Proton Pump Inhibitors

Proton pump inhibitors (PPIs) reduce acid levels in the stomach by inhibiting the hydrogen-potassium ATPase enzyme that pumps hydrogen ions to the lumen of the stomach.  PPIs irreversibly bind to the pump, which means that new pumps must be synthesized to continue acid production.  PPIs are used in the treatment of ulcers, GERD, esophagitis, and H. pylori infections.  Side effects include osteoporosis, increased risk of c. diff diarrhea, and increased risk of pneumonia.  

Class Drugs

• Dexlansoprazole

• Esomeprazole

• Lansoprazole

• Omeprazole

• Pantoprazole

• Rabeprazole

Class Mechanism of Action

Directly inhibits and irreversibly binds to H/K ATPase enzyme

Decreases production of gastric acid by 90%

New enzymes take 18 hours to synthesis, which is the source of new acid production

Class Applications

GERD

Stress ulcer treatment/prophylaxis

Erosive esophagitis

Duodenal ulcers

H. Pylori treatment

• H. Pylori is a gram negative bacteria that infects the lining of the stomach and causes ulcerations of the stomach lining. Treatment of ulcers is difficult without eradication of H. Pylori

• PPIs are combined with the following drugs for the treatment of H. Pylori

Amoxicillin (metronidazole is substitute in PCN allergic), clarithromycin ---- or ----

• Bismuth subsalicylate, metronidazole, and tetracycline

Class Adverse Effects

• Osteoporosis

• Vitamin B12 Deficiency

• Diarrhea

• Clostridium difficile colitis has been associated with use of PPIs

• Increased risk of pneumonia

Drug Table

Drug Name	Application	Comments	Image
Dexlansoprazole			"Dex Phone Book" "Lance" "Asshole"
Esomeprazole			"Eskimo" "Asshole"
Lansoprazole			"Lance" "Asshole"
Omeprazole			"Ohm" "Asshole"
Pantoprazole			"Pants"  "Asshole"
Rabeprazole			"Rabies" "Asshole"