Pantoprazole Nursing Implications
Pantoprazole Nursing Pharmacology
Pantoprazole is a prescription drug used to treat certain stomach and esophageal problems (such as acid reflux). It works by reducing the level of acid produced by the stomach. This medication relieves symptoms such as heartburn, swallowing problems, and a chronic cough.
It aids in the healing of acid damage to the stomach and esophagus, the prevention of ulcers, and the prevention of esophageal cancer.
Pantoprazole Protonix is a proton pump inhibitor (PPI), which is a type of medication (PPI). Pantoprazole is also useful in the treatment and prevention of stomach and intestinal ulcers.
Indications of Pantoprazole
- Short-term treatment of erosive esophagitis associated with gastroesophageal reflux disease (GERD). Pantoprazole is indicated for the short-term (up to 8 weeks) treatment of erosive esophagitis in adults and children aged five years of age and older (EE). An additional 8-week course of pantoprazole may be considered for adult patients who have not healed after 8 weeks of treatment. The safety of treatment for pediatric patients beyond 8 weeks has not been established.
- Maintenance of healing of erosive esophagitis. Pantoprazole is approved to maintain EE treatment and reduce readmission rates of daytime and nighttime heartburn symptoms in adult GERD patients. Controlled studies did not last more than a year.
- Pathological hypersecretory conditions including Zollinger-Ellison syndrome (ZE). Pantoprazole is approved for the long-term treatment of pathological hypersecretory conditions such as Zollinger-Ellison Syndrome (ZE).
Mechanism of Action of Pantoprazole
Pantoprazole is a proton pump inhibitor (PPI) that inhibits the final step in the production of gastric acid by covalently binding to the (H+, K+)-ATPase enzyme system at the secretory surface of the gastric parietal cell.
This outcome prevents both basal and stimulated gastric acid production, in spite of the stimulus. For all doses tested, binding to the (H+, K+)-ATPase results in an antisecretory effect that lasts longer than 24 hours (20 mg to 120 mg).
Pharmacokinetics of Pantoprazole
Pantoprazole is an enteric-coated tablet, which means its absorption starts only after the tablet passes through the digestive. Peak serum concentration (Cmax) and area under the serum concentration-time curve (AUC) rise proportionally to oral and intravenous doses ranging from 10 mg to 80 mg.
Pantoprazole does not accumulate, and its pharmacokinetics remain constant when taken multiple times per day. Pantoprazole serum concentrations decrease biexponentially after oral or intravenous administration, with a terminal elimination half-life of approximately one hour.
- Distribution. Pantoprazole has an apparent volume of distribution of 11 to 23.6 L, primarily in extracellular fluid. Pantoprazole binds to about 98 percent of serum proteins, primarily albumin.
- Metabolism. Pantoprazole is entirely absorbed into the body by the enzyme called cytochrome P450 (CYP) system. The metabolism of pantoprazole is unaffected by the route of drug administration (intravenous or oral). CYP2C19 demethylation accompanied by sulfation is the fundamental cellular process; some metabolic reactions include CYP3A4 oxidation. There is no indication that any of the pantoprazole metabolites are pharmacologically active.
- Elimination. Following a single oral or intravenous dose of 14C-labeled pantoprazole, an estimated 71% of the dose was excreted in the urine, with the residual 18% excreted in the feces via biliary excretion. The unaffected pantoprazole was not excreted by the kidneys.
Side Effects of Pantoprazole
Pantoprazole may have some unwanted side effects in addition to its necessary effects. Even though not all of these side effects are probable, they may require medical attention if they happen.
If any of the following symptoms are serious or persistent, notify the doctor immediately:
- headache
- nausea
- vomiting
- gas
- abdominal pain
- facial puffiness
- joint pain
- diarrhea
- dizziness
Some of the side effects may be severe. If the patient notice any of the following symptoms, contact the doctor immediately or seek emergency medical attention:
- skin blistering, peeling, or bleeding; sores on the lips, nose, mouth, or genitals; swollen glands; shortness of breath, fever, or flu-like symptoms
- urticaria, itchiness of the skin, swelling of some parts of the face including the lips, mouth, throat, and tongue, trouble swallowing, or hoarseness of voice
- muscle spasms, uncontrollable shaking of a part of the body, extreme tiredness; lightheadedness, dizziness, or seizures
- severe diarrhea with watery stools, stomach pain, or persistent fever
- new or worsening joint pain, sun-sensitive rash on cheeks or arms
- high blood sugar
- sensitivity to light
- urination that is excessive or infrequent, blood in the urine, fatigue, nausea, loss of appetite, fever, rash, or joint pain
Allergy of Pantoprazole
Pantoprazole can cause an allergic reaction, though this is uncommon. Rashes, swelling, and breathing difficulties are possible symptoms. This allergic reaction has the potential to develop into interstitial nephritis, a kidney disorder that can cause dehydration. The following are some of the symptoms of this condition:
- nausea or vomiting
- fever
- rash
- confusion
- blood in the urine
- bloating
- elevated blood pressure
The patient should consult the physician if any of these symptoms are observed. If symptoms are severe or life-threatening, they should to the closest hospital or dial the emergency hotline.
