Side Effects and Warnings

Question 1

Calcium Carbonate (TUMS)

Answer 1

Constipation
bloating & belching

***preferred in pregnancy

Question 2

Magnesium hydroxide (Milk of Magnesia)

Answer 2

Diarrhea

Question 3

Magnesium + Aluminum + Simethicone (Mylanta Classic)

Answer 3

WARNING: accumulation in renal dysfunction
Constipation from Al
Diarrhea from Mg

Question 4

Sodium bicarb + ASA + citric acid (Alka-Seltzer)

Answer 4

WARNING: risk of bleeding with ASA

Question 5

Famotidine (Pepcid)

Answer 5

WARNING: confusion and CNS effects (especially in elderly and renal impairment); QTC prolongation in renal impairment

Decrease dose when CrCl < 60 mL/min

Question 6

Ranitidine (Zantac)

Answer 6

WARNING: confusion and CNS effects (especially in elderly and renal impairment); increase ALT

Decrease dose when CrCl < 50

Question 7

Cimetidine

Answer 7

WARNING: confusion and CNS effects (especially in elderly and renal impairment)

Gynecomastia, impotence

Question 8

PPIs

Answer 8

Warnings:
-c diff infections (any GI infection)
-vitamin B12 deficiency >2 years
- osteoporosis > 1 year
-acute interstitial nephritis
- SLE
SE: HA, ab pain, nausea, diarrhea

Question 9

Misoprostol

Answer 9

Abdominal pain, diarrhea, QID dosing

Question 10

Sucralfate (Carafate)

Answer 10

Warning: its an Aluminum complex = accumulation in renal impairment
CONSTIPATION

Question 11

Drugs to avoid in PPIs that need a acidic stomach

Answer 11

Ripvirine, Atazanavir
Ledipasvir
Itraconazole (capsules), Ketoconazole, Posaconazole (oral susp)
Oral Cephalosporins
Iron products
Mesalamine (NSAID 5-ASA for UC)
Risedronate DR
Tyrosine Kinase Inhibitors

I’M A ORAL LIARR
Itraconazole
Mesalamine
Azoles
Oral Ceph
Lediapasvir
Iron
Atazanavir
Ripvirine
Risandronate

Question 12

Other drugs to AVOID with antacids because of binding

Answer 12

INSTIs
Bisphosphonates
Isoniazid (TB)
Levothyroxine
Mycophenolate (Transplant)
Quinolones (Levofloxacin)
Tetracyclines (Doxyclinine)
Sotalol
Steroids

QuIT SMILeS because of binding and accumulation

Question 13

Metoclopramide (Reglan)

Answer 13

BOXED WARNING: tardive dyskinesia
CI: GI obstruction, history of seizures, use with other drugs causing EPS
Warning: EPS, Parkinsonian like syndrome, NMS

AVOID in Parkinsons

SE: drowsiness, restlessness, HTN

Question 14

Which PPIs need are contraindicated with clopidogrel?

Answer 14

Esomeprazole (Nexium) and Omeprazole (Prilosec) because of CYP2C19 inhibition due to clopidogrel being a prodrug needing activation