Gastroesophageal reflux disease (GERD) case study

Gastroesophageal reflux disease (GERD) case study
GERD is a common disease caused by the backward flow or reflux of stomach acid into the esophagus. It has a negative effect on the quality of life in many ways. (Lewis et al., 2016). The most successful drug treatment for GERD has been to stop the stomach from making acid. Proton pump inhibitors have been shown to be the most effective acid blockers, helping to heal esophagitis and relieve symptoms of GERD. (Waller & Sampson, 2017). Prilosec would be Ms. Jones’ proton pump inhibitor. (Omeprazole).

How drugs work and how they are used

Prilosec works by working on the proton pumps in a way that can’t be undone. It stops the H+/K+ ATP pump on the parietal cells, which is the last step in making acid. (Waller & Sampson, 2017). So, Prilosec stops the stomach from making acid on its own and when it is triggered. The binding happens without competition, so the result depends on how much is used. (Waller & Sampson, 2017). In addition to easing the symptoms of GERD, it is also used to treat gastric ulcers in adults, erosive esophagitis, and peptic and duodenal ulcers as part of a combination treatment. Prilosec is also used to treat other diseases where there is a lot of stomach acid being made. Zollinger-Ellison syndrome, systemic mastocytosis, and multiple endocrine adenomas are some of these disorders. (Waller & Sampson, 2017).

Absorption, transport, metabolism, and elimination

People take Prilosec by mouth. For Ms. Jones, taking 20 mg once a day in the morning before a meal would work. (Waller & Sampson, 2017). The drug is in a hard gelatin pill that dissolves when it gets to the stomach and meets the acid there. Within three to six hours of taking Prilosec, the granules are quickly broken down and taken in the small intestine. After being taken by mouth for an hour, it starts to work. Within two hours, the drug has its full effect. The blocking can happen for up to 72 hours. It has been proven that acid production will start up again after three to five days if you stop taking omeprazole.

After several doses, the systemic bioavailability is 60%, and the amount of distribution is 0.4L/kg. (Waller & Sampson, 2017). It moves quickly through plasma and can bind 95% of plasma. (Waller & Sampson, 2017). Peak bloodstream levels happen between one and three hours after taking a drug by mouth. The cytochrome P450 system isoenzymes CYP2C19 and CYP3A4 quickly break down the Prilosec prodrug in the liver. (Waller & Sampson, 2017). The metabolites that are made are sulfone, sulfide, and hydroxy-omeprazole, and they don’t have much of an effect on how much stomach acid is made. Because of how quickly it breaks down, the half-life is only 30 to 60 minutes. (Waller & Sampson, 2017). About 77% of Prilosec that is taken by mouth is passed out of the body as byproducts, mostly through the urine. (Waller & Sampson, 2017). The rest are passed out of the body in feces because they come from bile.

Effects that are bad

There are a few things that could go wrong if you take Prilosec. Most of them are common, which means that most people have them. Shah and Gossman (2020) say that headaches and feeling dizzy are two of the bad affects. The drug can make you more likely to get upper respiratory tract infections and make you cough. There can be stomach pain, diarrhea, nausea, vomiting, and acid regurgitation in the digestive system. Most of the people here have stomach pain, which is the most common sign. (Shah & Gossmann, 2020). Back pain and stiffness in the muscles and bones have also been reported. Clostridium difficile can also cause regular bouts of diarrhea, which is a rare side effect. (Trifan et al., 2017). Long-term use is also linked to breaks in the hips, arms, or spine that are caused by osteoporosis. This side affect is more likely to happen to Ms. Jones because she is older. Toh, Ong, and Wilson (2015) say that there aren’t many cases of hypomagnesemia caused by long-term use of Prilosec.

Warnings and reasons not to use

Even though it hasn’t been proven safe for women who are pregnant or nursing, no major birth defects have been seen in these groups of women. (Waller & Sampson, 2017). It is safe to use while nursing, especially since it binds to 95% of the plasma and can’t get into the milk duct. (Waller & Sampson, 2017). I would keep a close eye on Ms. Jones, especially if she had diarrhea caused by clostridium difficile. (Waller & Sampson, 2017). I would also keep an eye out for signs and symptoms of osteoporosis, since long-term use of this drug raises the chance of osteoporosis, especially because of how it affects the body’s ability to absorb calcium from the digestive tract. PPIs stop the production of acid in the gut, which is needed for calcium intake. This means that calcium can’t be absorbed from the gut. Omeprazole is strongly not recommended for people with long-term liver problems, since digestion takes place in the liver. But decreasing doses can be given for acute infections of the liver. It is also not a good idea for people who have been allergic to drugs in this class in the past. Lastly, it shouldn’t be given to people with low magnesium because it will make their situation worse.

