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INTRODUCTION

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omeprazole (o-mep-ra-zole)

Image not available.Losec, Prilosec, Prilosec OTC, Zegerid

Classification

Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors

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Indications
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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 ≥ twice/wk.

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Action
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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.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness, fatigue, headache, weakness. CV: chest pain. GI: abdominal pain, acid regurgitation, constipation, diarrhea, flatulence, nausea, vomiting. Derm: itching, rash. Misc: allergic reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if drug therapy is successful.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor other CNS side effects (drowsiness, fatigue, weakness, headache), and report severe or prolonged effects.

  • Monitor any chest pain and attempt to determine if pain is drug induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).

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Interventions
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  • In cases of NSAID-induced gastritis, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for aspirin and other NSAIDs.

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Patient/Client-Related Instruction
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  • Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

  • Instruct patient to report bothersome or prolonged side effects, including skin problems (itching, rash) or GI effects (nausea, diarrhea, vomiting, constipation, heartburn, flatulence, abdominal pain).

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Pharmacokinetics
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Absorption: Rapidly absorbed following oral administration; immediate release formulation contains bicarbonate to prevent acid degradation.

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Distribution: Good distribution into gastric parietal cells.

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Protein Binding: 95%.

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Metabolism and Excretion: Extensively metabolized by the liver.

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Half-life: 0.5–1 hr (increased in liver disease to 3 hr).

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TIME/ACTION PROFILE (antisecretory effects)

ROUTE ONSET PEAK DURATION

PO—delayed release

PO—immediate release

within 1 hr

rapid

within 2 hr

30 min

72–96 hr

24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Metabolic alkalosis and hypocalcemia (Zegerid only).

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Use Cautiously in: Liver disease (dose reduction may be necessary); Geri: Increased risk of hip fractures in patients using high-doses ...

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