Proton pump inhibitors: important information for cardiologists

Author(s):  
M. M. Dolzhenko ◽  
I. V. Davydova

Thromboembolic disorders occupy an important place in the structure of cardiovascular pathologies. Anticoagulants and antiplatelet agents proved to be the most efficient preventive medications for this group of patients, they enable reduction of the risk for both primary and secondary thromboembolic complications. However, their main shortcoming is the high potential of serious adverse events, basically related to gastrointestinal tract. That’s why, to prevent stress ulcers and bleedings in these patients, administration of antiplatelet agents, thrombolysis and heparin therapy is obligatory combined with the proton pump inhibitors. The authors presented data of evidence‑based medicine regarding one of the proton pump inhibitors, Ezolong, that contains esomeprazole (branded generic of Organosyn company). This combined medication is a modern formulation with the improved properties and more prolonged and predictable effect.  Apart from its high protective efficacy, Ezolong is well tolerated, which is explained by the peculiarities of its pharmacodynamics and pharmacokinetics. Based on the complex of its clinical effects and safety profile, it is the drug of choice for patients with cardiovascular diseases. Ezolong is marketed in various formulations. Availability of its injectable formulation allows to achieve a quick intake of the active substance into the body, which is important for the therapy of acute pathologies and in case of impossibility of oral administration of the drug. Capsulated Ezolong provides easy administration, dosing accuracy, high adherence to the therapy of patients receiving outpatient treatment.  

2012 ◽  
Vol 4 ◽  
pp. CMT.S7253
Author(s):  
O.O. Oyetayo ◽  
C.A. Farris ◽  
J. Wahawisan

Clopidogrel is an antiplatelet agent indicated in the management of atherothrombotic conditions. Bleeding is a predictable adverse event associated with antiplatelet agents. While non-ulcerogenic; a major site of bleeding with clopidogrel is the gastrointestinal (GI) tract. The risk of GI bleeding with clopidogrel monotherapy is generally low; however, it increases with the presence of other risk factors such as aspirin use, advanced age, prior GI bleed, non-steroidal anti-inflammatory drugs, steroids and anticoagulants. In patients with a prior GI bleed, the risk of recurrence is high and strategies to prophylactically mitigate the risk should be implemented. In this review, evidence supporting the use of proton pump inhibitors to reduce the risk of recurrent GI bleed is discussed. Recommendations on an appropriate regimen to diminish the risk are provided.


Author(s):  
Rizwan Ahmed Memon ◽  
Fazeela Rizwan Memon ◽  
Ali Raza Memon ◽  
Jamshaid Ul Qadir Memon ◽  
Jawaid Hussain Laghari ◽  
...  

Background: Proton Pump inhibitors (PPI) are widely used all over the world as therapeutic agents as well as prophylactic agent at different age groups for multiple gastrointestinal disorders etc. it inhibits the hydrogen potassium pump (H/K ATPase Pump). PPI interferes the calcium absorption and thus disturbs acid secretion which leads to decrease the calcium level in the body. Objective: The present design is to evaluate the effects of PPI on serum calcium level in rabbit model. Study Design: Randomized Control Trial/ Study on Rabbit Model. Place and Duration of Study: This experimental study was done at Department of Pharmacology Isra Medical University Hyderabad (November 2020 to March 2021 Material & Methods: A total 20 healthy male rabbits with weight between 1-2kg were included in this study. While female rabbits, ill rabbits and rabbits with weight less than 1kg were excluded from study. Ten rabbits were given omeprazole sachet of 20mg orally dissolve in water once a day and 10 rabbits were given sachet of esomeprazole of 20mg dissolve in water once a day upto 90 days regularly. At different levels of study blood samples were obtained from vein near ear of rabbits and samples were centrifuged for 10minutes to obtain the serum. Then serum was sent to Isra Diagnostic Laboratory for analysis of serum calcium levels of all samples at different levels of study. Results: Serum calcium levels of all rabbits were analyzed at three different levels of study, at zero level before starting of experiment, at level I after completion of one month of experiment and level II after the completion of three months of experiment. The normal serum calcium level in rabbits is 13-15mg/dl.8There was a significant decline in serum calcium level in Group A (Omeprazole Group), while in Group B (Esomeprazole Group) there was no significant relation between decreased serum calcium levels. Conclusion: The study concluded that there is significant relation of longterm usage of PPI on serum calcium level.


