Proton Pump Inhibitors

Acid Controlling Agents

Proton Pump Inhibitors: (PPI) The newest drugs introduced for the treatment of acid-related disorders. More powerful than H2 antagonists, they bind directly to the hydrogen-potassium-ATPase pump mechanism. They irreversibly inhibit the action of this enzyme, which results in a total (100% blockage of pump) blockage of hydrogen ion secretion from the parietal cells.

I Definition
A. The parietal cells release positive hydrogen ions (protons) during HCl production
B. This process is called the “proton pump”
C. H2 blockers and antihistamines do not stop the action of this pump
II Mechanism of action (pg 797)
A. Irreversibly bind to h+/k+ ATPase enzyme
B. This bond prevents the movement of hydrogen ions from the pariental cell into the stomach
C. Result: achlorhydria – ALL gastric acid secretion is blocked
1. in order to return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.
III Drug Effect
A. Total inhibition of gastric acid secretion
1. lansoprazole (prevacid)
2. omeprazole (prilosec)...first in this new class
3. pantoprazole (protonix) IV
4. esomeprazole (nexium) IV
IV Indications
A. GERD maintenance therapy
B. Erosive esophagitis
C. Short-term treatment of active duodenal and benign gastric ulcers
D. Zollinger-Ellison syndrome (hypersecretory)
E. Treatment of H. pylori induced ulcers
V Side Effects
A. Safe for short term therapy
B. incidence low and uncommon (pretty nil)
VI Nursing Implications
A. Assess for allergies and history of liver disease
B. Pantoprazole is the only proton pump inhibitor available for parenteral administration, and can be used for patients who are unable to take oral medications (also esomeprazole) Nexium
C. May increase serum levels of diazepam, phenytoin, and cause increased chance for bleeding with warfarin.
D. In the patient taking omeprazole:
1. take before meals (empty stomach)
2. the capsule needs to be swallowed whole, not crushed, opened, or chewed
3. it may be given with antacids
4. emphasize that the treatment will be short term


Other Drugs

I Sucralfate (Carafate)
A. Cytoprotective agent
B. used for stress ulcers, erosions, PUD
C. Attracted to and binds to the base of ulcers and erosions forming a protective barrier over these areas
D. Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)
E. Not an antacid works like a band aid
F. Little absorption from the gut
G. May cause constipation, nausea, and dry mouth
H. May impair absorption of other drugs, especially tetracycline. Give alone
I. Binds with phosphate, may be used in chronic renal failure to reduce phosphate levels.
J. Do not administer with other medications.
II Misoprostol (Cytotec)
A. Synthetic prostaglandin analog
B. Prostaglandins have cytoprotective activity
1. protect gastric mucosa from injury (ulcers) by enhancing local production of mucus or bicarbonate. (Helps protect stomach from ulcers caused by NSAIDS)
2. promote local cell regeneration
3. help to maintain mucosal blood flow
C. Used for prevention of NSAID induced gastric ulcers
D. Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea
E. used to induce labor...pregnant women should not handle