Ulcer
Do all ICU patients need Stress Ulcer Prophylaxis?
Introduction ㅡ Patients who are admitted to ICU may suffer from Stress Ulceration, which is the development of superficial ulcers in the upper gastrointestinal (GI) tract. This differs from the reactivation of chronic duodenal or gastric ulcers as it is caused by either hypersecretion of gastric acid or impaired mucosal protection. Thus, m…
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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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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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Stress Ulcer
Management of gastroesophageal reflux disease
OVERVIEW ㅡ Gastroesophageal reflux disease (GERD) is a common chronic, relapsing condition that is associated with a risk of significant morbidity and the possibility of mortality from complications. Patients have heartburn, the hallmark of acid regurgitation, at least once a month. Many patients self-diagnose and self-treat, and do not seek medical attention for th…
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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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