2016 ◽  
Vol 98 (6) ◽  
pp. 371-375 ◽  
Author(s):  
R Singh ◽  
R Trickett ◽  
CER Meyer ◽  
S Lewthwaite ◽  
D Ford

Introduction Acute gastrointestinal stress ulceration is a common and serious complication of trauma. Prophylactic proton pump inhibitors (PPIs) or histamine receptor antagonists have been used in poly-trauma, burns and head and spinal injuries, as well as on intensive care units, for the prevention of acute gastric stress ulcers. Methods We prospectively studied the use of prophylactic PPIs in with femoral neck fracture patients, gathering data on all acute gastric ulcer complications, including coffee-ground vomiting, malena and haematemesis. We then implemented a treatment protocol in which all patients were given prophylactic PPIs, again prospectively collecting all data. Results Five hundred and fifteen patients were included. Prior to prophylactic PPI, 15% of patients developed gastric stress ulcer complications, with 3% requiring acute intervention with oesophagogastroduodenoscopy (OGD), 5% requiring transfusions and 4% experiencing surgical delays. All patients had delayed discharges. Following PPI implementation, no patients developed gastric stress ulcer complications. Conclusions Femoral neck fracture patients create a substantial workload for orthopaedic units. The increasingly elderly population often have comorbidities, and concomitantly use medications with gastrointestinal side effects. This, combined with the stress of a fracture and preoperative starvation periods increases the risk of gastric ulcers. Here, the use of prophylactic PPIs statistically reduced the incidence of gastric stress ulcers in patients with femoral neck fractures, resulting in fewer surgical delays, reduced length of hospital stay and reduced stress ulcer-related mortality.


2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Eimear O' Reilly ◽  
Aquila Gopaul ◽  
Lisa Cogan

Abstract Background Proton pump inhibitors (PPIs) are one of the most frequently prescribed drug classes in the older person. Indications for PPI use are outlined in the NICE guidelines, however they are often prescribed without an appropriate indication resulting in increased healthcare costs and increased exposure to potential adverse clinical effects. Methods To determine the rate of inappropriate prescribing of PPI’s, an audit was carried out to assess the incidence of inappropriate prescribing in an Acute Rehabilitation facility pre and post Education to Hospital Doctors. An audit was carried out, pre and post intervention, on patients over the age of 65 years admitted to an acute rehabilitation hospital between 2018 and 2019. Patient’s medical charts were reviewed and data was collected on PPI prescribing. Results Cycle 1-Pre Education; 83 people included in the audit. Mean age was 80.8 years[SD ±9]. 43% of patients were on a PPI, all of which were prescribed the generic form. 83.4% of patients had no indication for PPI use. Of the 16.6%, indications included GORD, Barrett’s oesophagus, PUD and PPI prophylaxis against NSAID’s including aspirin. 77.7% were on therapeutic dose without any indication. 100% of patients were on PPI for longer than 6 weeks. Cycle 2, Post education: 86 patients were included in re-audit. Mean age was 81.5[SD ±10]. 60.4% of patients were on PPI. Of those, 55% had no indication for PPI. Of the 44% on PPI, indications were similar to those in Cycle 1. 83% of patients were on PPI longer than 6 weeks. 56.5% were on inappropriate dose of PPI. Conclusion This audit highlighted the inappropriate prescribing of PPI’s in the older person. By providing education to Doctors about NICE PPI prescribing guidelines, overall rate of inappropriate prescribing of PPI decreased by 28.4% and accurate dosing of PPI improved by 21.2%.


2017 ◽  
Vol 15 (7) ◽  
pp. 1030-1036.e1 ◽  
Author(s):  
Margot E. Cohen ◽  
Joanne M. Hathway ◽  
Hojjat Salmasian ◽  
Jianfang Liu ◽  
Melissa Terry ◽  
...  

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