Chronic atrophic gastritis should use omeprazole?

It is only for medical professionals to read for reference.
Inventory 6 major irrational use of proton pump inhibitors, you may have committed too.

Proton pump inhibitors are a class of drugs that inhibit gastric acid secretion, which can specifically and non-competitively act on the final link of gastric acid secretion-H+-K+-ATPase on gastric parietal cells.

Proton pump inhibitors have a wide range of clinical applications.
In recent years, the clinical application of proton pump inhibitors has phenomena such as over-indications, over-dose medication, and improper choice of solvents, which can increase the medication risk of patients.

Which patients should not use proton pump inhibitors? What is the dosage of proton pump inhibitors? Which solvents are not suitable for proton pump inhibitors? Today, we have passed 1 quiz + 6 prescriptions.
Let's discuss together how to avoid the 6 irrational use of proton pump inhibitors.

Self-test questions (multiple choice questions) Regarding proton pump inhibitors, the following usage errors are: A.
Patients with chronic atrophic gastritis should use omeprazole enteric-coated tablets.

B.
Patients with soft tissue injury should use ilaprazole sodium for injection.

C.
Omeprazole sodium for injection should be used in patients after reduction of nasal bone fractures.

D.
Lansoprazole for injection should be used in patients with duodenal ulcer bleeding.

E.
Lansoprazole for injection is a 5% dextrose injection.

Answer Click on the blank space below to get the answer.
Correct answer: A B C E Irrational medication 1: Omeprazole enteric-coated tablets for patients with chronic atrophic gastritis▎ Case: Gastroenterology clinic, patient, male, 49 years old.

Gastroscope: Chronic atrophic gastritis (mainly stomach), Helicobacter pylori (Hp) test was negative.

▎Diagnosis: Chronic atrophic gastritis (mainly stomach body).

▎Prescription: Omeprazole enteric-coated tablets 20 mg orally once a day ▎Analysis: Omeprazole can effectively inhibit gastric acid secretion, while patients with chronic atrophic gastritis (mainly gastric body) decrease or lose gastric acid secretion, so use Omeprazole Meprazole will not only fail to achieve the purpose of treatment, but will aggravate the condition.

As an endogenous mucosal protective agent, teprenone can improve various defense capabilities of the mucosa, including increasing the secretion of gastric mucus, maintaining the normal structure and function of the mucus and hydrophobic layer, increasing the level of hexosamine in the gastric mucosa, and promoting The synthesis of endogenous prostaglandins increases gastric mucosal blood flow, promotes cell regeneration, maintains the homeostasis of gastric mucosal cells, inhibits neutrophil penetration, reduces oxidative damage, and is effective in treating chronic atrophic gastritis.

▎Recommendation: Replace omeprazole enteric-coated tablets with teprenone (50mg, 3 times a day, orally after meals).

Irrational medication 2: Small dose of lansoprazole enteric-coated tablets▎ Case: Gastroenterology clinic, patient, female, 27 years old.

Previously healthy, no history of drug allergy.

Gastroscope: Chronic gastritis, Hp test is positive.

▎Diagnosis: Hp-positive chronic gastritis.

▎Prescription: Lansoprazole enteric-coated tablets 15mg 1 day 2 times a day orally half an hour before meals 220 mg bismuth potassium citrate granules 2 times a day orally half an hour before meals 1 g amoxicillin capsules 1g 1 day 2 times a day clarithromycin tablets after meals 0.
5g 2 times a day orally after meals for 14 days▎Analysis: standard quadruple therapy for eradication of H.
pylori, lansoprazole enteric-coated tablets 30mg, twice a day, half an hour before meals; bismuth potassium citrate granules 220mg, 2 times a day, half an hour before meals; 1g amoxicillin capsules, 2 times a day, orally after meals; clarithromycin tablets 0.
5g, 2 times a day, orally after meals.

The course of treatment is 10 to 14 days.

In this case, the dose of lansoprazole enteric-coated tablets was small, and the acid inhibitory effect was weak, which could easily lead to the failure of Hp eradication.

▎Recommendation: Correct the dosage of lansoprazole enteric-coated tablets.

Irrational medication 3: Large dose of omeprazole enteric-coated tablets▎ Case: Gastroenterology clinic, patient, male, 36 years old.

Gastroscopy: duodenal ulcer, Hp test was negative.

▎Diagnosis: duodenal ulcer.

▎Prescription: Omeprazole enteric-coated tablets 20 mg orally twice a day ▎Analysis: All patients with peptic ulcer should receive gastric acid suppression therapy, and proton pump inhibitors are the first choice.

Omeprazole enteric-coated tablets, 20mg each time, once a day, take the medicine half an hour before breakfast.

The course of treatment for duodenal ulcer is 4 to 6 weeks, and for gastric ulcer is 6 to 8 weeks.

For patients with high-risk factors and huge ulcers, it is recommended to extend the course of treatment to 12 weeks.

Large doses of proton pump inhibitors can cause adverse reactions.

▎Recommendation: Adjust the dosage of omeprazole enteric-coated tablets.

Irrational medication 4: Use of ilaprazole sodium for injection in patients with soft tissue injury▎ Case: Orthopedic ward, patient, female, 42 years old.

▎Diagnosis: left foot soft tissue injury.

▎Prescription: 0.
9% sodium chloride injection 100mL 10mg of ilaprazole sodium for injection Usage: intravenous drip once a day ▎Analysis: ilaprazole sodium for injection is used for peptic ulcer bleeding.

This case is a soft tissue injury, and there is no indication for preventive use of proton pump inhibitors.

Omeprazole sodium for injection can be used to prevent stress ulcers, and those who are indicated for proton pump inhibitor prophylaxis can use omeprazole sodium for injection.

▎Recommendation: Proton pump inhibitors should not be used.

Irrational medication 5: Omeprazole sodium for injection in patients after reduction of nasal bone fractures▎ Case: Otolaryngology ward, patient, female, 34 years old.

▎Diagnosis: After reduction of nasal bone fracture.

▎Prescription: 0.
9% Sodium Chloride Injection 100mL Omeprazole Sodium 40mg for Injection Usage: intravenous drip once a day ▎Analysis: various difficult and complicated major operations before the operation (the expected operation time is not less than 4 hours ), such as partial liver resection and pancreatic cancer resection, short-term intravenous proton pump inhibitors can be used to prevent stress ulcers.

It is not necessary to prevent the use of proton pump inhibitors for perioperative patients with small surgical trauma, short surgical time, and no underlying diseases.

▎Recommendation: There is no indication for omeprazole sodium for injection.

Irrational medication 6: 5% glucose injection is selected as the vehicle of lansoprazole for injection▎ Case: Gastroenterology ward, patient, male, 54 years old.

▎Diagnosis: bleeding from duodenal ulcer.

▎Prescription: 5% glucose injection 100mL lansoprazole 30mg for injection Usage: intravenous drip once a day ▎Analysis: Lansoprazole for injection is suitable for duodenal ulcers with bleeding.

The aqueous solution of lansoprazole for injection is unstable and can quickly decompose in acidic solution to cause polymerization and discoloration, so avoid using it with acidic drugs.

0.
9% sodium chloride injection is suitable for intravenous infusion, and acidic solvents such as 5% glucose injection should be avoided.

Before using Lansoprazole for injection, dissolve the contents of the bottle with 5 mL sterile water for injection, and then dilute it with 100 mL 0.
9% sodium chloride injection for intravenous infusion.
The intravenous infusion time is no less than 30 minutes.

▎Recommendation: Correct the lansoprazole vehicle for injection.

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