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HOME » NOTES » NURSING PHARMACOLOGY » PROTON PUMP INHIBITORS

Proton Pump Inhibitors

UPDATED ON MAY 6, 2023 BY MARIANNE BELLEZA, R.N.

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Get to know the proton pump inhibitors in this nursing pharmacology guide for student nurses.
Learn about proton pump inhibitors, its uses, and the nursing considerations for patients using
them.

The gastric acid pump or proton pump inhibitors suppress gastric acid secretion by specifically
inhibiting the hydrogen-potassium adenosine triphosphate enzyme system on the secretory
surface of the gastric parietal cells.

1. Proton Pump Inhibitors: Generic and Brand Names

2. Disease spotlight: Gastroesophageal Reflux
3. What are Proton Pump Inhibitors?
4. Therapeutic actions
5. Indication
6. Pharmacokinetics
7. Contraindications and Cautions
8. Adverse effects
9. Interactions
10. Nursing considerations
10.1. Nursing Assessment
10.2. Nursing Diagnosis and Care Planning
10.3. Nursing Implementation with Rationale
10.4. Evaluation
11. Practice Quiz: Proton Pump Inhibitor
12. Recommended Resources
13. See Also
14. References and Sources

Proton Pump Inhibitors: Generic and Brand

Names
Here is a table of the most commonly encountered proton pump inhibitor:

Proton pump inhibitors

dexlansoprazole (Kapidex)
esomeprazole (Nexium)
lansoprazole (Prevacid)
omeprazol (Prilosec)
pantoprazole (Protonix)
rabeprazole (Aciphex)

Disease spotlight: Gastroesophageal Reflux

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Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into
the tube connecting the mouth and the stomach (esophagus).

GERD is a mild acid reflux that occurs at least twice a week, or moderate to severe acid
reflux that occurs at least once a week.
Common signs and symptoms of GERD include a burning sensation in the chest
(heartburn), usually after eating, which might be worse at night; chest pain; difficulty
swallowing; regurgitation of food or sour liquid; and a sensation of a lump in your throat.

What are Proton Pump Inhibitors?

Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the
stomach.

Therapeutic actions
The desired actions of antacids include the following:

Blocks the final step of acid production, lowering the acid levels in the stomach.
Inhibits the hydrogen-potassium adenosine triphosphate enzyme system on the secretory
surface of the gastric parietal cells.

Indication
Antacids are indicated for the following:

Treatment and maintenance of erosive esophagitis, treatment of heartburn associated with

GERD.
Treatment of GERD, severe erosive esophagitis, duodenal ulcers, and pathological
hypersecretory condition.
Treatment of gastric ulcer.
Maintenance therapy for healing duodenal ulcers and esophagitis.
In combination therapy for eradicating Helicobacter pylori infection.
Approved for use in children for treatment of GERD, peptic ulcer, and Zollinger-Ellison
syndrome.

Pharmacokinetics
Esomeprazole, lansoprazole, and pantoprazole are available in delayed-release oral forms and as
IV preparations; rabeprazole, dexlansoprazole, and omeprazole are available only in delayed-
release oral forms.

Route Onset Peak Duration

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Oral Varies 0.5-3.5h Varies

T 1/2: 30 to 60 mins

Metabolization: Liver

Excretion: Urine and bile

Contraindications and Cautions

The following are contraindications and cautions when using proton pump inhibitors:

Allergy. These drugs are contraindicated in the presence of a known allergy to either the
drug or the drug components to prevent hypersensitivity reactions.
Pregnant or lactating women. Caution should be used in pregnant or lactating women
because of the potential for adverse effects on the fetus or neonate.
Patients 18 years old and below. The safety and efficacy of these drugs have not been
established for patients younger than 18 years of age, except for lansoprazole, which is the
proton pump inhibitor of choice if one is needed for a child.

Adverse effects
Adverse effects when using proton pump inhibitors include:

CNS: Headache, dizziness, vertigo, insomnia.

Skin: Rash.
GI: Diarrhea, abdominal pain, nausea, vomiting.
Respiratory: Upper respiratory infections, cough.

