H2 Blockers and PPIs

Question 1

Symptoms of GERD

Answer 1

Heartburn
Regurgitation, 
Vomiting, 
Pain on swallowing, 
Hoarseness

Less common: Stomach pain, non-burning chest pain, difficulty swallowing, chronic sore throat, cough

Question 2

Antacids

Pharmacological Use

Answer 2

Short term relief of GERD symptoms

Question 3

List a few antacids

Answer 3

Tums
Maalos
Mylanta

Question 4

Antacids

Adverse Effects

Answer 4

Overdose can cause Milk-alkali Syndrome with Hypercalcemia, Alkalosis, and Renal impairment

Question 5

H2 Antagonists

List them

Answer 5

Rantidine, Famotidine, Cimetidine, Nizatidine

Question 6

H2 Antagonists

Indications

Answer 6

Reduce production of acid in stomach

Used for peptic ulcer disease

Prevents NSAID induced ulcers and allows for peptic ulcers to heal

Question 7

H2 Antagonists

Adverse Effects

Answer 7

Very safe

Rare renal and hepatic toxicity

Question 8

H2 Antagonists

When do they reach peak serum conc?

Answer 8

1-3 hours after dosing

Question 9

PPIs

MOA

Answer 9

Block acid secretion by irreversibly binding to and inhibiting the H+/K+ ATPase pump on luminal surface of parietal cells

Needs to first be activated in acidic stomach environment

Question 10

PPIs

When should they be taken?

Answer 10

Most effective 30-60 min before meals so they are in bloodstream when the parietal cells are stimulated

Question 11

PPIs

List them

Answer 11

Omeprazole
Lansoprazole
Rabeprazole
Pantoprazole
Esomeprazole

Question 12

PPIs

Indications

Answer 12

DOC for Zollinger-Ellison Syndrome and GERD that is not responsive to H2 antagonists

Used in combo treatment of H Pylori

Duodenal ulcers

Question 13

PPIs

Drug Interactions

Answer 13

Should NOT be given simultaneously with H2 antagonists

Reduce absorption of ketoconazole

Increase digoxin absorption

Metabolized by CYP450 and can decrease metabolism and clearance of benzodiazepines, warfarin, and phenytoin

Question 14

PPIs

Adverse Effects

Answer 14

Very mild- diarrhea, headache, drowsiness, muscle pain, constipation

Prolonged use may lead to B12 deficiency

Question 15

What is the major mucosal protective agent?

Answer 15

Sucralfate

Question 16

Sucralfate

MOA

Answer 16

Binds selectively to necrotic tissue to form a barrier against gastric acid

Pepto Bismol acts similarly

Question 17

Sucralfate

Indications

Answer 17

Duodenal ulcers

Suppression of H Pylori

Question 18

Sucralfate

Drug Interactions

Answer 18

Should not be given with cimetidine or ranitidine, but may be given 2 hrs prior