A Nursing Guide to Proton Pump Inhibitors

• Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastric distress. 
• If the patient develops ulcers in the gastrointestinal tract or has acidity, the healthcare providers might prescribe a proton pump inhibitor to relieve its symptoms. 
• Ask your patients to take it 30 minutes before the meal. Otherwise, it will not show its efficient effects.
  

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastric distress. The gastrointestinal tract is a long, hollow, and muscular tube that consists of the pharynx, esophagus, stomach, and small and large intestines. Its primary functions are to digest and absorb foods and fluids and excrete metabolic waste. 

If the patient develops ulcers in the gastrointestinal tract or has acidity, the healthcare providers might prescribe a proton pump inhibitor to relieve its symptoms.  

Proton pump inhibitors block the last step in gastric acid secretion. It combines with hydrogen, potassium, and adenosine triphosphate in the parietal cells of the stomach. 

Proton pump inhibitors bind to the activated proton pump on the apical membrane of parietal cells. They inhibit acid secretion into the gastric lumen. Therefore, commonly used in the treatment of health conditions, such as: 

• gastric and duodenal ulcers 
• gastroesophageal reflux disease (GERD) 
• pathologic hypersecretory conditions.
  

The common examples of proton pump inhibitors include: 

• esomeprazole 
• lansoprazole 
• omeprazole 
• pantoprazole 
• rabeprazole

Here in this article, we will briefly discuss each proton pump inhibitor, its indications, doses, and dosage forms with the nursing processes. 

Examples of Proton Pump Inhibitors

Dexlansoprazole

• Available as: 30mg and 60mg capsules 
• Usual adult dose: 30 to 60 mg orally per day 
• Indicated in: erosive esophagitis, heartburn associated with non-erosive GERD 
• Brand name: Dexilant
  

Esomeprazole

• Available as: 20mg and 40mg capsules and injection 
• Usual adult dose: 20 to 40mg per day 
• Indicated in: Helicobacter pylori eradication, GERD, erosive esophagitis 
• Brand name: Nexium

Lansoprazole

• Available as: 15mg and 30mg capsules and orally disintegrating tablets 
• Usual adult dose: 15 to 30mg per day orally 
• Indicated in: duodenal ulcer, gastric ulcer, NSAID-associated gastric ulcer, hypersecretory conditions, H. pylori eradication, GERD, erosive esophagitis 
• Brand name: Prevacid 

Omeprazole

• Available as: 10mg, 20mg and 40mg capsules 
• Usual adult dose: 20 to 40mg per day orally 
• Indicated in: duodenal ulcer, gastric ulcer, hypersecretory conditions, H. pylori eradication, GERD, erosive esophagitis 
• Brand name: Prilosec 

Omeprazole and Sodium Bicarbonate

• Available as: 20mg and 40mg powder for suspension  
• Usual adult dose: 20 to 40mg per day orally 
• Indicated in: duodenal ulcer, benign gastric ulcer, GERD, erosive esophagitis 
• Brand name: Zegerid 
  

Pantoprazole

• Available as: 20mg and 40mg tablets and 40mg injection 
• Usual adult dose: 40mg/day 
• Indicated in: erosive esophagitis, hypersecretory conditions 
• Brand name: Protonix  

Rabeprazole

• Available as: 20mg tablet, 5mg, and 10mg sprinkles 
• Usual adult dose: 20mg per day orally 
• Indicated in: Duodenal ulcer, hypersecretory conditions, H. pylori eradication, GERD, erosive esophagitis 
• Brand name: Aciphex
  

Side Effects of Proton Pump Inhibitors

Generally, proton pump inhibitors are well tolerated. However, they can cause the following side effects: 

• Headache 
• Nausea 
• Constipation 
• Diarrhea 
• Flatulence 
• Abdominal pain  
• Long-term use associated with C. difficile infection can increase the risk of fractures and cause hypomagnesemia 

Drug Interactions of Proton Pump Inhibitors

They may interfere with the metabolism of 

• Diazepam 
• Phenytoin 
• Warfarin
  

That can result in their increased half-lives and increased plasma concentrations of these drugs.  

Proton pump inhibitors might also interact with other drugs that depend on the gastric pH to get absorbed. It includes medicines, such as:

• Ketoconazole 
• Digoxin 
• Ampicillin   
• Iron salts 

Proton Pump Inhibitors and Nursing Implementation

• As a nurse, you must implement the following points when administrating a proton pump inhibitor.

• Administer the proton pump inhibitor to the patient 30 minutes before the meal. However, oral pantoprazole can be given with or without food.

• In patients with hepatic or renal impairment, you do not need to adjust the dose of proton pump inhibitors.

• Ask the patient not to open, crush or chew the capsule. Instead, swallow it whole with water. These formulations are often sustained release or delayed release. Therefore opening them or crushing them will affect their efficacy.  
• When giving IV esomeprazole, lansoprazole, or pantoprazole, check the package insert and your facility’s policy for reconstitution, compatibility, and infusion time information

• If the patient cannot swallow the tablet or capsule, you can give them lansoprazole. Open it and mix the granules in juice or apple sauce so the patient can consume them easily.

• Ask the patient not to consume any other herbal drug or over-the-counter or prescription drugs without consulting the healthcare provider first with proton pump inhibitor therapy

• Tell your patients to notify you soon if they have any adverse effects of proton pump inhibitors therapy, such as headache, diarrhea, abdominal pain, and nausea or vomiting. 

The Bottom Line

Proton pump inhibitors are generally safe and commonly used to relieve the symptoms of ulcers and acidity. Ask your patients to take it 30 minutes before the meal. Otherwise, it will not show its efficient effects.  

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