Proton Pump Inhibitors
Get to know the proton pump inhibitors in this nursing pharmacology guide for student nurses. Learn about proton pump inhibitors, its uses, and the nursing considerations for patients using them.
The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium adenosine triphosphate enzyme system on the secretory surface of the gastric parietal cells.
Proton Pump Inhibitors: Generic and Brand Names
Here is a table of the most commonly encountered proton pump inhibitor:
| Classification | Generic name | Brand name |
| Proton pump inhibitors | dexlansoprazole | Kapidex |
| esomeprazole | Nexium | |
| lansoprazole | Prevacid | |
| omeprazole | Prilosec | |
| pantoprazole | Protonix | |
| rabeprazole | Aciphex |
Disease spotlight: Gastroesophageal Reflux
Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting the mouth and the stomach (esophagus).
- GERD is a mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.
- Common signs and symptoms of GERD include a burning sensation in the chest (heartburn), usually after eating, which might be worse at night; chest pain; difficulty swallowing; regurgitation of food or sour liquid; and a sensation of a lump in your throat.
What are Proton Pump Inhibitors?
Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach.
Therapeutic actions
The desired actions of antacids include the following:
- Blocks the final step of acid production, lowering the acid levels in the stomach.
- Inhibits the hydrogen-potassium adenosine triphosphate enzyme system on the secretory surface of the gastric parietal cells.
Indication
Antacids are indicated for the following:
- Treatment and maintenance of erosive esophagitis, treatment of heartburn associated with GERD.
- Treatment of GERD, severe erosive esophagitis, duodenal ulcers, and pathological hypersecretory condition.
- Treatment of gastric ulcer.
- Maintenance therapy for healing duodenal ulcers and esophagitis.
- In combination therapy for eradicating Helicobacter pylori infection.
- Approved for use in children for treatment of GERD, peptic ulcer, and Zollinger-Ellison syndrome.
Pharmacokinetics
Esomeprazole, lansoprazole, and pantoprazole are available in delayed-release oral forms and as IV preparations; rabeprazole, dexlansoprazole, and omeprazole are available only in delayed-release oral forms.
| Route | Onset | Peak | Duration |
| Oral | Varies | 0.5-3.5h | Varies |
| T 1/2: 30 to 60 mins | |||
| Metabolization: Liver | |||
| Excretion: Urine and bile | |||
Contraindications and Cautions
The following are contraindications and cautions when using proton pump inhibitors:
- Allergy. These drugs are contraindicated in the presence of a known allergy to either the drug or the drug components to prevent hypersensitivity reactions.
- Pregnant or lactating women. Caution should be used in pregnant or lactating women because of the potential for adverse effects on the fetus or neonate.
- Patients 18 years old and below. The safety and efficacy of these drugs have not been established for patients younger than 18 years of age, except for lansoprazole, which is the proton pump inhibitor of choice if one is needed for a child.
Adverse effects
Adverse effects when using proton pump inhibitors include:
- CNS: Headache, dizziness, vertigo, insomnia.
- Skin: Rash.
- GI: Diarrhea, abdominal pain, nausea, vomiting.
- Respiratory: Upper respiratory infections, cough.
Interactions
Clinically important drug to drug interactions for proton pump inhibitors include the following drugs:
- Benzodiazepines, phenytoin, warfarin: There is a risk of increased serum levels and increased toxicity of benzodiazepines, warfarin, and phenytoin if these are combined with these drugs; patients should be monitored closely.
- Ketoconazole and theophylline. Decreased levels of ketoconazole and theophylline have been reported when combined with these drugs, leading to loss of effectiveness.
- Sucralfate. Sucralfate is not absorbed well in the presence of these drugs, and doses should be spaced at least 30 minutes apart if this combination is used.
- Clopidogrel. There is an increased risk of cardiovascular events if proton pump inhibitors are combined with clopidogrel; this combination should be avoided.
Nursing considerations
Nursing considerations when using proton pump inhibitors include the following:
Nursing Assessment
History taking and physical examination of a patient using proton pump inhibitors include:
- Assess for possible contraindications and cautions: history of allergy to a proton pump inhibitor to reduce the risk of hypersensitivity reaction and current status of pregnancy or lactation because of the potential for adverse effects on the fetus or nursing baby.
- Perform a physical examination to establish baseline data before beginning therapy to determine the effectiveness of the therapy and to evaluate for the occurrence of any adverse effects associated with drug therapy.
- Inspect the skin for lesions, rash, pruritus, and dryness to identify possible adverse effects.
- Assess neurological status, including level of orientation, affect and reflexes to evaluate for CNS effects of the drug.