Long-Term Effects of Pantoprazole
- People who use proton pump inhibitors, such as pantoprazole, may be more likely than others to fracture their wrists, hips, or spine. Proton pump inhibitor users may develop fundic gland polyps (a type of growth on the stomach lining). These risks are greatest in people who take high doses of one of these medications for a year or more. Discuss the risks of taking pantoprazole with the doctor.
- Hypomagnesemia may actually happen with long-term usage (more than a year); adverse effects including tetany, arrhythmias, as well as seizures may occur; in 25% of cases evaluated, magnesium supplementation solely did not enhance low serum magnesium levels, and the PPI had to be stopped; suggest monitoring magnesium levels prior to actually starting PPI treatment and on a regular basis.
- Long-term use (e.g., more than 3 years) may result in cyanocobalamin malabsorption or deficiency.
Adverse Effects of Pantoprazole
- General: allergic reaction, fever, photosensitivity, blurring of vision, facial edema, malaise
- Nervous system: headache, dizziness, alteration to the sense of taste, metallic/bitter taste,
- Psychiatric: confusion, hallucination, depression
- Respiratory: nasopharyngitis and pharyngolaryngeal pain among pediatric patients between the ages of 2 and 16 years, cough, nasal congestion, pharyngitis.
- Gastrointestinal: diarrhea, nausea, vomiting, stomach pain, dry mouth, constipation, hepatitis, fundic gland polyps.
- Musculoskeletal: joint pain, fracture, rhabdomyolysis
- Hematologic: leukopenia, thrombocytopenia, agranulocytosis, pancytopenia,
- Skin: rash, itchiness, urticaria. erythema multiforme, steven-johnson syndrome
- Metabolic: increased creatinine level, elevated triglycerides, and liver enzymes, hyponatremia, hypomagnesemia.
- Immune system: systemic lupus erythematosus
- Infections: Clostridium difficile
- Urinary: Acute tubulointerstitial nephritis
Drug Interactions with Pantoprazole
Pantoprazole oral tablet may interact with other medicines, herbs, or vitamins the patient was also taking. That is why the doctor should closely monitor all of the medications. If the patient has any concerns about how this medication might interact with something else the patient’s taking, consult the doctor or pharmacist. The following are some drugs that may interact with pantoprazole.
- HIV medications. Certain HIV medications should not be combined with pantoprazole. Pantoprazole may reduce the amount of these drugs in the body significantly. This may impair their ability to combat HIV infection.
- Anticoagulants. Some people who take anticoagulants and pantoprazole may see an increase in INR and prothrombin time (PT). This can increase the risk of severe bleeding. If the patient takes these medications together, the doctor should keep an eye on INR and PT levels.
- Drugs affected by stomach pH. Pantoprazole reduces stomach acid production. As a result, the body’s absorption of some drugs that are sensitive to the effects of decreased stomach acid may be reduced. This effect may reduce the effectiveness of these medications.
- Systemic anti-cancer drugs. Taking chemotherapy drugs with pantoprazole may result in increased levels of anticancer medication in the body. If the patient is taking high doses of these medications, the doctor may advise the patient to discontinue pantoprazole during treatment.
Nursing Considerations for Patients on Pantoprazole
- Inform the patient to talk to their doctor if they are allergic to pantoprazole, or any kind of proton pump inhibitors and its ingredients. They can ask the pharmacist for the list of ingredients.
- Before taking pantoprazole, inform the patient to inform their doctor if they have or have a history of liver disease and lupus.
- Pantoprazole can lower magnesium levels in the body. If the patient has a history of hypomagnesemia, tell the patient to inform the doctor first before starting the treatment.
- Inform the patient to tell the doctor if they have or have ever had low levels of magnesium, calcium, or potassium in the blood; hypoparathyroidism (a disease in which the body does not produce sufficient parathyroid hormone [PTH; a natural component needed to regulate the level of calcium in the blood]); deficiency in vitamin B12 in the body; osteoporosis (a disease in which the bones become thin and break easily); or an autoimmune disease (a condition in which the body attacks its own tissues).
- If the patient is scheduled for surgery or dental procedures, advise the patient to inform the doctor or dentist regarding the medication they are taking. This includes prescription drugs, nonprescription drugs, vitamins, nutritional supplements, and herbal products.
