NUR 635 Topic 10 DQ 1

Sample Answer for NUR 635 Topic 10 DQ 1 Included After Question

Brenda is working as a nurse practitioner student and is seeing a patient that has been prescribed omeprazole for the past four months. She decides to continue this medication as the patient is not reporting any side effect or adverse reaction. Determine if this medication is appropriate utilizing available evidence and treatment guidelines. If this medication is not appropriate, would it be appropriate for a “near miss” incident to be documented in this situation? Document drug-drug interactions with proton pump inhibitors or antacids. Describe the interaction and the clinical management of the situation. Provide rationale and justification for continuing medication, or discuss alternative therapy that could eliminate the drug-drug interaction.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 5.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 10 DQ 1

Title: NUR 635 Topic 10 DQ 1

Appropriateness of Omeprazole Prescription:

Proton pump inhibitors (PPIs) like omeprazole are frequently given for treatment associated with acid reflux, including GERD, peptic ulcers, and other related disorders. Because of possible side effects and concerns about misuse, the long-term use of this powerful inhibitor of stomach acid output has come under examination. In addition, rebound acid hypersecretion can occur when used for a prolonged time, and tapering should be used to stop PPI (Rosenthal & Burchum, 2020).

Because proton pump inhibitors, such as omeprazole, affect cytochrome P450 enzymes and gastric pH, they may interact with other drugs. One crucial interaction is how they affect other medications’ metabolism and absorption, especially those that need an acidic environment to be absorbed as well as possible (Rosenthal & Burchum, 2020).

Since antacids elevate the pH of the stomach, they may interfere with the absorption of some drugs, particularly those that need an acidic environment to dissolve and be absorbed. Theoretically, using PPIs and antacids at the same time may lessen the efficiency of drugs that need an acidic environment, such as some antibiotics (like tetracyclines) and antifungals (like ketoconazole) (Rosenthal & Burchum, 2020).

In this case, clinical management entails carefully considering when to administer medication. It may be possible to lessen the interaction by giving impacted drugs at a reasonable interval apart from PPIs or antacids. Alternatively, one way to avoid drug-drug interactions is to look at substitute medications that don’t depend on stomach acidity for absorption. (Al Ali et al., 2022)

References

Al Ali, H. S., Jabbar, A. S., Neamah, N. F., & Ibrahim, N. K. (2022). Long-term use of omeprazole: Effect on hematological and biochemical parameters. Acta Med Indones, 54(4), 585-594.

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

A Sample Answer For the Assignment: NUR 635 Topic 10 DQ 1

Title: NUR 635 Topic 10 DQ 1

Omeprazole is approved for short-term therapy of duodenal ulcers, gastric ulcers, erosive eosphagitis and GERD. Long term, it is approved for hypersecretory conditions and should be limited for use between 4 to 8 weeks (Rosenthal & Burchum, 2020). In Brenda’s case, she has been using the medication for too long. 

Near-miss events are errors that occur in the process of providing medical care that are detected and corrected before a patient is harmed. The Institute of Medicine (IOM) and others have identified near-miss reporting and analysis as vital to understanding and correcting weaknesses in the health care delivery system and to preventing actual adverse events (AEs) that harm patients (Crane et al., 2017). I do not think Brenda’s situation would be considered a “near miss” due to no reports of side effects or adverse reactions. 

PPIs have the potential to interact with a wide variety of medications due to alteration of the pH of the stomach, which can potentially change absorption, activation, and binding of medications. Multiple HIV medications such as nelfinavir (Aricept) and rilpivirine (Edurant) require acid for proper absorption, so they are not absorbed in therapeutic doses when given with PPIs. For the same reason, some hepatitis C medications require that lower-dose or no PPIs be given during therapy. Conversely, PPIs will increase digoxin (Lanoxin) levels in the blood because of increased absorption, potentially leading to digoxin toxicity (Obert & Obert 2016). 

Sucralfate is an effective antiulcer medication and is known to have minimal side effects and lack of significant drug interactions. This drug promotes healing by creating a protective barrier against acid and pepsin (Rosenthal & Burchum, 2020). This would probably be a better option for Brenda for Brenda to try that would eliminate the drug drug interaction. 

References:

Crane, S., Sloane, P. D., Elder, N. C., Cohen, L. W., Laughtenschlager, N., & Zimmerman, S. (2017, August). Advances in patient safety and medical liability. AHRQ. https://www.ahrq.gov/patient-safety/reports/liability/crane.html 

Obert, L., & Obert, J. (2016, February 1). PPIs and antacids: How to avoid interactions. Contemporary Clinic. https://www.contemporaryclinic.com/view/ppis-and-antacids-how-to-avoid-interactions 

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.