PPIs

Question 1

true or false - following an endoscopic treatment of severe peptic ulcer bleeding, you can give high dose IV PPI to reduce risk of rebleeding and the need for surgery

Answer 1

true

Question 2

Should you decrease the dose of a PPI in pt who need to continue NSAID treatment after ulcer has healed?

Answer 2

no not normally because symptomatic ulcer deterioration may occur

Question 3

discuss the use of PPI in pt with CF

Answer 3

can be used in pt with CF to reduce the degradation of pancreatic enzyme supplements

Question 4

what type of dosage is needed to control excessive secretion of gastric acid in Zollinger-Ellison syndrome

Answer 4

often high doses required

Question 5

MOA

Answer 5

they inhibit gastric acid secretion by blocking the hydrogen potassium adenosine triphoshatase enzyme system (aka proton pump) of the gastric parietal cell

Question 6

important safety info, MHRA: very low risk of subacute cutaneous lupus erythematous (SCLE)

Answer 6

• drug includes SCLE can occur weeks, months or even years after exposure to drug
• if pt develops lesions, esp in sun-exposed areas of skin, and it is accompanied by arthralgia advice them to…
  
  • avoid exposing skin to sun
  • consider SCLE as possible diagnosis
  • consider discontinuing PPI unless it is imperative for a serious acid related condition
  • in most cases, symptoms resolve on PPI withdrawal
  • topical or systemic steroids may be necessary for treatment only if no signs of remission after a few weeks or months

Question 7

true or false - a patient who develops SCLE with one PPI may be at risk of the same reaction with another PPI

Answer 7

true

Question 8

A patient develops some lesions on their hands and face. They also have arthralgia. You look at their PMR and it is as follows

• cetirizine 10mg OD
• omeprazole 20mg OD
• naproxen 250mg TDS PRN

What do you suspect?

Answer 8

Possibly SCLE from PPI, although very rare.
Suspect it is there is lesions on sun exposed areas of skin accompanied by arthalgia.

Question 9

cautions - what can PPIs do (5)

Answer 9

• increase risk of fractures (esp when used >1yr elderly at high doses)
• increase risk of GI infections including CDI
• mask the symptoms of gastric cancer in adults
• long term treatment can reduce absorption of B12
• pt at risk of osteoporosis

Question 10

What to do with pt at risk of osteoporosis who are taking PPIs

Answer 10

• maintain adequate intake of calcium and vit D, and if necessary, recieve other preventative therapy

Question 11

monitoring requirements

Answer 11

consider serum-mg conc before and during prolonged treatment with PPI, esp when used with other drugs that cause hypomagnesaemia or with digoxin

Question 12

SE of PPIs

Answer 12

• abdominal pain
• constipation
• diarrhoea
• dizziness
• dry mouth
• GI disorders
• insomnia
• nausea, vomiting
• skin reactions
• hypomasgnesaemia (more common after 1 yr treatment, but sometimes occurs after 3 months)

Question 13

which one is not known to be harmful in P or BF

Answer 13

omeprazole