- Provide safety and fall risk precautions to patients, especially elders. Long-term use of pantoprazole may lead to bone loss or fracture. Discuss the ways to prevent bone fracture, which may include taking calcium and vitamin D supplements.
- Monitor the patient closely and watch out for any symptoms of a serious condition, such as heartburn, lightheadedness, unusual sweating, pain in the chest, jaw, arm, and shoulder, and unexplained weight loss.
- Assess the patient and evaluate the effectiveness of the medication with GERD symptoms. Ask the patient if they experience relief with the following symptoms: Heartburn, nausea, difficulty swallowing, acid reflux, and feeling of a lump in the throat.
- Pantoprazole can be taken with or without food. For best effects, advise the patient to take it at the same time every day.
- Instruct the patient to swallow the pantoprazole tablet whole, and not cut, crush or chew the medication.
- Discuss with the patient the proper storage of the medicine. Store at room temperature between 20 to 25 degrees Celsius.
- Instruct the patient to keep pantoprazole out of the reach of children.
- For pregnant women or if the patient is planning to get pregnant, advise the patient to talk to their doctor first before starting to take pantoprazole.
- Pantoprazole may cross through breast milk and be passed on to a nursing baby. Taking pantoprazole is not recommended for breastfeeding mothers. Advise the patient to notify their doctor if they practice breastfeeding.
- If the patient, is scheduled for neuroendocrine tumor screening tests, advise his/her to tell the doctor first. Pantoprazole can cause incorrect results in neuroendocrine tumor screening tests. The doctor might ask the patient to stop taking this medication at least 14 days before the testing.
- Discuss with the patient that pantoprazole must be taken as directed. The length of time the patient is going to take it will be determined by the type and severity of their condition. If they do not take it as directed, there are serious complications that might happen.
- Tell the patient not to stop taking pantoprazole without the doctor’s advice. The body will decrease its ability to control symptoms of GERD if pantoprazole is discontinued without a doctor’s supervision.
- In case of a missed dose, instruct the patient to take the next dose as scheduled. Never double the dose at the same time.
- If the patient experiences overdosage with pantoprazole, call the poison control center immediately. Symptoms of pantoprazole toxicity include tremors, decreased activity, and ataxia.
- Assess the patient for side effects of pantoprazole. Advise the patient to increase fluid intake when having headaches or diarrhea. Advise the patient to talk to their doctor immediately if they experience side effects from the medicine and not take any medications to relieve symptoms without consulting their doctor first to avoid further complications.
- Pantoprazole can cause some serious side effects like Clostridium difficile in the intestines. Monitor if the patient experiences watery stools, fever, and severe stomach pain. Notify the doctor immediately.
- For patients taking oral suspension, instruct the patient to take the medicine 30minutes before a meal.
- For patients with a nasogastric tube or gastrostomy tube, use a size 16 French or larger tube. Do not give pantoprazole oral suspension through NGT or gastrostomy tube with smaller size.
- Mix pantoprazole only with apple juice when given through an NGT or gastrostomy tube.
- If the patient complains decrease in the amount of urine or the presence of blood in urine, advise the patient to consult the doctor immediately. Some patients taking pantoprazole may develop a kidney problem called acute tubulointerstitial nephritis.
- Watch out if the patient experience new or worsening joint pain, or a rash on the cheeks, these could be symptoms of a certain type of lupus or worsening lupus. If the patient has any of these, notify the doctor right away.
- Monitor the patient for symptoms of vitamin b12 deficiency, this includes shortness of breath, lightheadedness, arrhythmia, muscle weakness, pale color skin, fatigue, changes in mood, tingling sensation, or numbness of upper and lower extremities. Advise the patient to visit the doctor immediately for proper treatment.
- Assess the patient for symptoms of hypomagnesemia. Refer to the doctor immediately if the patient experiences dizziness, spasm of hands, feet, or voice, seizure, jitteriness, and muscle pain.
- Discuss with the patient ways how to prevent heartburn and GERD. Eat a small amount every meal to avoid overeating. Do not eat 3 to 4 hours before bedtime and avoid eating late at night. Do not lie down after eating. Raise the head of the patient at least 6 to 8 inches. This is to avoid stomach contents to goes up to the esophagus that may cause a burning sensation.
- Some foods and drinks can trigger heartburn and GERD symptoms. Talk to the patient to have moderation or avoid certain food and beverages, this includes tomatoes and citrus fruits like orange and grapefruit. Other drinks that may induce reflux are coffee, sodas, alcohol, carbonated drinks, and tea.
- In doing physical activities, advise the patient to choose the right kind of exercise that may not affect acid reflux symptoms. Avoid exercises that may involve pressure on the abdomen that may add force to the stomach and stimulate stomach contents to travel up the esophagus. As much as possible avoid exercises that may increase pressure on the intra-abdominal area that may trigger reflux symptoms.
