Omeprazole

INTRODUCTION

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 ≥ twice/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.

Adverse Reactions/Side Effects

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.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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).

Interventions

• 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.

Patient/Client-Related Instruction

• 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).

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: Extensively metabolized by the liver.

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

Contraindications/Precautions

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

Use Cautiously in: Liver disease (dose reduction may be necessary); Geri: Increased ...