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Drug Study: Omeprazole (Nexium)Classification: Gastric Antisecretory Drugs – Proton Pump Inhibitor

Action: Suppress gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in the gastric parietal cell: characterized as a gastric acid pump inhibitor, since it blocks the final step of acid production.

Indication: Short-term treatment of active duodenal ulcer, gastroesophageal reflux disease (GERD), including erosive esophagitis and symptomatic GERD; long term treatment of pathologic hypersecretory conditions (e.g. Zollinger-Ellison syndrome, multiple endocrine adenomas, systemic multiple endocrine adenomas, systemic mastocytosis); to maintain healing of erosive esophagitis; in combination with clarithromycin to eradicate H. pylori, use clarithromycin and amoxicillin in combination with omeprazole in patients with a 1-year history of duodenal ulcers or active duodenal ulcers to eradicate H. pylori; short-term treatment of active benign gastric ulcer.

Adverse Reactions: Angina, tachycardia, bradycardia; palpitation, headache, dizziness, rash, diarrhea, abdominal pain, acid regurgitation, nausea, vomiting, constipation, flatulence, cough, upper respiratory infection, asthenia, back pain.

Nursing Considerations

Assessment

  • Assess other medications patient may be taking for effectiveness and interactions (especially those dependent on cytochrome P450 metabolism or those dependent on acid environment for absorption).
  • Monitor therapeutic effectiveness and adverse reactions at beginning of therapy and periodically throughout therapy.
  • Assess GI system: bowel sounds every 8hours, abdomen for pain and swelling, appetite loss.
  • Monitor hepatic enzymes: AST, ALT, increased alkaline phosphatase during treatment.
  • Assess knowledge/teach appropriate use of this medication, interventions to reduce side effects, and adverse symptoms to report.

Nursing Diagnoses

  • Pain, chronic (uses)
  • Knowledge-deficit (teaching)

Planning

  • Give before patient eats: patient should swallow capsule whole
  • Do not open, chew, or crush: may give with antacids

Implementation

  • Take as directed, before eating
  • Do not crush or chew capsules
  • Delayed release capsule may be opened and contents be added to apple sauce
  • Caution patient to avoid alcohol, salicylates, ibuprofen: may cause GI irritation
  • Patient may experience anorexia; small frequent meals may help to maintain adequate nutrition
  • Report severe headache, unresolved severe diarrhea, or changes in respiratory status. Inform physician if patient is or intends to become pregnant. Breast-feeding is not recommended.

Evaluation

  • Absence of epigastric pain, swelling, fullness