PPI & H2 Blockers

Question 1

Cimetidine

A: MOA

B: Route (3)

C: Adverse Effects (3)

Answer 1

A: H2 Blocker

B: [PO / IV / Injection]

C:

1. Gynecomastia with long term usage
2. Impotence sometimes
3. [Cardiac Arrythmias & hypOtension with IV bolus] = RARE

Question 2

Cimetidine

A: Therapeutic Usage (4)

B: Disclaimer for usage of this drug class with PPIs

Answer 2

A: PUGZ​

1. PUD
2. GERD - Erosive
3. [Upper GI bleeding Px]
4. [Zollinger Ellison Syndrome] (hypersecretory conditions)

B: [H2 Blockers] may be added to PPIs to stop [nocturnal acid breakthrough] BUT will also DEC efficacy of PPIs

Question 3

Ranitidine

A: MOA

B: Route (2)

C: Adverse Effects (3)

Answer 3

A: H2 Blocker

B: [PO / IV]

C: Adverse Effects are Rare but = DACAP**

1. Agitation
2. Anemia
3. Confusion
4. Depression
5. INC risk of developing PNA

Question 4

Ranitidine

A: Therapeutic Usage (4)

B: Disclaimer for usage of this drug class with PPIs

Answer 4

A: PUGZ

1. PUD
2. GERD - Erosive
3. [Upper GI bleeding Px]
4. [Zollinger Ellison Syndrome] (hypersecretory conditions)

B: [H2 Blockers] may be added to PPIs to stop [nocturnal acid breakthrough] BUT will also DEC efficacy of PPIs

Question 5

Omeprazole and Rabeprazole

A: MOA (3)

B: Route

C: Adverse Effects (9)

Answer 5

A:

1st: Resides as weak bases concentrated in [acid compartment of parietal cells]
2nd: inactive prodrug is activated in that [acid compartment of parietal cells]
3rd: [Reactive Sulfhydryl group forms diSulfide bond with Cysteine on [H-K ATPase pump] –> [Pump inactivation]

B: PO

C:

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1. Diarrhea
2. Nausea
3. Skin Rash
4. Dizziness
5. [Vit B12 Deficiency with long term use]
6. C.Diff infection
7. PneumOnia
8. [Mg Serum INC with long term use]
9. ONLY HA for Rabeprazole

Question 6

Omeprazole and Rabeprazole

A: Therapeutic Usage (4)

B: Contraindications (3)

Answer 6

A: 1D-GZ

• GERD
• [Zollinger Ellison Syndrome] (hypersecretory conditions)
• [1st component of H.Pylori Triple therapy]
• Duodenal Ulcers - short term tx

B:

1. INC concentrations of [Diazepam / Warfarin / Phenytoin] by DEC their liver clearance (PPIs are metabolized by CYP450)
2. DEC absorption of Ketoconazole
3. INC absorption of Digoxin

Question 7

[Sucralfate (Carafate)]

A: MOA

B: Route

C: Adverse Effects (4)

Answer 7

A: [Aluminum Sucrose Mucosal Protective Agent] - binds selectively to necrotic tissue –> forms barrier against gastric acid

B: PO

C:

1. [Constipation AND Diarrhea]
2. Flatulence
3. [Dry Mouth]
4. Nausea

Question 8

[Sucralfate (Carafate)]

A: Therapeutic Usage (2)

B: Contraindications (3)

C: Which class of Acid Blockers can NOT be given with [Sucralfate (Carafate)]

Answer 8

A:

• Duodenal Ulcers
• Suppresses H.Pylori

B:

1. DEC absorption of [CORD - [Cimetidine & Cipro] / Digoxin / Ofloxacin / Ranitidine]
2. [Grapefruit citric acid] (INC absorption of Sucralfate-A1 Aluminum which–> exacerbates renal failure/insufficiency)
3. Colloidal Bismuth (has same MOA)

C: [H2 Blockers] - BUT CAN GIVE SUCRALFATE 2 HOURS PRIOR TO CIMETIDINE

Question 9

Antacids (Tums / Maalox / Mylanta)

A: Adverse Effects (3)

B: Which class of drugs should NOT be given simultaneously with Antacids?

Answer 9

Ingestion of Large amounts of Ca+ and [Adsorbable Alkali] –> [MilK Alkali SyndromE]

1. Kidney impairment
2. Alkalosis
3. HypErcalcemia

B: H2 Blockers

Question 10

Which class of Acid Blockers have the ability to cross [Blood/Placental Barriers]

Answer 10

H2 Blockers