908
P A R T 1 1
Drugs acting on the gastrointestinal system
to determine the effectiveness of the therapy and to
evaluate for the occurrence of any adverse effects
associated with drug therapy.
■
■
Inspect the skin for lesions, rash, pruritus and
dryness
to identify possible adverse effects.
■
■
Assess neurological status, including level of
orientation, affect and reflexes,
to evaluate for
CNS effects of the drug.
■
■
Inspect and palpate the abdomen
to determine
potential underlying medical conditions
; assess
for changes in bowel elimination and GI upset
to identify possible adverse effects.
■
■
Assess respiratory status, including respiratory rate
and rhythm; note evidence of cough, hoarseness
and epistaxis,
to monitor for potential adverse
effects of the drug.
Implementation with rationale
■
■
Administer drug before meals to ensure that the
person does not open, chew or crush capsules;
they should be swallowed whole
to ensure the
therapeutic effectiveness of the drug.
■
■
Provide appropriate safety and comfort measures
if CNS effects occur
to prevent injury.
■
■
Monitor the person for diarrhoea or constipation
in order to institute an appropriate bowel program
as needed
.
■
■
Monitor the person’s nutritional status; use of
small frequent meals may be helpful
if GI upset is
a problem
.
■
■
Arrange for medical follow-up if symptoms are
not resolved after 4 to 8 weeks of therapy
because
serious underlying conditions could be causing the
symptoms.
■
■
Offer support and encouragement
to help the
person cope with the disease and the drug regimen.
■
■
Provide thorough teaching, including the drug
name and prescribed dosage; the importance of
taking the drug whole without opening, chewing
or crushing it; signs and symptoms of possible
adverse effects and measures to minimise or
prevent them; danger signs that need to be
reported to the healthcare provider immediately;
nutritional measures, such as small, frequent
meals; safety measures, such as avoiding driving
and getting assistance with ambulation as
needed; methods for dealing with constipation or
diarrhoea; and the need for periodic monitoring
and evaluation,
to enhance knowledge about drug
therapy and to promote compliance.
Evaluation
■
■
Monitor response to the drug (relief of GI
symptoms caused by hyperacidity; healing of
erosive GI lesions).
■
■
Monitor for adverse effects (GI effects, CNS
changes, dermatological effects, respiratory
effects).
■
■
Monitor the effectiveness of comfort and safety
measures and compliance with the regimen.
■
■
Evaluate the effectiveness of the teaching plan
(person can name the drug and dosage and
describe adverse effects to watch for, specific
measures to avoid them and measures to take to
increase the effectiveness of the drug).
Acute renal impairment caused by interstitial nephritis is
a recognised complication of treatment with omeprazole.
Presenting symptoms may be non-specific and include
malaise, fever, nausea, lethargy, weight loss, rash and
eosinophilia. People known to be taking omeprazole
who exhibit these symptoms should undergo urine
microscopy and assessment of renal function. If either
or both are abnormal, omeprazole should be withdrawn
pending nephrology assessment.
1
Interstitial nephritis
should also be considered if there is an unexpected rise
in serum creatinine.
Since publishing information about omeprazole-
induced interstitial nephritis in 2000,
1
there have been
21 further cases reported to CARM; nine were reported
in 2005 alone. Interstitial nephritis has also been
reported with pantoprazole
2
and lansoprazole
3
; CARM
has received three such reports for pantoprazole. This
reaction is thought to be rare but proton pump inhibitors
are now believed to be the commonest cause of
interstitial nephritis in the Auckland region, perhaps due
to their widespread use.
4
This suggests that prescribers
should be vigilant for this adverse reaction when using
omeprazole or other proton pump inhibitors.
References
1. Savage, R. (2001). Omeprazole-induced interstitial
nephritis.
Prescriber Update, 20
(Feb), 11–13.
.
htm.
2. Pfizer New Zealand Ltd. (2005). Somac
(pantoprazole) tablets data sheet.
govt.nz/profs/Datasheet/s/somacHeartBurnRelieftab.
pdf.
3. Wyeth (NZ) Limited. (2002). Zoton (lansoprazole)
capsules data sheet.
Datasheet/z/zotoncap.htm.
4. Simpson, I. J., Marshall, M. R., Pilmore H.,
et al. (2006). Proton pump inhibitors and acute
interstitial nephritis—report and analysis of 15 cases.
Nephrology
,
11(5),
381–385.
Source:
MEDSAFE. (2006).
Prescriber Updates, 27(1)
, 3. www.
medsafe.govt.nz/profs/PUarticles/watchingbriefsJune06.htm.
■■
BOX 57.4
Proton pump inhibitors and interstitial
nephritis
