Proton Pump Inhibitors Flashcards

1
Q

What is the ROA of all the H2 antagonists and PPIs?

A

Oral

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2
Q

What are the signs of GERD?

A

Heartburn, regurgitation, vomiting and pain on swallowing

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3
Q

Antacid MOA

A

Stomach acid is neutralized briefly after each dose

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4
Q

Antacid SE

A

Ingestion of large amounts of calcium and adsorbable alkali can lead to hypercalcemia, alkalosis and
renal impairment, a constellation known as milk-alkali syndrome

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5
Q

Histamine Antagonist MOA

A

Reduce production of acid in the stomach by H2 receptor antagonism

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6
Q

Histamine Antagonist SE

A

Very safe - rare SE of renal and hepatic toxicity

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7
Q

Do H2 antagonists cross the BBB? Placenta?

A

􏰃 Cross the blood-brain and placental barriers

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8
Q

Proton Pump Inhibitor MOA

A

Effectively block acid secretion by irreversibly binding to and inhibiting the H-K ATPase pump that resides on the luminal surface of the parietal cell membrane.

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9
Q

What is the molecular mechanism of the PPIs action?

A
  1. They are weak bases concentrated in the acid
    compartment of parietal cells
  2. The inactive prodrug is activated in the acid environment
  3. A reactive sulfhydryl group then forms a disulfide bond with cysteine residue on the H- K-ATPase pump, thereby inactivating the enzyme
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10
Q

Why shouldn’t H2 antagonists be given with PPIs?

A

H2 antagonists should not be given simultaneously with PPIs, because the antagonists reduce the efficacy of the PPIs

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11
Q

What are PPIs the drug of choice for?

A

They are of the drug of choice for treatment of Zollinger-Ellison syndrome and GERD when not responsive to H2 antagonists

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12
Q

What are the drug interactions of PPIs?

A

PPIs are metabolized by CYP450 and therefore can decrease the metabolism and clearance of benzodiazopines, warfarin and phenytoin

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13
Q

What vitamin can PPIs inhibit the absorption of?

A

Vitamin B12

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14
Q

PPI SE

A

Mild. Include diarrhea, headache, drowsiness, muscle pain and constipation.

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15
Q

Mucosal Protective Agent MOA

A

It is thought to polymerize and bind electively to necrotic tissue, creating a barrier between the gastric contents and the mucosa

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16
Q

What is an example of a mucosal protective agent?

A

Sucralfate

17
Q

What has the same mechanism as sucralfate?

A

Colloidal bismuth (Pepto-Bismol)

18
Q

What are examples of H2 antagonists?

A

Cimetidine
Famotidine
Nizatidine
Ranitidine

19
Q

What are examples of PPIs?

A

Omeprazole
Lansoprazole
Rabeprazole

20
Q

What is the main route of elimination for H2 antagonists?

A

Mainly renal

21
Q

What is the main route of elimination for PPIs?

A

Mainly hepatic

22
Q

What are the major SE of cimetidine?

A

Gynecomastia