Proton Pump Inhibitors

Proton pump inhibitors, or PPIs for short, are medications used to treat conditions like peptic ulcers, gastroesophageal reflux disorder or GERD, and Zollinger-Ellison syndrome, which is caused by a gastrin-secreting tumor that leads to excess gastric acid secretion which then results in peptic ulcers. Proton pump inhibitors are also included in the combination treatment against H. pylori, since they have a weak antibacterial effect.

Now, proton pump inhibitors usually end in "-prazole", and include medications that are administered orally, like omeprazole, lansoprazole, dexlansoprazole, rabeprazole; as well as medications available intravenously, like pantoprazole and esomeprazole.

Once administered, proton pump inhibitors act on the parietal cells in the stomach by binding to and inhibiting the H+/K+-ATPase or proton pumps. These pumps are involved in the secretion of gastric acid by exchanging potassium ions from the lumen with hydronium from the cells. As a result, proton pump inhibitors ultimately decrease gastric acid secretion.

Side effects of proton pump inhibitors are uncommon, but can include headaches, dizziness, fatigue, and blurred vision, as well as dry mouth, increased thirst, and hiccups. In addition, some clients may experience gastrointestinal disturbances, such as increased or decreased appetite, nausea, abdominal pain, constipation, or diarrhea. Also, prolonged acid suppression can decrease the absorption of iron, calcium, magnesium, and vitamin B12, or cobalamin.

When the gastric juices are less acidic, it also allows ingested pathogens, like Clostridioides difficile, to survive and invade the gastrointestinal tract. Therefore, clients treated with proton pump inhibitors are more susceptible to gastrointestinal infection; this is also associated with an increased risk of microaspiration and lung colonization, leading to pneumonia. Other side effects may include a skin rash, and osteoporosis.

Now, as far as contraindications go, significant drug interactions should be considered before administering proton pump inhibitors. Specifically, the change in the gastric pH can reduce the absorption of certain medications, such as digoxin and ketoconazole.

Omeprazole can also reduce the rate of elimination of the oral anticoagulant warfarin, as well as anticonvulsants, such as phenytoin and carbamazepine, and benzodiazepines like diazepam, causing them to build up in the body and enhancing their action. In addition, omeprazole can reduce the activation of the antiplatelet medication clopidogrel. Finally, omeprazole is contraindicated during pregnancy, while the rest are safe to use.

Now, before administering a proton pump inhibitor, be sure to obtain a baseline assessment of your client, including vital signs, neurological status, respiratory status, and gastrointestinal symptoms like diarrhea and constipation; as well as the presence of any abdominal tenderness, distension, rebounding, or guarding.

Then, review any recent diagnostic information, including CBC, renal and hepatic function, electrolytes and vitamin B12 level. If your client is diagnosed with an ulcer, also review their radiologic or endoscopic results.

Then, explain how the medication can help decrease their symptoms, and review the prescribed length of treatment. In addition, prompt them to notify their healthcare provider if their symptoms don't resolve within four to eight weeks.

Alright, if your client is prescribed an oral proton pump inhibitor, teach them to take their medication before meals. Be sure to remind them that they should swallow their medication tablets or capsules whole without chewing, splitting or crushing the medication.

If the medication is in the form of granules, instruct your client to sprinkle the granules onto one teaspoonful of applesauce or into a cup containing one teaspoonful of apple juice; caution them to not mix the granules with water, other liquids or other foods. Stress the importance of swallowing the mixture right away, followed by several sips of water to wash the granules down into their stomach.

If your client continues to experience gastrointestinal discomfort, recommend small, frequent meals. In addition, remind them to increase their dietary intake of vitamin B12 during treatment, and remind them to avoid smoking, alcohol, aspirin or other NSAIDs, caffeine, and spicy foods that may irritate the gastrointestinal tract.

Also, advise your client to notify their healthcare provider right away if they experience fever, abdominal pain, or blood in their stool; as well as other warning symptoms like confusion or hallucinations.

Now, if you are caring for a client in the intensive care unit, you could be ordered to administer a proton pump inhibitor intravenously to prevent the development of a stress ulcer, which can present with symptoms such as hematemesis, melena, hypotension, or shock. Be sure to always administer the medication through an infusion pump at the ordered rate.

After administering the medication, be sure to monitor the injection site for thrombophlebitis, and assess your client closely for headache, dizziness, or blurred vision, and monitor for the development of a gastrointestinal infection.

While caring for clients taking proton pump inhibitors, monitor them for therapeutic effects of the medication. Finally, continue to monitor for side effects or complications, and report any changes in the client's condition to the healthcare provider.

Alright, as a quick recap …. Proton pump inhibitors are medications used to treat conditions like peptic ulcers, GERD, and Zollinger-Ellison syndrome, and include omeprazole, lansoprazole, dexlansoprazole, rabeprazole, pantoprazole, and esomeprazole. Once administered, proton pump inhibitors act on the parietal cells in the stomach by binding to and inhibiting the H+/K+-ATPase, or proton pumps, causing a decrease in gastric acid secretion.

Now, when caring for a client prescribed a proton pump inhibitor, nursing considerations consist of obtaining baseline assessment information and your client's recent diagnostic data. Client teaching includes proper self-administration, potential side effects, recommended dietary changes, and when to contact their healthcare provider.