PUD/GERD

Question 1

Which antacids are renally cleared and and require CAUTION in renal impairment?

Answer 1

Al, Mg

Question 2

Which antacids are safe in pregnancy?

Answer 2

All EXCEPT NaHCO3 (fluid overload, metabolic alkalosis)

Question 3

Antacids SIDE EFFECTS?

Answer 3

CaCO3 - hypercalcemia

Mg(OH)2 - hypermag

Al, Ca - CONSTIPTION**

Mg - Diarrhea

NaHCO3 - GAS**

Al(OH)3 - Aluminum intoxication

NaHCO3 - Sodium load

Question 4

Antacids DRUG INTERACTIONS

Answer 4

Chelation of

 - tetracyclines (doxycycline)
 - FQ ( levo, cipro)

** AVOID ANTACIDS 2 hrs BEFORE or 6 hrs AFTER**

Levothyroxine - seperate by 4 HOURS

IRON - needs ACID pH ( vit C)

Drugs that beed ACIDIC pH
- fluconazole, itraconazole

Question 5

Tagamet

Answer 5

Cimetidine (H2 blocker)

Forms: tabs, oral sln

Treats: Duodenal ulcers
Gastric ulcers; GERD

SE: ** drowsiness, AGITATION, Diarrhea**

Caution: GYNECOMASTIA!!!

Question 6

Zantac

Answer 6

Ranitidine

Forms: IV/IM, tabs, caps, syrup

Treats: duodenal ulcers

Question 7

Pepcid

Answer 7

Famotidine

Forms: IV, tabs, suspensions

Question 8

Axid

Answer 8

Nizatidine

Treats: capsules, solution

Question 9

Less than two episodes a week of GERD, start with which class?

Answer 9

LOW DOSE H2 BLOCKER

Question 10

IF two or more episodes of GERD a week, start with what class?

Answer 10

PPI

Question 11

SE of of H2 blockers

DRUG INTERACTIONS

Answer 11

Dizziness, sedation, HA, confusion, can WORSEN dementia and androgen. (CNS, SIDE EFFECTS)

Cimetidine has antiandrogen effects and causes gynecomastia & impotence

Cimetidine is a CYP1A2 inhibitor: ^ WARFARIN, theophylline

Question 12

Dose adjustment for renal impairment for PPI’s?

Answer 12

CrCl < 50 ml/min

Reduce dose by 50%

Question 13

What is DOC H2 blocker in pregnancy?

Answer 13

Zantac (RANITIDINE)

Question 14

OTC PPI options?

Answer 14

Prilosec

Zegerid

Nexium

Prevacid

Question 15

Prilosec

Answer 15

Omeprazole

Forms: caps, tabs, susp/packet, 20mg OTC tabs

Dose: 20-40 mg PO on empty stomache (30-60 mins before meals ( CAN take with Antacids)

DI: ^ phenytoin + Warfarin
Decrease ketoconazole, itraconazole, Iron
Decrease Clopidogrel (PRODRUG)

Question 16

Zegrid

Answer 16

Omeprazole + Bicarbonate

• mix powder w/ 30mL of water and take immediately

Question 17

Nexium

Answer 17

Esomeprazole MAGNESIUM

Forms: CAPSULES mix w/ apple sauce), SUSP, IV, nexium-24HR-OTC tablets)

Esomeprazole STRONTIUM( NOT THE 
SAME)

20-40mg QD/ Zollinger-Ellison 40mg BID.

Take at-least one hour prior (60 minutes) before meals.

Question 18

Prevacid

Answer 18

Lansoprazole

Forms: caps, Prevacid-24HR-OTC, ODT, susp, SHOULD NOT BE GIVEN THROUGH NG tube

Dose: 15-30mg QD, before meals; before breakfast

**ALSO used in “PREVPAC”:

Lansoprazole
Amoxacillin 500mg
Clarithromycin

Question 19

Dexilant

Answer 19

DEXlansoprazole

Forms: 30,60 caps, 30mg soluTAB ODT tabs,

NOT OTC!!!

**CAPSULES W/ or W/O FOOD!!!!

Question 20

Which two PPI’s come in IV formulationz?

Answer 20

Pantiprazole (protonix)

Esomeprazole (Nexium)

Question 21

Protonix

Answer 21

Pantoprazole

Forms: tabs, SUSP(packets), IV

Take W or WO FOOD

ORAL SUSP- only with apple sauce or apple juice 30 mins before

Dose: 40mg QD
- zollinger-Ellison: 40mg BID

Question 22

Aciphex

Answer 22

Rabeprazole

Forms: tabs, SPRINKLE CAPS,

Tabs w or w/o food
Caps 30 min before meal

Question 23

PPI’s SE & PRECAUTIONA

Answer 23

HA, dizziness

Chronic use may cause Vit B12 deficiency, which may ^ chance of C.difficile

Decrease Mag & Ca++: ^ FRACTURE RISK!

^ Risk of pneumonia
^ RISK OF FRACTURES!!

Decrease Bioavailability of drugs that need ACIDIC ENVIRONMENT

• ketoconazole, itraconazole, atazanavir, nelfinavir, erlotinib, nilotinib

Prilosec & Nexium: Inhibit 2C19( ^ phenytoin, Warfarin) and DECREASE conc of PLAVIX as it is a PRODRUG of 2C19

No dose adjustment with renal IMPAIRMENT!

Question 24

Which drugs cause ^^ chance of FRACTURES!!?? (OSTEOPOROSIS)

Answer 24

1) PPI’s
2) Glucocorticoids
3) SSRI’s
4) TZD’s (pioglitazone)

Question 25

Cytotec

Answer 25

Misoprostol

• prostaglandin.

Treats: prevention of NSAID induced GI ulcers.
200mcg QID w/ FOOD.

         **MEDICAL termination of PREGNANCY < 49 dys + mifepristone

MOA: synthetic prostaglandin that replaces the protective prostaglandins that NSAIDS inhibit.

      * INDUCES uterine CONTRACTION*

SE: Diarrhea (40%)
Abdominal pain (7-20%)
Uterine BLEEDING/spontaneous ABORTION
PREGNANCY CATEGORY X

Question 26

Carafate

Answer 26

SucrulFATE

ALUMINUM sucrose SULFATE

Moa: Acid —> adheres to defective mucosa —> BARRIER

NON-ABSORBED BUT: Al salt may accumulate in RENAL FAILURE

dosage: Tx of duodenal ulcers

           1g QID EMPTY STOMACHE

ADMINITER OTHER drugs 2 houss BEFORE

SE: CONSTIPATION, gas, Dry MOUTH

Caution: AVOID IN RENAL FAILURE
Pregnancy CAT B

DI: adsorption(chelation)

Avoid all other drugs at least 2 hrs before or 6 hrs after