Proton-Pump Inhibitor (PPI).

How would you handle a patient who wants to begin long-term PPI use?

The patient should not be allowed to take the drug for more than 4 months unless otherwise indicated. The drug should be initialized in the smallest dosage and not necessary added over time since the efficacy is not lost. Possible measures will also be taken to prevent the potential increase of pneumonia, clostridium difficile infections, fractures, hypomagnesemia, and hypocalcemia among others (Metz, 2018).Proton-Pump Inhibitor (PPI).

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What would your discussion with them entail?

The discussion would entail the side effects related to long-term use, the likelihood for dependency on the drug, its interactions with other medication as well as withdrawal impacts. The patient will be educated on the severe side effects of PPIs long-term use. An alternative therapy would also be recommended.Proton-Pump Inhibitor (PPI).

In what patients or disease states would you not recommend PPI use?

The long-term use of PPIs is indicated in patients with reflux disease and use of maintenance nonsteroidal anti-inflammatory drugs (NSAIDs) (Metz, 2018). It can also be used for hypersecretory states. For acid suppression, the drug should be indicated for short-term use.

What if H. Pylori is found to be present?

H.pylori should be treated completely for at least four weeks before beginning a long-term use of PPIs (Tan & Graham, 2018).  This is because; the use of PPIs in infected patients can increase the risk of gastric cancer.Proton-Pump Inhibitor (PPI).

Recommendation

If a patient is taking esomeprazole and clopidrogel together, it is likely that the efficacy of clopidogrel will be reduced (Metz, 2018). This is because, the interaction of the two drugs results to decreased exposure to the clopidogrel’s active metabolite. Moreover, their administration at different times does not prevent the interaction and hence their co-administration is not recommended. In essence, concomitant use of the two drugs reduces the mean platelet aggregation inhibition, bleeding times and leads to increased index of platelet reactivity (Tangamornsuksan et al., 2017).Proton-Pump Inhibitor (PPI).

References

Metz, D. C. (2018). Long-term use of proton-pump inhibitor therapy. Gastroenterology & hepatology, 4(5), 322.

Tan, M. C., & Graham, D. Y. (2018). Proton pump inhibitor therapy after Helicobacter pylori eradication may increase the risk of gastric cancer. BMJ evidence-based medicine, 23(3), 111-112.

Tangamornsuksan, W., Thiansupornpong, P., Morasuk, T., Lohitnavy, O., & Lohitnavy, M. (2017, July). A pharmacokinetic model of drug-drug interaction between clopidogrel and omeprazole at CYP2C19 in humans. In 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) .Proton-Pump Inhibitor (PPI).