Download omeprazole (o-mep-ra-zole) - DavisPlus

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Contraindications/Precautions
Contraindicated in: Hypersensitivity; Lactation: Discontinue omeprazole or
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omeprazole (o-mep-ra-zole)
discontinue breast feeding.
Use Cautiously in: Liver disease (dosepmay be necessary); OB, Lactation,
Losec, PriLOSEC, PriLOSEC OTC
Classification
Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors
Pregnancy Category C
Pedi: Safety not established in pregnant or breast feeding women, or children ⬍1 yr;
Patients using high-doses for ⬎1 year (qrisk of hip, wrist, or spine fractures).
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, fatigue, headache, weakness. CV: chest pain. GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, acid regurgitation, constipation, diarrhea,
Indications
GERD/maintenance of healing in erosive esophagitis. Duodenal ulcers (with or without anti-infectives for Helicobacter pylori). Short-term treatment of active benign
gastric ulcer. Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome. Reduction of risk of GI bleeding in critically ill patients. OTC: Heartburn occurring ⱖtwice/wk.
Action
Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic
Effects: Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. Healing of duodenal ulcers.
Pharmacokinetics
Absorption: Rapidly absorbed following oral administration; immediate release
formulation contains bicarbonate to prevent acid degradation.
Distribution: Good distribution into gastric parietal cells.
Protein Binding: 95%.
Metabolism and Excretion: Mostly metabolized by the liver via the cytochrome
P450 (CYP) system (primarily CYP2C19 isoenzyme, but also the CYP3A4 isoenzyme)
(the CYP2C19 enzyme system exhibits genetic polymorphism; 15– 20% of Asian
patients and 3– 5% of Caucasian and Black patients may be poor metabolizers and
may have significantlyqomeprazole concentrations and anqrisk of adverse effects);
inactive metabolites are excreted in urine (77%) and feces.
Half-life: 0.5– 1 hr (qin liver disease to 3 hr).
TIME/ACTION PROFILE (antisecretory effects)
ROUTE
PO-delayed release
Plate # 0-Composite
ONSET
within 1 hr
⫽ Canadian drug name.
PEAK
within 2 hr
⫽ Genetic Implication.
DURATION
72–96 hr
flatulence, nausea, vomiting. F and E: hypomagnesemia (especially if treatment duration ⱖ3 mo). Derm: itching, rash. MS: bone fracture. Misc: allergic reactions.
Interactions
Drug-Drug: Omeprazole is metabolized by the CYP450 enzyme system and may
compete with other agents metabolized by this system.pmetabolism and mayqeffects of antifungal agents, diazepam, digoxin, flurazepam, triazolam, cyclosporine, phenytoin, saquinavir, tacrolimus, and warfarin. Maypabsorption of
drugs requiring acid pH, including ketoconazole, itraconazole, ampicillin,
iron salts, and digoxin. Has been used safely with antacids. May significantlypeffects of atazanavir and nelfinavir (concurrent use not recommended). Mayqrisk
of bleeding with warfarin (monitor INR/PT). Voriconazole mayqlevels. Maypthe
antiplatelet effects of clopidogrel; avoid concurrent use. Mayqlevels of cilostazol;
considerpdose of cilostazol from 100 mg twice daily to 50 mg twice daily. Rifampin
mayplevels and maypresponse; avoid concurrent use. Hypomagnesemiaqrisk of
digoxin toxicity. Mayqlevels of tacrolimus and methotrexate.
Drug-Natural Products: St. John’s wort mayplevels and maypresponse;
avoid concurrent use.
Route/Dosage
PO (Adults): GERD/erosive esophagitis— 20 mg once daily. Duodenal ulcers associated with H. pylori— 40 mg once daily in the morning with clarithromycin for 2
wk, then 20 mg once daily for 2 wk or 20 mg twice daily with clarithromycin 500 mg
twice daily and amoxicillin 1000 mg twice daily for 10 days (if ulcer is present at beginning of therapy, continue omeprazole 20 mg daily for 18 more days); has also
been used with clarithromycin and metronidazole. Gastric ulcer— 40 mg once daily
for 4– 6 wk. Reduction of the risk of GI bleeding in critically ill patients— 40 mg
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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initially, then another 40 mg 6– 8 hr later, followed by 40 mg once daily for up to 14
days. Gastric hypersecretory conditions— 60 mg once daily initially; may be increased up to 120 mg 3 times daily (doses ⬎80 mg/day should be given in divided
doses); OTC— 20 mg once daily for up to 14 days.
PO (Children 1– 16 yr and 5– 9 kg): GERD/erosive esophagitis— 5 mg once
daily.
PO (Children 1– 16 yr and 10– 19 kg): GERD/erosive esophagitis— 10 mg
once daily.
PO (Children 1– 16 yr and ⱖ20 kg): GERD/erosive esophagitis— 20 mg once
daily.
NURSING IMPLICATIONS
Assessment
● Assess patient routinely for epigastric or abdominal pain and frank or occult
blood in the stool, emesis, or gastric aspirate.
● Monitor bowel function. Diarrhea, abdominal cramping, fever, and
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bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
Lab Test Considerations: Monitor CBC with differential periodically during
therapy.
May causeqAST, ALT, alkaline phosphatase, and bilirubin.
May cause serum gastrin concentrations toqduring first 1– 2 wk of therapy. Levels return to normal after discontinuation of omeprazole.
Monitor INR and prothrombin time in patients taking warfarin.
May cause hypomagnesemia. Monitor serum magnesium prior to and periodically
during therapy.
Potential Nursing Diagnoses
Acute pain (Indications)
Implementation
● Do not confuse Prilosec (omeprazole) with Prozac (fluoxetine) or Pris-
tiq (desvenlafaxine). Do not confuse omeprazole with fomepizole.
● PO: Administer doses before meals, preferably in the morning. Capsules should
be swallowed whole; do not crush or chew. Capsules may be opened and sprin-
Plate # 0-Composite
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kled on cool applesauce, entire mixture should be ingested immediately and followed by a drink of water. Do not store for future use.
● Powder for oral suspension: Administer on empty stomach, as least 1 hr before a
meal. For patients with nasogastric or enteral feeding, suspend feeding for 3 hr before and 1 hr after administration. Empty packet contents into a small cup containing 1– 2 tablespoons of water. Do not use other liquids or foods. If administered through a nasogastric tube, suspend in 20 mL of water. Stir well and drink
immediately. Refill cup with water and drink again.
● May be administered concurrently with antacids.
Patient/Family Teaching
● Instruct patient to take medication as directed for the full course of therapy, even if
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feeling better. Take missed doses as soon as remembered but not if almost time for
next dose. Do not double doses.
May cause occasional drowsiness or dizziness. Caution patient to avoid driving or
other activities requiring alertness until response to medication is known.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods
that may cause an increase in GI irritation.
Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or
persistent headache to health care professional promptly.
Instruct patient to notify health care professional of onset of black, tarry
stools; diarrhea; abdominal pain; or persistent headache or if fever and
diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Advise female patient to notify health care professional if pregnancy is planned or
suspected or if breast feeding.
Evaluation/Desired Outcomes
● Decrease in abdominal pain or prevention of gastric irritation and bleeding. Heal-
ing of duodenal ulcers can be seen on x-ray examination or endoscopy.
● Decrease in symptoms of GERD and erosive esophagitis. Therapy is continued for
4– 8 wk after initial episode.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company
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