal reflux disease (GORD) and dyspepsia
- Eradication of H.pylori infection used in combination with antibiotic therapy
What is the mechanism of action of PPIs? Specifically omeprazole
Reduce gastric acid secretion by irreversibly binding to H+/K+ ATPase in the gastric parietal cells
What are the common side effects associated with PPIs?
GI upset and headache
What can prolonged use of PPIs cause?
hypomagnesaemia- which can lead to neuromotor symptoms (such as tetany- involuntary muscle contractions) and arrhythmias
True or false?
An increase in PH in the stomach can increase risk of infections such as c.diff
True
Why is omeprazole generally avoided in elderly patients?
it can cause a high risk of fractures- links with worstening osteoporosis
What drugs do PPIs interact with- specifically omeprazole? why? what alternative could you use
May reduce the antiplatelet effects of clopidogrel by decreasing its activation by cytochrome P450 enzymes.
if contraindicated other PPIs may be co prescribed with clopidogrel
What is the typical prescription for prevention of NSAID- associated peptic ulcers?
lansoprazole 30mg orally daily
What is the treatment for H.pylori?
PPI
Two antibacterial
BNF states:
Oral first line for 7 days:
A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (treatment choice should take into account previous treatment with clarithromycin or metronidazole).
When are oral PPIs best taken?
In the morning with or without food
What should be monitored if patients is on PPI for more than a year?
Magnesium levels due to the risk of hypomagnesaemia
When should PPIs be withheld?
When testing for H.pylori as this can generate a false negative result