- Advise the patient to avoid clothes that are too tight and fitting, as it adds pressure on the abdomen and may pull up acids and food from the stomach into the esophagus. Wearing comfortable and well-fitted clothes may encourage the digestive system to function properly, thus, preventing acid reflux too.
- For pregnant women, heartburn is a more common experience, especially during the second and third semesters. Hormonal change, growth of the abdomen, and increased pressure in the abdomen are some of the reasons why they are at risk of heartburn and acid reflux. Instruct the patient to avoid spicy and fried food as much as possible and eat in small frequent feedings, instead of eating three large main meals. Avoid lying down after eating, allow at least a few minutes to assure that gastric contents would not food and acid rise to the esophagus.
Nursing Care Plan for Patients on Pantoprazole
Possible Nursing Diagnoses
- Risk for Diarrhea related to the gastrointestinal action of pantoprazole
- Risk for Constipation related to GI action of pantoprazole
- Disturbed Sensory Perception (Visual) related to the possible side effects of pantoprazole
- Deficient Knowledge related to new drug prescription
- Alteration in Comfort
- Impaired Urinary Elimination
Nursing Assessment
| Pantoprazole Nursing Interventions | Rationale |
| Assess the patient for signs and symptoms of stomach pain, heartburn or reflux, stomach upset, nausea or vomiting, and GI bleeding. | To confirm the indication for administering pantoprazole. |
| Check the patient’s allergy status. | Previous allergic reaction to pantoprazole will render the patient unable to take them. Alternatives to pantoprazole should therefore be considered in case of allergy. |
| Assess if the patient is pregnant or is a lactating mother. | Pantoprazole should be prescribed in caution to a pregnant woman or lactating mother as these drugs are under pregnancy category B. |
| Check the patient’s list of current medications. | The following medications may interact with pantoprazole: Anticonvulsants, anticoagulants, and benzodiazepines. PPIs can cause an alteration in the function of some enzymes that may delay the clearance of the said drugs. Bisphosphonates. The use of pantoprazole and bisphosphonates is associated to an increased likelihood of osteoporotic fractures, especially in women aged 65 and above.Astemizole. This absorbed more effectively in an acidic environment. Since PPIs work by reducing acid production, it is recommended that other antifungals be used. Digoxin. PPIs can potentiate the absorption of digoxin. Extreme caution is necessary to prevent possible cardiac side effects. |
| Perform a focused physical assessment on the patient’s abdomen through inspection, palpation, and auscultation of bowel sounds. | To confirm the indication for administering pantoprazole, and to assess the patient’s GI motility. |
| Assess the patient’s mucous membranes and his/her ability to swallow. | To check for any potential problems with administration, hydration, and absorption. To ensure that the right form of pantoprazole is given. |
| Collect blood for kidney function tests. | PPIs such as pantoprazole should be used cautiously in patients with kidney disorders as they can damage kidney function. |
Nursing Planning and Intervention
| Pantoprazole Nursing Interventions | Rationale |
| Administer pantoprazole at least 30 minutes before meal. | To ensure enough time for activation, optimal absorption, and therapeutic action of pantoprazole. |
| Administer PPIs about 1 hour before or 2 hours after administering other oral medications, as prescribed. | Ideal spacing of PPIs and other oral medications will ensure adequate absorption of the drugs administered. |
| Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking pantoprazole. Instruct the patient on how to self-administer pantoprazole. | To inform the patient on the basic information about pantoprazole, as well as to empower him/her to safely self-administer the medication. |
| Monitor the patient’s bowel movement and commence stool chart. | PPIs such as pantoprazole may cause diarrhea or constipation. Early detection of either side effect can help institute a bowel program and relieve them effectively. |
Nursing Evaluation
| Pantoprazole Nursing Interventions | Rationale |
| Ask the patient to repeat the information about pantoprazole. | To evaluate the effectiveness of health teaching on pantoprazole. |
| Monitor the patient for signs and symptoms of stomach pain, heartburn or reflux, stomach upset, nausea or vomiting, and GI bleeding. | If the patient starts to have a coffee ground vomiting and/or persistent abdominal pain, the use of pantoprazole needs to be reviewed by the physician. Having blood in the stool or difficulty of swallowing may also warrant a review of the need to continue pantoprazole or to switch to an alternative treatment. |
| Monitor the patient’s weight daily. | Pantoprazole may cause unintentional weight gain or weight loss. |
| Monitor the patient’s kidney function. | To ensure that the pantoprazole does nnot cause any renal impairment. |
| Monitor the patient’s response to pantoprazole. | To check for the relief of GI symptoms, as well as to see if pantoprazole is effective or should be shifted to other GI medications due to an allergic reaction, severe side effects, or adverse reactions. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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