Proton Pump Inhibitors (PPIs)

• Proton Pump Inhibitors (PPIs) block the hydrogen-potassium ATPase pump.
• The hydrogen-potassium ATPase pump acts as a proton pump on the gastric parietal cell.
• The pump is responsible for secreting hydrogen ions, which bind with chloride to form hydrochloric or stomach acid.
• Blocking this pump reduces the acidity of stomach contents.
• "-prazole" is a common suffix for these medications.
  • Examples include Omeprazole, Pantoprazole, and Lansoprazole.

Therapeutic Use

• Treats GERD, where acidic gastric contents lead to discomfort.
• Treats Erosive esophagitis, decreasing inflammation of the esophagus lining caused by reflux.
• Used for Peptic Ulcer Disease.
• Treats H. pylori infection by promoting the impact of antibiotics.
• Used for the prevention of stress ulcers due to intensive surgery.

Adverse Effects

• PPI use changes stomach pH, potentially leading to microorganism growth.
• Long-term therapy increases the risk of C.diff infection.
• Pneumonia can occur with small amount of acid, containing bacteria gets aspirated into the lungs.
• Rebound acid hypersecretion can occur where gastric cells produce stronger acid than before.
• Tapering medication is recommended by gradually reducing the dosage to reduce the risk of adverse effects.
• Malabsorption of minerals and vitamins, leading to poor calcium absorption.
• Reduced vitamin B12, causing pernicious anemia, can occur for use of more than two years.
• Can lead to low magnesium absorption or hypomagnesemia.
• Osteoporosis can occur with decreased calcium absorption, with long-term use potentially causing bone fragility and high risk of fracture.

Client Teaching

• Take lowest dose in the shortest amount of time, as this results in fewer adverse effects.
• Discontinue use when there is a clear indication from medical professional.
• Immediately report any signs or symptoms of diarrhea, cramps, or fever indicating possible C.diff.
• Ensure adequate intake of Vitamin D and Calcium.
• Take 30 to 60 minutes before meal will allow the drug to attach to proton pump cells.
  • Oral suspensions are available.
• Avoid NSAIDs and Aspirin when taking PPIs.
• Take Calcium and Vitamin D supplements to prevent osteoporosis.
• For ER tablets, do not chew or crush.
• Report diarrhea if it occurs with prolonged use.

Drug Interaction

• Antiplatelet drugs like Clopidogrel enzymes interact with PPIs when activated.
• HIV medications require stomach acid which PPIs may decrease, reducing its effectiveness.
• PPIs inhibit the enzyme that metabolizes Warfarin.