Proton Pump Inhibitors (PPIs)

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Questions and Answers

A patient taking a PPI reports frequent diarrhea, abdominal cramps, and a low-grade fever. Which of the following is the most appropriate nursing action?

Administer an anti-diarrheal medication and monitor for improvement.
Reassure the patient that these are common side effects and encourage continued use of the PPI.
Instruct the patient to increase their intake of probiotic-rich foods.
Suspect _C. difficile_ infection and notify the healthcare provider immediately. (correct)

A client is prescribed a PPI for long-term management of GERD. What potential adverse effect should the nurse prioritize when educating the client?

Hypertension and fluid retention.
Increased risk of bleeding.
Vitamin B12 deficiency and related neurological symptoms. (correct)
Elevated liver enzymes.

Why are PPIs typically administered 30-60 minutes before a meal?

To enhance absorption of the medication into the bloodstream.
To allow the drug to bind to the proton pumps on parietal cells when they are actively secreting acid triggered by food intake. (correct)
To prevent interactions with food, which can decrease the drug's effectiveness.
To minimize the risk of gastric irritation and nausea.

A patient is prescribed clopidogrel and a PPI concurrently. What is the primary concern regarding this drug interaction?

Decreased effectiveness of clopidogrel due to impaired activation. (C)

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In a patient with a history of osteoporosis, what advice should the nurse give regarding PPI use?

Use PPIs at the lowest effective dose for the shortest duration possible, while ensuring adequate calcium and vitamin D intake. (C)

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A patient is prescribed an enteric-coated PPI tablet. Which instruction should the nurse include in the patient's education?

Swallow the tablet whole; do not chew or crush it. (B)

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A patient has been taking a PPI for several months and is now ready to discontinue the medication. What approach is recommended to stop PPI therapy and why?

Taper the dose gradually to minimize rebound acid hypersecretion. (A)

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Which of the following conditions is a recognized therapeutic use of PPIs?

Erosive esophagitis. (C)

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Flashcards

PPI Mechanism

Block the hydrogen potassium ATPase pump on gastric parietal cells, reducing stomach acid production.

PPI Therapeutic Uses

GERD, erosive esophagitis, peptic ulcer disease, H. pylori treatment, and stress ulcer prevention.

PPI Adverse Effects

C. diff infection, pneumonia, rebound acid hypersecretion, malabsorption of minerals/vitamins, osteoporosis.

PPI & C. diff

PPIs change stomach pH, allowing microorganisms to grow, increasing the risk of C. diff.

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Rebound Acid Hypersecretion

Gastric cells produce more acid than before after stopping PPIs, causing heartburn.

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PPI Client Teaching Points

Take the lowest dose for the shortest time and report diarrhea or fever.

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PPI Administration Timing

Take 30-60 minutes before a meal.

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PPI Drug Interactions

Clopidogrel effectiveness may be reduced and warfarin metabolism inhibited.

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Study Notes

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.