Interactions
Clinically important drug to drug interactions for proton pump inhibitors include the following
drugs:

Benzodiazepines, phenytoin, warfarin: There is a risk of increased serum levels and

increased toxicity of benzodiazepines, warfarin, and phenytoin if these are combined with
these drugs; patients should be monitored closely.
Ketoconazole and theophylline. Decreased levels of ketoconazole and theophylline have
been reported when combined with these drugs, leading to loss of effectiveness.
Sucralfate. Sucralfate is not absorbed well in the presence of these drugs, and doses
should be spaced at least 30 minutes apart if this combination is used.
Clopidogrel. There is an increased risk of cardiovascular events if proton pump inhibitors
are combined with clopidogrel; this combination should be avoided.

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Nursing considerations
Nursing considerations when using proton pump inhibitors include the following:

Nursing Assessment
History taking and physical examination of a patient using proton pump inhibitors include:

Assess for possible contraindications and cautions: history of allergy to a proton pump
inhibitor to reduce the risk of hypersensitivity reaction and current status of pregnancy or
lactation because of the potential for adverse effects on the fetus or nursing baby.
Perform a physical examination to establish baseline data before beginning therapy to
determine the effectiveness of the therapy and to evaluate for the occurrence of any
adverse effects associated with drug therapy.
Inspect the skin for lesions, rash, pruritus, and dryness to identify possible adverse effects.
Assess neurological status, including level of orientation, affect and reflexes to evaluate for
CNS effects of the drug.
Inspect and palpate the abdomen to determine potential underlying medical conditions;
assess for changes in bowel elimination and GI upset to identify possible adverse effects.
Assess respiratory status, including respiratory rate and rhythm; note evidence of cough,
hoarseness, and epistaxis, to monitor for potential adverse effects of the drugs.

Nursing Diagnosis and Care Planning

Nursing diagnoses related to drug therapy might include the following:

Diarrhea related to GI effects.

Risk for constipation related to GI effects.
Imbalanced nutrition: less than body requirements related to GI effects.
Disturbed sensory perception (kinesthetic, auditory) related to CNS effects.
Risk for injury related to CNS effects.
Deficient knowledge regarding drug therapy.

Nursing Implementation with Rationale

Nursing interventions for patients using proton pump inhibitors include the following:

Proper administration. Administer drug before meals to ensure that the patient does not
open, chew, or crush capsules; they should be swallowed whole to ensure the therapeutic
effectiveness of the drug.
Safety and comfort measures. Provide appropriate safety and comfort measures if CNS
effects occur to prevent patient injury.
Institute a bowel program. Monitor the patient for diarrhea or constipation in order to
institute an appropriate bowel program as needed.

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Monitor nutritional status. Monitor the patient’s nutritional status; use of small frequent
meals may be helpful if GI upset is a problem.
Ensure follow-up. Arrange for medical follow-up if symptoms are not resolved after 4 to 8
weeks of therapy because serious underlying conditions could be causing the symptoms.
Provide patient support. Offer support and encouragement to help the patient cope with
the disease and the drug regimen.
Educate the patient and folks. Provide thorough patient teaching, including the drug
name and prescribed dosage; the importance of taking the drug whole without opening,
chewing, or crushing it; signs and symptoms of possible adverse effects and measures to
minimize or prevent them.

Evaluation
Evaluation of a patient using proton pump inhibitors include the following:

Monitor patient response to the drug (relief of GI symptoms caused by hyperacidity,

healing of erosive GI lesions).
Monitor for adverse effects (GI effects, CNS changes, dermatological effects, respiratory
effects).
Monitor the effectiveness of comfort and safety measures and compliance with the
regimen.
Evaluate the effectiveness of the teaching plan (patient can name the drug and dosage and
describe adverse effects to watch for, specific measures to avoid them, and measures to
take to increase the effectiveness of the drug).

Practice Quiz: Proton Pump Inhibitor

Here’s a 5-item quiz for this proton pump inhibitor study guide. Please visit our nursing test bank
page for more NCLEX practice questions.

