Paper II
2014 March (2010 Scheme) · 40 marks · 120 min

Question

Proton pump inhibitors

Q73 marksShort Notes

Answer

Examples: Omeprazole, Pantoprazole, Lansoprazole, Rabeprazole, Esomeprazole

Mechanism of action

  • Prodrugs, activated in the acidic environment of the parietal cell canaliculus
  • Irreversibly inhibit the H⁺/K⁺-ATPase (proton pump) on the luminal membrane of gastric parietal cells — the final common step of acid secretion
  • Produce profound and long-lasting suppression of both basal and stimulated gastric acid secretion

Uses

  • Peptic ulcer disease
  • GERD
  • Zollinger-Ellison syndrome
  • H. pylori eradication (as part of combination therapy)
  • NSAID-induced ulcer prophylaxis

Adverse effects

  • Generally well tolerated: headache, GI upset
  • Long-term use: increased risk of fractures (calcium malabsorption), vitamin B12 deficiency, hypomagnesaemia, increased risk of C. difficile infection and community-acquired pneumonia

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