Drugs can affect each other

With omeprazole, there are a number of drug reactions that can happen. Rilpivirine is one of the reactions that can be very bad. It lessens how well Rilpivirine works when taken together. This is because omeprazole stops the stomach from making acid, which makes it easier for Rilpivirine to be absorbed. (Waller & Sampson, 2017). Clopidogrel is the second drug that causes a very bad reaction. Clopidogrel is also broken down in the liver. When taken with Prilosec, the metabolism of cytochrome P450 enzymes is greatly slowed down, which makes the drug less effective in the body. (Waller & Sampson, 2017). When the drug is taken with cephalosporins, it works much less well. As a proton-pump inhibitor, Prilosec stops acid from being made, which is needed for that drug to be absorbed. (Waller & Sampson, 2017).

Drug administration and drug dosing rules

Prilosec is taken by mouth once a day, at 20 mg, by people with GERD. (Waller & Sampson, 2017). Most of the time, it is taken before a meal, ideally the first meal of the day. The length of treatment is four weeks. In kidney failure, there is no need to change the dose. But less of the drug is given to people with hepatic cirrhosis or any other illness that affects the liver. (Waller & Sampson, 2017).

Treatments that don’t involve drugs

GERD can be treated with a number of non-drug therapies that have been shown to be successful. The first step is to stay upright for three hours after a meal to stop acid from going back up into the stomach. (Lewis et al., 2016). The power of gravity is a big part of how acid reflux is controlled. When a person lies down after a big meal, the stomach contents come back up into the throat, causing heartburn. During the first three hours, when food is still being processed, it is best to stay standing up. To stop the reflux, the person can raise the head of the bed, which will raise the upper side of the body while they sleep. Working out after a meal can also make acid reflux worse, so you should try to avoid doing that. When you work hard, your stomach muscles tighten and push stomach contents through a weaker lower esophageal barrier.

Second, making some changes to your food can help GERD symptoms a great deal. Some things that cause your stomach to make more acid and give you more heartburn are fats, common drinks, onions, and chocolate. But the amount of heartburn each person gets from the food varies from person to person. (Lewis et al., 2016). I’d tell Ms. Jones to try different things and see what works for her. So, she can stay away from the other things that give her heartburn.

Third, if you want to stop acid reflux, it’s better to eat small meals more often than one big meal. Lewis et al. (2016) say that it takes longer for the stomach to empty after a big meal and that the LES is always being pressed on. The best time to eat a big meal is at noon, followed by small meals in the evening. One shouldn’t eat right before bed because it makes the body make more acid.

Patient education

First, I would tell Ms. Jones to take one 20 mg pill once a day with a big glass of water in the morning before any meal. Studies show that you should wait thirty minutes before you eat. (Lewis et al., 2016). Second, I would tell her to raise the head of her bed so she doesn’t have to deal with reflux at night. Third, I would tell her to stay away from foods that make her body make more acid, like green leafy veggies. Lewis et al. (2016) say that green vegetables like spinach, kale, and Brussels sprouts are typically low in fat and sugar and high in alkalinity. Because of this, they help ease the symptoms of GERD. I would tell the person to stick to the treatment plan for the best results. I would also tell her to wear loose, relaxed clothes so she doesn’t put too much pressure on her stomach and end up with acid reflux.

Keeping an eye on things

The magnesium levels are the first thing to keep an eye on during healing. When you keep taking Prilosec, the amount of magnesium in your blood drops. (Lewis et al., 2016). To find out how much magnesium is in the blood, it is best to take blood samples before starting treatment. The samples are then taken at regular intervals during treatment to check the amount of magnesium and make the right changes. If there are any signs of hypomagnesemia, the PPI treatment must be stopped. Some of these signs are shakes, seizures, and weird heartbeats. Second, during treatment, the amount of calcium is also kept an eye on. If you take Prilosec for a long time, you are more likely to get osteoporosis. Lewis et al. (2016) found that this is partly because of how it affects the intake of calcium. Calcium can’t be absorbed without acid. When PPIs are around, it is harder for the drug to get into the bloodstream. Before therapy, calcium levels are checked, and during therapy, they are kept an eye on. Based on this information, the next steps are decided.

References

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.

Shah N, Gossman W. (2020). Omeprazole. StatPearls Publishing. Retrieved from https://www.statpearls.com/articlelibrary/viewarticle/26168/

Toh, J. W. T., Ong, E., & Wilson, R. (2015). Hypomagnesaemia associated with long-term use of proton pump inhibitors. Gastroenterology report, 3(3), 243-253.

Trifan, A., Stanciu, C., Girleanu, I., Stoica, O. C., Singeap, A. M., Maxim, R., … & Boiculese, L. (2017). Proton pump inhibitors therapy and risk of Clostridium difficile infection: systematic review and meta-analysis. World journal of gastroenterology, 23(35), 6500.

Waller, D. G., & Sampson, T. (2017). Medical pharmacology and therapeutics E-Book. Elsevier Health Sciences.

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