PPIs
HYPOmagnesemia associated with PPI therapy
As a clinical pharmacist, you will hear about proton pump inhibitor-induced hypomagnesemia . PPI therapy has been associated with hypomagnesemia, possibly due to reduced magnesium absorption. Hypomagnesemia has been reported after three months of PPI therapy, but the risk increases after a year. Data is conflicting on whether PPI therapy causes hypomagnesemia. Two m…
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PPIs
Optimizing PPIs for GERD
As a GI pharmacist, you play a key role in optimizing proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD) . PPIs are still the mainstay for severe or frequent GERD symptoms, such as heartburn or regurgitation 2 or more times/week. Recommend starting with a standard-dose PPI (omeprazole 20 mg, etc) once daily 30 to 60 min …
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Stress Ulcer
Minimize unsuitable use of PPIs for stress ulcers
As a critical care pharmacist, you will be asked to re-evaluate the use of proton pump inhibitors (PPIs) or H2-blockers for stress ulcer prophylaxis. We know that stress ulcer prophylaxis isn't indicated for floor patients. But many ICU patients don't need it either... Mounting evidence suggests it doesn't decrease mortality or clinically significan…
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PPIs
When short- or long-term use of PPIs is appropriate
As a pharmacist, you should give more focus on reining in inappropriate use of proton pump inhibitors [PPIs] (omeprazole, etc) due to new expert guidance and payer restrictions. Washington State's Medicaid won't cover more than 2 months of a PPI per year without a prior auth. Other payers will likely consider similar limitations. This isn'…
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Stress Ulcer
Quick guide of dyspepsia
Overview ㅡ Dyspepsia is a predominant epigastric pain. It may be associated with epigastric fullness, nausea, heartburn, or vomiting. Endoscopy is warranted in all patients aged 60 years or older and selected younger patients with "alarm" features. In all other patients, testing for Helicobacter pylori is recommended; if positive, empiric treatment …
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PPIs
Appropriate drug regimens for Helicobacter pylori eradication
Clarithromycin and tetracycline shortages will bring up more questions about appropriate drug regimens for H. pylori ( see Table 1 ) . Triple therapy with a proton pump inhibitor (PPI) , clarithromycin, and amoxicillin or metronidazole is often used first-line, but usually should NOT be. Efficacy rates are falling due to increasing clarithromycin resistance. For fu…
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Pregnancy and Breastfeeding
Dyspepsia and gastro-esophageal reflux during pregnancy
Overview ㅡ Dyspepsia is a term used to describe a number of symptoms associated with the upper gastrointestinal tract that may include upper abdominal pain or discomfort, a feeling of upper abdominal 'fullness' or 'heaviness', reflux, heartburn, belching, nausea, and vomiting... Causes. Dyspepsia in pregnancy is commonly due to gastro-esophage…
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PPIs
Approach to gastritis
Introduction ㅡ Gastritis is the acute or chronic inflammation of the gastric mucosa. The acute form is the most common stomach disorder. Gastritis may occur with other serious conditions, such as atrophy of the stomach. Table (1). Causes of gastritis Comment …
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Stress Ulcer
Pharmacology of histamine 2 (H2) antagonists
Therapeutic actions ㅡ H2 antagonists or H2-blocker inhibit the action of histamine at the H2 receptors of the stomach, inhibiting gastric acid secretion and reducing total pepsin output; the resultant decrease in acid allows healing of ulcerated areas. See additional notes Peptic Ulcer; assessment and management and Dyspepsia . Th…
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PPIs
Pharmacotherapy of oral proton pump inhibitors (PPIs)
Overview ㅡ Proton pump inhibitors (PPIs) effectively block gastric acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump that resides on the luminal surface of the parietal cell membrane. Dosage and indications For patients admitted with suspected upper gastrointestinal (GI) bleeding, discontinuing co…
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