Question

J.H. is a 42-year old male that will be discharged home from the hospital today following a brief admission for abdominal pain. He was diagnosed with a gastric ulcer and GERD and is being sent home on Po omeprazole (Prilosec) 20mg BID for 12 weeks.

1. As the nurse completing his discharge instructions, please list three teaching points regarding omeprazole that you will need to include in his discharge instructions. Be sure that the education provided in your answer is specific to this particular medication and not too general in nature. (3 points)

a.

b.

c.

2. J.H. wants to know whether or not he can continue to take OTC Po antacids if he has breakthough symptoms of GERD while taking omeprazole (Prilosec). How do you as the nurse respond to this patient’s question? (This patient question does not require a phonecall to the provider!) Please include your rationale and reference in APA format. (1 point)

3. The nurse is caring for a P.M., a 78-year old female, in the ER who was recently started on a medication by her primary provider for “bad heartburn”. The patient’s family reports concern that P.M. has been confused and seemed disoriented this morning. When reviewing the patient’s medication list, the nurse knows that which of the following medications can cause confusion and disorientation in the elderly? (1 point)

a. An antacid

b. A PPI

c. An H2 antagonist

d. A mucosal protectant

Answer 1

Ans.

A) Carcinoma: In long-term (2-year) studies in rats, omeprazole produced a dose-related increase in gastric carcinoid tumors. While available endoscopic evaluations and histologic examinations of biopsy specimens from human stomachs have not detected a risk from short-term exposure to omeprazole, further human data on the effect of sustained hypochlorhydria and hypergastrinemia are needed to rule out the possibility of an increased risk for the development of tumors in humans receiving long-term therapy.

B) Clostridioides (formerly Clostridium) difficile-associated diarrhea (CDAD): Use of proton pump inhibitors (PPIs) may increase risk of CDAD, especially in hospitalized patients; consider CDAD diagnosis in patients with persistent diarrhea that does not improve. Use the lowest dose and shortest duration of PPI therapy appropriate for the condition being treated.

C )  Cutaneous and systemic lupus erythematosus: Has been reported as new onset or exacerbation of existing autoimmune disease; most cases were cutaneous lupus erythematosus (CLE), most commonly, subacute CLE (occurring within weeks to years after continuous therapy). Systemic lupus erythematosus (SLE) is less common (typically occurs within days to years after initiating treatment) and occurred primarily in young adults up to the elderly. Discontinue therapy if signs or symptoms of CLE or SLE occur and refer to specialist for evaluation; most patients improve 4 to 12 weeks after discontinuation of omeprazole.

2 )

In general, PPIs like omeprazole are used first because they're better than H2 blockers at reducing stomach acid. ... You can take omeprazole with an antacid (for example, Gaviscon) if you need to, but leave a gap of 2 hours between them.

But a recent study found that when people stop taking these popular pills many experience painful "rebound" symptoms, often worse than before they started taking the drug. ... Her doctor prescribed a common PPI called Prilosec (omeprazole) when she got heartburn from taking an antibiotic on top of arthritis drugs

3 )

B - PPI

PPIs are used frequently in the geriatric inpatient setting, often for prolonged periods of time and are not necessarily taken according to indications. 44 Increasing evidence suggests that PPIs may trigger potentially serious complications. 45 Some case reports suggest that omeprazole may induce delirium.