1. The physician has prescribed Nexium (esomeprazole) for a client with erosive gastritis.
The nurse should administer the medication:

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A. 30 minutes after meals

B. 30 minutes before meals
C. With each meal
D. In a single dose at bedtime

1. Answer: B. 30 minutes before meals

Option B: Proton pump inhibitors reduce the production of acid in the stomach. Proton
pump inhibitors work best when they are taken 30 minutes before the first meal of the day.

2. Proton pump inhibitor use will likely result in:

A. Heartburn
B. Diverticulosis
C. Gastric ulcer formation
D. Achlorhydria

2. Answer: D. Achlorhydria.

Option D: Because the proton pump inhibitors stop the final step of acid secretion, they
can block up to 90% of acid secretion, leading to achlorhydria (absence of acid).

3. A patient is prescribed with esomeprazole for the treatment of GERD. Upon review of
current medication use, the nurse noted that the patient is taking clopidogrel. The nurse
warned the patient that esomeprazole:

A. Have no evidence of potential interaction with clopidogrel

B. Increase the effectiveness of clopidogrel
C. Decrease the effectiveness of clopidogrel
D. Increase acid production

3. Answer: C. Decrease the effectiveness of clopidogrel

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Option C: Esomeprazole inhibits CYP2C19 enzyme which serves as a pathway for certain
medication. One of which is clopidogrel, so taking it with esomeprazole will potentially
decrease the effectiveness of clopidogrel.

4. A nurse is checking the nasogastric tube position of a client receiving a long term therapy
of Omeprazole (Prilosec) by aspirating the stomach contents to check for the PH level. The
nurse proves that correct tube placement if the PH level is?

A. 5
B. 6.3
C. 6.5
D. 7

4. Answer: A. 5

Option A: Gastric placement is indicated by a pH of less than 4, but may increase to

between pH 4-6 if the patient is receiving acid-inhibiting drugs.

5. Prolonged use of Proton Pump Inhibitors will likely result with the following except:

A. Hypermagnesemia
B. Pneumonia
C. Fractures
D. Hypochlorhydria

5. Answer: A. Hypermagnesemia

Option A: Long term use of PPIs affects intestinal magnesium absorption leading to
hypomagnesemia.

Recommended Resources
Our recommended nursing pharmacology resources and books:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small
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policy.

Pharm Phlash! Pharmacology Flash Cards #1 BEST SELLER!

Test-yourself review cards put critical clinical information for nearly 400 of the
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Nurses. Increase your test scores in pharmacology class.

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Focus on Pharmacology (8th Edition)

Focus on Nursing Pharmacology makes challenging concepts more
approachable. Engaging learning features cultivate your clinical application,
critical thinking and patient education capabilities. This updated 8th edition
builds on your knowledge of physiology, chemistry and nursing fundamentals
to help you conceptualize need-to-know information about each group of
drugs.

Pharmacology Made Incredibly Easy (Incredibly Easy! Series®)

Nursing pharmacology guide offers step-by-step guidance so you can grasp
the fundamentals in enjoyable Incredibly Easy style. This is the perfect
supplement to class materials, offering solid preparation for NCLEX® as well as
a handy refresher for experienced nurses. Colorfully illustrated chapters offer
clear, concise descriptions of crucial nursing pharmacology concepts and
procedures.

Lehne’s Pharmacology for Nursing Care (11th Edition)

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thorough understanding of key drugs and their implications for nursing care.
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enjoyable. We recommend this book if you want a comprehensive nursing
pharmacology guide.

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monographs for nearly 3700 generic, brand-name, and combination drugs.
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Pharmacology and the Nursing Process

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user-friendly pharmacology information. The photo atlas contains over 100
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ideal for mobile study.

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See Also
Here are other nursing pharmacology study guides:

Nursing Pharmacology – Study Guide for Nurses

Our collection of topics related to nursing pharmacology
Pharmacology Nursing Mnemonics & Tips
These nursing mnemonics aim to simplify the concepts of pharmacology through the use of
a simple, concise guide.
Generic Drug Name Stems Cheat Sheet
Learn about these generic drug name stems to help you make sense of drugs easier!
Common Drugs and Their Antidotes
A guide to drug antidotes that nurses should be familiar about.
IV Fluids and Solutions Guide & Cheat Sheet
Get to know the different types of intravenous solutions or IV fluids in this guide and cheat
sheet.
Drug Dosage Calculations NCLEX Practice Questions (100+ Items)
Care to take the challenge? This quiz aims to help students and registered nurses alike
grasp and master the concepts of medication calculation.

