Gastrointestinal System Disorders Q 262

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A patient unable to tolerate oral medications may be prescribed which of the following proton pump inhibitors to be administered intravenously?

  

    A. lansoprazole (Prevacid)

    B. omeprazole (Prilosec)

    C. pantoprazole (Protonix)

    D. esomeprazole (Nexium)

    

    

Correct Answer: C. pantoprazole (Protonix)

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Pantoprazole is the only proton pump inhibitor that is available for intravenous administration. For erosive esophagitis associated with gastroesophageal reflux disease, pantoprazole administration can be oral or intravenous. For Zollinger-Ellison syndrome, pantoprazole administration can also be oral or intravenous. Intravenously, the recommendation is to administer 80 mg of pantoprazole every 12 hours. The other medications in this category may only be administered orally.

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Option A: As proton pumps recycle periodically in the stomach, it may take a few days for PPIs to achieve a full effect – and of note, their duration of action is slower than some other medications that affect acid production, such as histamine-receptor blockers. These medications are best administered before food intake as proton pumps become activated during meals, and administration of PPIs prior to food intake will enhance the drug’s efficacy.

Option B: Omeprazole should be ingested 30 to 60 minutes before meals. It may be taken with antacids. When taken twice daily, the first dose should be before breakfast and the second dose before dinner. The capsule and tablet should be swallowed whole, not crushed or chewed. However, it is permissible to open the capsule and mix the contents with one tablespoon of applesauce, soft enough to be swallowed without chewing.

Option D: Most practitioners recommend that the patient take the PPI first thing in the morning when taken once daily. If twice-daily dosing is employed, then a second dose is usually added approximately 30 minutes before dinner. For some select patients with nighttime predominance of symptoms, the timing of once-daily administration may change to 30 minutes pre-dinner.

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