Proton pump inhibitors are a class of novel drugs that are the most potent acid suppressors on the market today. Since omeprazole’s introduction in 1990, they have been clinically proven to be better than H2RAs. Over the past decade their use has been scrutinized because of several harmful disease associations.
How would you handle a patient who wants to begin long-term PPI use?
What would your discussion with them entail?
In what patients or disease states would you not recommend PPI use?
What if H. Pylori is found to be present?
The following FDA warning appears in the clopidogrel package insert: “Drug interactions: Co-administration of Plavix with omeprazole, a proton pump inhibitor that is an inhibitor of CYP2C19, reduces the pharmacological activity of Plavix if given concomitantly or if given 12 hours apart. ” Plavix (clopidogrel) [package insert] Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership Bridgewater, NJ. 2009.
Evidence-based guidelines such as those provided by the AGA state: “PPI therapy does not need to be altered in concomitant clopidogrel users as there does not appear to be an increased risk for adverse cardiovascular events”. (Strong recommendation, high level of evidence) Am J Gastroenterol 2013; 108:308–328; doi:10.1038/ajg.2012.444.
This leaves the provider to make a professional decision.
You may wish to read the portion of clopidogrel’s package insert [link below] regarding pharmacogenomics as well as the article found in Medscape [link below] regarding genetics in pharmacotherapy before answering the last question. Pharmacogenomics is, and will become, an increasingly bigger part of care as we move forward.
After reviewing the package insert for clopidrogel and available evidence regarding this combination, what would you recommend if a patient is taking esomeprazole and clopidrogel together?
This discussion post requires two steps:
Step 1: Submit your completed initial response, [MS Word document or equivalent] to the Assignment folder “Discussion Post Originality Check” for Turnitin similarity checking. Click on the ‘Assignments’ link in the course navigation bar to locate the assignment folder. You are required to achieve an acceptable similarity score before proceeding to step two. See the Course Resources module’s subfolder ‘Turnitin’ for policy and algorithm (acceptable score) details.
Step 2: Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.
Transcript for Proton Pump Inhibitors video
H2 Blocker mechanism of action: https://www.youtube.com/watch?v=jstP3IZGLsc
Transcript for Animation of Ranitidine video
Transcript for Microbiology-Helicobacter Pylori (Ulcer) video