esomeprazole

NexIUM

Indications

Action

Pharmacokinetics

Time/action profile (blood levels*)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache

Gastrointestinal

• pseudomembranous colitis (life-threatening)
• abdominal pain
• constipation
• diarrhea
• dry mouth
• flatulence
• nausea

Fluid and Electrolyte

• hypomagnesemia (especially if treatment duration ≥3 mo)

Musculoskeletal

• bone fracture

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Assess routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
• Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis.
• Lab Test Considerations: May cause ↑ serum creatinine, uric acid, total bilirubin, alkaline phosphatase, AST, and ALT.
  • May alter hemoglobin, WBC, platelets, serum sodium, potassium, and thyroxine levels.
  • May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during therapy.

Potential Nursing Diagnoses

Implementation

• Do not confuse Nexium with Nexavar.
• Antacids may be used while taking esomeprazole.
• Oral: Administer at least 1 hr before meals. Capsules should be swallowed whole.
  • Delayed-release capsules: For patients with difficulty swallowing, place 1 tbsp of applesauce in an empty bowl. Open capsule and carefully empty the pellets inside onto applesauce. Mix pellets with applesauce and swallow immediately. Applesauce should not be hot and should be soft enough to swallow without chewing. Do not store applesauce mixture for future use. Tap water, orange juice, apple juice, and yogurt have also been used. Do not crush or chew pellets.
  • For patients with an NG tube, delayed-release capsules can be opened and intact granules emptied into a 60-mL syringe and mixed with 50 mL of water. Replace plunger and shake syringe vigorously for 15 sec. Hold syringe with tip up and check for granules in tip. Attach syringe to NG tube and administer solution. After administering, flush syringe with additional water. Do not administer if granules have dissolved or disintegrated. Administer immediately after mixing.
  • For Delayed-release oral suspension: Mix contents of packet with 1 tbsp (15 mL) of water, leave 2–3 min to thicken, stir and drink within 30 min.
  • For Delayed-Release Oral Suspension Nasogastric or Gastric Tube: Add 15 mL of water to a syringe and then add contents of packet. Shake the syringe, leave 2–3 min to thicken. Shake the syringe and inject through the nasogastric or gastric tube within 30 min.

• Intravenous Administration

• Reconstitute each vial with 5 mL of 0.9% NaCl, LR, or D5W. Do not administer solutions that are discolored or contain a precipitate. Stable at room temperature for up to 12 hr.
• Rate: Administer over at least 3 min.
• Intermittent Infusion: Diluent: Dilute reconstituted solution to a volume of 50 mL with D5W, 0.9% NaCl, or LR for adults and with 0.9% NaCl for pediatric patients.Concentration: 0.8 mg/mL (40-mg vial) or 0.4 mg/mL (20-mg vial). Solutions diluted with 0.9% NaCl or LR are stable for 12 hr and those diluted with D5W are stable for 6 hr at room temperature.
• Rate: Administer over 10–30 min.
• Y-Site Compatibility: ceftaroline, doripenem
• Y-Site Incompatibility: tacrolimus, telavancin. Do not administer with other medication or solutions. Flush line with 0.9% NaCl, LR, or D5W before and after administration.

Patient/Family Teaching

• Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Advise patient to read the Patient Information sheet prior to starting therapy and with each Rx refill in case of changes.
• Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
• Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache to health care professional promptly.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially St. John's wort.
• Advise patient to notify health care professional if signs of hypomagnesemia (seizures, dizziness, abnormal or fast heartbeat, jitteriness, jerking movements or shaking, muscle weakness, spasms of the hands and feet, cramps or muscle aches, spasm of the voice box) occur.
• Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

• Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or endoscopy.
• Decrease in symptoms of GERD and erosive esophagitis. Sustained resolution of symptoms usually occurs in 5–8 days. Therapy is continued for 4–8 wk after initial episode.
• Decreased incidence of gastric ulcer during continuous NSAID therapy.
• Eradication of H. pylori in duodenal ulcer disease.
• Decrease in symptoms of hypersecretory conditions, including Zollinger-Ellison.