Pharm #1 - H2/PPI

Question 1

Cimetidine

MOA

Answer 1

blocks histamine H2 receptors and decreases gastric acid secretion

Question 2

Cimetidine

Contraindication

Adverse

Answer 2

None

SE:

1. Gynecomastia w/ long term use
2. impotence

• bolus reported to cause cardiac arrythmias and hypotension

– H2 antagonists can be added to PPIs to stop nocturnal acid breakthrough BUT may decrease efficacy of PPIs

Question 3

Ranitidine

MOA

Contra

Answer 3

MOA

blocks histamine H2 receptors and decreases gastric acid secretion

Contra: NONE

Question 4

Ranitidine

SE

Answer 4

SE:

1. Agitation
2. Anemia
3. COnfusion
4. Depression

– may increase risk of developing pneumonia

–2. H2 antagonists can be added to PPIs to stop nocturnal acid breakthrough BUT may decrease efficacy of PPIs

Question 5

Therapeutic use for Cimetidine and Ranitidine

Answer 5

1. duodenal ulcers
2. Gastric ulcers
3. Erosive GERD
4. Prevent upper GI bleeding
5. Hypersecretory conditons
   * * Zollinger-Ellision syndrome

Question 6

DOC for Zollinger-Ellision syndrome

Answer 6

PPI’s like omeprazole

Question 7

Omeprazole

MOA

CONTRA

Answer 7

MOA:
1. inhibits H/K pump in the gastric PARIETAL cells

CONTRA:
1. increase concentrations of DIAZEPAM, WARFARIN and PHENYTOIN by decreasing their clearance by the liver

2. PPIs can reduce absorption of ketoconazole and increase absorption of digoxin

Question 8

How do PPIs affect ketoconazole and digoxin?

Answer 8

Reduce absorption of ketoconazole

• Increase absorption of digoxin (toxicity)

Question 9

What class of drugs does the following:

increase concentrations of DIAZEPAM, WARFARIN and PHENYTOIN by decreasing their clearance by the liver

Answer 9

PPIs

Question 10

Omeprazole

SE

Answer 10

1. Diarrhea
2. Nausea
3. Skin Rash
4. DIzziness

• not normally used with H2 antagonists
• reduced efficacy of PPis
  NEW: LONG TERM MAY CAUSE B12 deficiency due to decreased acidity

Question 11

What drugs can cause B12 deficiency

Answer 11

PPI’s

omeprazole, rabeprazole

Question 12

Sucralfate (carafate)

MOA

Answer 12

Mucosal protective agent

1. binds selectively to necrotic tissue to form a barrier against gastric acid

(same as colloidal bismuth –> pepto bismol)

Question 13

Sucralfate (carafate)

Adverse

Answer 13

Minor:

1. constipation
2. Flatulence
3. Dry mouth
4. Diarrhea

Question 14

Sucralfate (carafate)

Contraindications

Answer 14

1. Can decrease absorption of cimetidine, ciprofloxacin, digoxin, ofloxacin, ranitidine if given simultaneously with sucralfate
   - problem in patients with renal insufficiency/failure