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Aspirin Nursing Considerations & Patient Teaching Drug Guide

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Acetaminophen (Tylenol) Nursing Considerations & Patient Teaching Drug Guide
Enoxaparin (Lovenox) Nursing Considerations and Patient Teaching Drug Guide
Hydromorphone (Dilaudid) Nursing Considerations & Patient Teaching Drug Guide
Lisinopril Nursing Considerations and Patient Teaching Drug Guide
Metoprolol Nursing Considerations & Patient Teaching Drug Guide

Gastrointestinal System Drugs

Antacids
Histamine-2 Antagonists
Proton Pump Inhibitors

Respiratory System Drugs

Antihistamines
Bronchodilators and Antiasthmatics
Decongestants
Expectorants and Mucolytics
Inhaled Steroids
Lung Surfactants

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Endocrine System Drugs

Adrenocortical Agents
Antidiabetic Agents
Glucose-Elevating Agents
Hypothalamic Agents
Insulin
Parathyroid Agents: Bisphosphonates, Calcitonins
Pituitary Drugs
Sulfonylureas
Thyroid Agents

Autonomic Nervous System Drugs

Adrenergic Agonists (Sympathomimetics)

Adrenergic Antagonists (Sympatholytics)
Anticholinergics (Parasympatholytics)
Cholinergic Agonists (Parasympathomimetics)

Immune System Drugs

Antiarthritic Drugs
Immunostimulants
Immunosuppressants
Nonsteroidal Anti-Inflammatory Drugs
Salicylates

Chemotherapeutic Agents

Anthelmintics
Anti-Infective Drugs
Antibiotics
Antifungals
Antineoplastic Agents
Antiprotozoal Drugs
Antiviral Drugs

Reproductive System Drugs

Male Reproductive System Drugs

Female Reproductive System Drugs

Nervous System Drugs

Antidepressants
Antiparkinsonism Drugs
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Antiseizure Drugs
Anxiolytics and Hypnotic Drugs
General and Local Anesthetics
Muscle Relaxants
Narcotics, Narcotic Agonists, and Antimigraine Agents
Neuromuscular Junction Blocking Agents
Psychotherapeutic Drugs

Cardiovascular System Drugs

Antianginal Drugs
Antiarrhythmic Drugs
Antihyperlipidemic Drugs
Antihypertensive Drugs
Cardiotonic-Inotropic Drugs
Diuretics
Drugs Affecting Coagulation

References and Sources

The following are the recommended supplemental reading for this proton pump inhibitor nursing
pharmacology study guide:

Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer
Health/Lippincott Williams & Wilkins. [Link]
Juurlink, D. N., Gomes, T., Ko, D. T., Szmitko, P. E., Austin, P. C., Tu, J. V., … & Mamdani, M. M.
(2009). A population-based study of the drug interaction between proton pump inhibitors
and clopidogrel. Cmaj, 180(7), 713-718. [Link]
Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical
nursing. Philadelphia: JB Lippincott.

Nursing Pharmacology
Drugs Affecting the Gastrointestinal System
Inhaled Steroids
MINT Group Uses Social Media to Attract Men Into Nursing

Marianne Belleza, R.N.

Marianne leads a double life, working as a staff nurse during the day and moonlighting as a writer for Nurseslabs at night.
As an outpatient department nurse, she has honed her skills in delivering health education to her patients, making her a
valuable resource and study guide writer for aspiring student nurses.

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3 thoughts on “Proton Pump Inhibitors”

P. Davis
April 29, 2019 at 7:01 AM

Thank you Nurselabs, you make learning less difficult.

Reply

dhanaraj
April 29, 2019 at 11:57 AM

Very useful messages much thanks to Marianne Belleza, R.N.

Reply

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shirley
April 30, 2019 at 12:25 PM

Thanks for giving a lots of clarity in a simple way about PPI

Reply

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