Vonoprazan
Limit use of Voquezna for H. pylori
As a community pharmacist, you should be updated. Voquezna Dual Pak and Triple Pak will be new prescribed combos for treating H. pylori . These combos contain vonoprazan, the first potassium-competitive acid blocker (PCAB)... Think of vonoprazan as a "fancy PPI ", with some differences. For instance, PPIs block activ…
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PPIs
Which patients on aspirin should get PPI
As a pharmacist, you will be asked, which patients on low-dose aspirin should also get a proton pump inhibitor . New recommendations will clarify which patients on low-dose aspirin should also get a proton pump inhibitor . Daily low-dose aspirin at least DOUBLES GI risk. There's one additional serious GI ulcer or bleed for every 200 patient…
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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
Proton pump inhibitors (PPIs)
PROTON PUMP INHIBITORS... EXAMPLES: Omeprazole, lansoprazole, esomeprazole, pantoprazole. MECHANISM OF ACTION: Inhibit H + /K + ATPase on luminal surface of gastric parietal cells and thereby reduce gastric acid secretion. INDICATIONS Gastric/duodenal ulceration. As part of triple therapy for eradication of Helicoba…
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Pregnancy and Breastfeeding
Gastrointestinal agents during pregnancy and breastfeeding
FDA pregnancy categories prior to 2014, figure (1) . Gastroesophageal reflux disease (GERD) occurs in up to 80%, of pregnancies and peaks in the third trimester. The exact mechanism and pathogenesis of this condition associated with pregnancy is likely multifactorial ( table 1 ) . Figure (1) FDA pregnan…
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PPIs
The interaction between PPI (omeprazole) and clopidogrel, what is your recommendations?
PRODIGY has published a guideline on antiplatelet treatment. This contains a scenario on the management of gastrointestinal adverse effects. This scenario discusses how to manage a patient at high risk of gastrointestinal bleeds. Ensure that general measures to reduce risk of gastrointestinal (GI) adverse effects have been taken... Prescribing …
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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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Pregnancy and Breastfeeding
OTC options for treating gastrointestinal issues in pregnancy
PREGNANT WOMEN WILL ASK THE PHARMACIST about OTCs for GI complaints. We know nausea and vomiting in pregnancy is common. But be ready to help manage other GI problems if nondrug measures aren't enough. HEARTBURN ― Suggest an antacid with calcium first or one with aluminum/magnesium ( Maalox , etc) . These are considered safe at labeled doses, work quickly an…
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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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