- Inspect and palpate the abdomen to determine potential underlying medical conditions; assess for changes in bowel elimination and GI upset to identify possible adverse effects.
- Assess respiratory status, including respiratory rate and rhythm; note evidence of cough, hoarseness, and epistaxis, to monitor for potential adverse effects of the drugs.
Nursing Diagnosis and Care Planning
Nursing diagnoses related to drug therapy might include the following:
- Diarrhea related to GI effects.
- Risk for constipation related to GI effects.
- Imbalanced nutrition: less than body requirements related to GI effects.
- Disturbed sensory perception (kinesthetic, auditory) related to CNS effects.
- Risk for injury related to CNS effects.
- Deficient knowledge regarding drug therapy.
Nursing Implementation with Rationale
Nursing interventions for patients using proton pump inhibitors include the following:
- Proper administration. Administer drug before meals to ensure that the patient does not open, chew, or crush capsules; they should be swallowed whole to ensure the therapeutic effectiveness of the drug.
- Safety and comfort measures. Provide appropriate safety and comfort measures if CNS effects occur to prevent patient injury.
- Institute a bowel program. Monitor the patient for diarrhea or constipation in order to institute an appropriate bowel program as needed.
- Monitor nutritional status. Monitor the patient’s nutritional status; use of small frequent meals may be helpful if GI upset is a problem.
- Ensure follow-up. Arrange for medical follow-up if symptoms are not resolved after 4 to 8 weeks of therapy because serious underlying conditions could be causing the symptoms.
- Provide patient support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.
- Educate the patient and folks. Provide thorough patient teaching, including the drug name and prescribed dosage; the importance of taking the drug whole without opening, chewing, or crushing it; signs and symptoms of possible adverse effects and measures to minimize or prevent them.
Evaluation
Evaluation of a patient using proton pump inhibitors include the following:
- Monitor patient response to the drug (relief of GI symptoms caused by hyperacidity, healing of erosive GI lesions).
- Monitor for adverse effects (GI effects, CNS changes, dermatological effects, respiratory effects).
- Monitor the effectiveness of comfort and safety measures and compliance with the regimen.
- Evaluate the effectiveness of the teaching plan (patient can name the drug and dosage and describe adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug).
Practice Quiz: Proton Pump Inhibitor
Here’s a 5-item quiz for this proton pump inhibitor study guide. Please visit our nursing test bank page for more NCLEX practice questions.
1. The physician has prescribed Nexium (esomeprazole) for a client with erosive gastritis. The nurse should administer the medication:
A. 30 minutes after meals
B. 30 minutes before meals
C. With each meal
D. In a single dose at bedtime
1. Answer: B. 30 minutes before meals
- Option B: Proton pump inhibitors reduce the production of acid in the stomach. Proton pump inhibitors work best when they are taken 30 minutes before the first meal of the day.
2. Proton pump inhibitor use will likely result in:
A. Heartburn
B. Diverticulosis
C. Gastric ulcer formation
D. Achlorhydria
2. Answer: D. Achlorhydria.
- Option D: Because the proton pump inhibitors stop the final step of acid secretion, they can block up to 90% of acid secretion, leading to achlorhydria (absence of acid).
3. A patient is prescribed with esomeprazole for the treatment of GERD. Upon review of current medication use, the nurse noted that the patient is taking clopidogrel. The nurse warned the patient that esomeprazole:
A. Have no evidence of potential interaction with clopidogrel
B. Increase the effectiveness of clopidogrel
C. Decrease the effectiveness of clopidogrel
D. Increase acid production
3. Answer: C. Decrease the effectiveness of clopidogrel
- Option C: Esomeprazole inhibits CYP2C19 enzyme which serves as a pathway for certain medication. One of which is clopidogrel, so taking it with esomeprazole will potentially decrease the effectiveness of clopidogrel.
4. A nurse is checking the nasogastric tube position of a client receiving a long term therapy of Omeprazole (Prilosec) by aspirating the stomach contents to check for the PH level. The nurse proves that correct tube placement if the PH level is?
A. 5
B. 6.3
C. 6.5
D. 7
4. Answer: A. 5
- Option A: Gastric placement is indicated by a pH of less than 4, but may increase to between pH 4-6 if the patient is receiving acid-inhibiting drugs.
5. Prolonged use of Proton Pump Inhibitors will likely result with the following except:
A. Hypermagnesemia
B. Pneumonia
C. Fractures
D. Hypochlorhydria
5. Answer: A. Hypermagnesemia
- Option A: Long term use of PPIs affects intestinal magnesium absorption leading to hypomagnesemia.