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CC Sept 2017 Proton Pump Inhibitor (PPI) Overuse

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echoecho's version from 2017-10-15 21:13

Section

Question Answer
True or false? PPI are one of the most widely prescribed medications in the US?true
List the FDA-approved indications of use of PPIs?GERD, PUD, Zollinger-Ellison syndrome, off label conditions (acute pancreatitis, to reduce risk of bleeing in hypertensive gastropathy due to cirrhosis)
Although relatively safe, what increases with prolonged use?increases the risk of an adverse drug event
Chronic use of PPIs results from what?unnecessary and continued intake after an acute event (such as continued use after treatment for H. pylori or when appropriately used to prevent GERD or GI bleeding in high-risk patients)
List the type of patient at high risk for GI bleeding?1) NSAIDs 2) corticosteroids 3) anti-platelet therapy 4) anticoagulants
List the potential risks associated with long-term PPI use?1) drug-to-drug interactions 2) PPI-associated toxicity 3) reduced absorption of essential nutrients 4) increased medication costs
Long-term PPI use has been associated with what adverse events?1) acute interstitial nephritis 2) bone fracture 3) chronic renal insufficiency 4) GI infections 5) increased risk of pneumonia
PPIs are now considered the leading cause of what, which resolves, in most cases after discontinuation of the medication?acute interstitial nephritis
PPIs can cause a decrease in _____ absorption, especially when taken in the form of ______ ______?calcium; calcium carbonate
Instruct patients to take calcium ____, a calcium formualation that is not affected by increased gastric pH?citrate
Chronic PPI intake results in ______ bone density and ______ risk of fractures (although study results are inconsistent)?decreased; increased
_______ absorption is also decreased with PPI use and this becomes significant in patients on diuretics?magnesium
Vitamin _____ absorption may be decreased by chronic PPI use?B12
Observations of increased cardiac events in patients taking PPIs may be due to what?altered antiplatelet therapy effect or direct myocardial / coronary vessel alterations, but more robust data are needed
Why should chronic PPI use be avoided in patients at increased risk of chronic renal disease?because chronic PPI use has been associated with chronic renal insufficiency development
True or false? A recent observational study showed an increased risk of death among chronic users of PPIs. It showed risk of death rising with duration of therapy, and higher risk among those taking PPIs for nongastrointestinal conditions?true
List the common drug-to-drug interactions involving PPIs?1) induction of enzymes 2) inhibition of acid secreation
PPI inhibition of the function of hepatic CYP2C19 can reduce the activity of what drug?This inhibition appears to be drug specific to what PPI and may not occur with other PPIs ?: 1) clopidogrel (Plavix) 2) Omeprazole (Prilosec)
*** What 2 PPIs are favored in patients requiring both a PPI and Clopidrogrel?1) Pantoprazole (Protonix) 2) Rabeprazole (Aciphex)
Why should long-term use of PPIs be avoided if possible?1) cost of long-term use 2) potential end organ effects 3) malabsorption of important nutrients 4) infections 5) possibility of drug-to-drug interactions
List the drug-drug interactions associated with PPI use with Clopidogrel (Plavix)?1) effect = decreased activity of Clopidogrel 2) may be specific to Omeprazole (Prilosec) due to inhibition of hepatic CYP2C19
List the drug-drug interactions associated with PPI use with Diazepam (Valium)?1) effect = increased drug levels of Diazepam 2) with omeprazole - hepatic metabolism inhibited
List the drug-drug interactions associated with PPI use with Warfarin (Coumadin)?1) effect = increased activity of Warfarin 2) mechanisms unknown
List the drug-drug interactions associated with PPI use with Phenytoin (Dilantin)?1) effect = increased drug levels 2) with Omeprazole - hepatic metabolism inhibited
List the drug-drug interactions associated with PPI use with Methotrexate (Trexall)?1) effect = increased drug levels 2) mechanism unknown
List the drug-drug interactions associated with PPI use with Levothyroxine (Synthroid)?1) effect = decreased absorption 2) low gastric pH reduces absorption
List the drug-drug interactions associated with PPI use with Ketoconazole?1) effect = increased absorption 2) low gastric pH increases absorption
List the drug-drug interactions associated with PPI use with Nifedipine (Procardia)?1) effect = increased absorption 2) low gastric pH increases absorption
List the drug-drug interactions associated with PPI use with Digoxin (Lanoxin)?1) effect = increased absorption 2) low gastric pH increases absorption
List the drug-drug interactions associated with PPI use with Alendronate (Fosamax)?1) effect = increased absorption 2) low gastric pH increases absorption
*** SUMMARY = PPIs are highly effective and well tolerated, true or false?true
*** SUMMARY = Long term use interfere with absorption of ______, _______ and other essential nutrients?calcium, magnesium
*** SUMMARY = Long-term use of PPIs should be ______ if possible?avoided
*** SUMMARY = Omeprazole can decrease levels of______ metabolites, thus reducing its effectiveness?clopidogrel
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