Why is everyone on Protonix

Nurseboy1 · Oct 9, 2005

But why are we treating something that doesn't exist?? This seems to be a trend in medicine today. I can understand prophalaxsis in some things, like DVT prevention, since there is a physiological risk with limited activity. But when did the whole inpatient population start having excess gastric acid production? Just because someone is on an antibiotic doesn't mean that they need protonix. Now if you have a GI diagnosis that is caused by increased acid I can see using these drugs, but everyone??? Am I missing something here????

According to my med-surg textbook, stress ulcers have some known causes such as trauma, burns, head injuries, sepsis, respiratory failure. Stress ulcers also arise from unknown etiology. It is therefore easier to prevent the ulcer from occuring then to treat a resulting ulcer and its potential complications (infection, bleeding, hypovolemia, perforation). Once the patient is discharged usually the use of the PPI is discontinued.

lsyorke, RN · Oct 9, 2005

According to my med-surg textbook, stress ulcers have some known causes such as trauma, burns, head injuries, sepsis, respiratory failure. Stress ulcers also arise from unknown etiology. It is therefore easier to prevent the ulcer from occuring then to treat a resulting ulcer and its potential complications (infection, bleeding, hypovolemia, perforation). Once the patient is discharged usually the use of the PPI is discontinued.

I totally agree with those situations. They are massive assaults on the body, but we're seeing residents order protonix on ALL inpatients. If it was really that prevalant in the general public then everyone would be on protonix/pepcid/zantac. Are we altering a normal metabolic mechanism for no reason? Acid is in the stomach for a reason. It's part of a normal digestive process. To decide to alter that mechanism due to a medical situation totally unrelated to that mechanism has to make one wonder.

Nurseboy1 · Oct 10, 2005

I totally agree with those situations. They are massive assaults on the body, but we're seeing residents order protonix on ALL inpatients. If it was really that prevalant in the general public then everyone would be on protonix/pepcid/zantac. Are we altering a normal metabolic mechanism for no reason? Acid is in the stomach for a reason. It's part of a normal digestive process. To decide to alter that mechanism due to a medical situation totally unrelated to that mechanism has to make one wonder.

While I can't account for all inpatients, my unit being pulmonary medicine uses protonix since GERD increases the incidence of aspiration pneumonia. Also in our lung transplant population we see many problems with GERD post-op often leading to the patient undergoing a Nissen funduplication. One reason that could be worth thought is the effect of chronic disease on the body, and people are living longer with chronic diseases today than in the past. The increasing incidence of chronic illness could result in greater concern now for stress ulcer formation than previously.

lsyorke, RN · Oct 10, 2005

OK, I guess I'm not the only one wondering about this. Here's a study on it:

http://www.ahrq.gov/clinic/ptsafety/chap34.htm

This is just one section that I found interesting

"Prevalence and Severity of the Target Safety Problem

The risk of stress ulceration and subsequent GI bleeding depends on a patient's underlying illness, its severity, and related comorbidities. Using liberal criteria for assessment of bleeding, early reports estimated the incidence of GI bleeding due to stress ulceration in ICU patients to be as high as 5-25%.14,15 However, more recent prospective studies, using stricter definitions of clinically significant GI bleeding and following large cohorts of patients, have revealed more modest estimates of 0.1% in low-risk ICU patients and 2.8% in ventilated patients"

Note, it's not pharmaceutical sponsored.

Nurseboy1 · Oct 10, 2005

Interesting study, so really no matter what we give it shows no statistical benefit in the prevention of stress related ulcers:confused: . Since I have to work tomorrow I am going to ask our pharmacist the rationale behind our stress ulcer prophylaxsis.

lsyorke, RN · Oct 10, 2005

Realize that this is probably only one study done, but the risk is ALOT smaller that even I thought! Now I'm on a roll(gotta love google!) Here's another one saying the same thing.

http://www.brighamandwomens.org/pharmacoepid/Research/EduMaterials/Acid%20suppression%20update%20July%202002.pdf

neneRN, BSN, RN · Oct 10, 2005

As above posters have said, typically given as a precaution.

A lot of pts are NPO for surgery or procedures; with nothing going in the gut, you want to decrease the acid churning around in there.

With stroke pts or any pt with an ALOC, you want to prevent aspiration pneumonia.

With your dementia pts who may not be eating properly, again decrease that acid if there's nothing in the gut to mix with it.

If there's ANY reason to suspect a potential complication, of course you would want to take those measures. Protonix is not going to harm them, but it may help them.

mandykal, ADN, RN · Oct 10, 2005

I have a question regarding protonix. Isn't protonix suppose to be given alone and not with other medications??

b/c it's suppose to reduce the HCL production, the other medications wouldn't be broken down totally and not fully absorbed. I see protonix given with all 9am meds at assisted living, I don't know if I'm understanding this medication completely, can someone educate me? ( I don't have a drug book on hand)

jbeck817 · Oct 10, 2005

I always tell fellow staff that Protonix should be in the hospital water system....HAHAHAHA:lol2:

The title pretty much speaks for itself as far as my question. I've had too many patients who were on Protonix with no hx of ulcers, GERD, anything. So why?!