Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors
Gastroesophageal reflux disease (GERD). Duodenal ulcers (including combination therapy with clarithromycin and amoxicillin to eradicate Helicobacter pylori and prevent recurrence). Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome.
Binds to an enzyme 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 acid reflux. Healing of duodenal ulcers and esophagitis. ↓ acid secretion in hypersecretory conditions.
Adverse Reactions/Side Effects
CNS: dizziness, headache, malaise. GI: abdominal pain, constipation, diarrhea, nausea. Derm: photosensitivity, rash. MS: neck pain. Misc: allergic reactions, chills, fever.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if drug therapy is successful.
Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.
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 any neck pain to rule out musculoskeletal pathology; that is, attempt to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
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.
Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.
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 headache, chills, fever, malaise, or GI effects (nausea, diarrhea, constipation, abdominal pain).
Absorption: Delayed-release tablet is designed to allow rabeprazole, which is not stable in gastric acid, to pass through the stomach intact. Subsequently 52% is absorbed after oral administration.
Metabolism and Excretion: Mostly metabolized by the liver (hepatic cytochrome P450 3A and 2C19 enzyme systems); 10% excreted in feces; remainder excreted in urine as inactive metabolites.