PA 525: PHARM PEARLS EXAM STUDY GUIDE
MOA: Competitively inhibits histamine at H2receptors of the gastric parietal cells -
leading to decreased acid suppression *(less activation of the H+/K+-ATPase (the proton
pump))
- reduce acid secretion stimulated by gastric and Ach - ANSWER H2 blockers
Cimetidine (Tagamet),Ranitidine (Zantac), Famotidine (Pepcid) - ANSWER H2 blockers
MOA: Inhibits acid secretion by *inhibiting the H+/K+-ATPase (proton pump)*
- block the final common pathway of acid secretion - ANSWER Proton pump inhibitors
Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid),
dexlansoprazole (Dexilant), rabeprazole (Aciphex), and pantoprazole (Protonix) -
ANSWER Proton pump inhibitors
*adverse effects:* (generally safe) but can cause diarrhea, constipation, HA, fatigue,
myalgia. Rare: blood dyscrasias. Cimetidine can cause ICU delirium - ANSWER H2
blockers
*adverse effects:* short serum half life, have rapid first pass and systemic hepatic
metabolism, N/V/D, HA
- linked to C.diff, pneumonia, osteoporotic fractures, rebound acid hypersecretion -
ANSWER Proton pump inhibitors
When should you use an H2 blocker or proton pump inhibitor? - ANSWER used to treat
indigestion and GERD by reducing effects of stomach acid on stomach or esophagus
h2: ok at lowering meal-time secretion, but good at nocturnal acid secretion
PPIs: good at both lowering mealtime secretion and nocturnal secretion
Which *H2 blocker* can cause confusion in the elderly and should be avoided? -
ANSWER Cimetidine
When should PPI's be taken in relation to mealtimes? - ANSWER *should be
administered on an empty stomach, 1 hour before a meal* so peak serum levels
coincide with the maximal activity of proton pump secretion
If you are treating for H.pylori infection and the patient has a penicillin allergy, what
medication can you prescribe? - ANSWER 4 drug regimen:
- PPI (ends in prazole)
- bismuth subsalicylate
, - *metronidazole* --INSTEAD OF AMOXICILLIN
- tetracycline
- clarithromycin
M: inhibits cell synthesis, DNA strand breakage (don't drink alcohol)
T: inhibits bacterial synthesis (stains teeth)
C: Macrolide inhibits protein synthesis
What are ondansetron and promethazine used for? - ANSWER antiemetic
MOA: *5-HT3 receptor antagonist that Blocks serotonin*, both peripherally on vagal
nerve terminals and centrally in the chemoreceptor trigger zone *(CTZ)* - ANSWER
ondansetron (zofran)
5-HT3 receptor antagonist - ANSWER ondansetron (zofran)
MOA: *1st generation antihistamine (H1)*
•Also blocks dopaminergic, muscarinic and alpha-adrenergic receptors in the brain
•Believed that *muscarinic blocking effect is responsible for antiemetic activity* -
ANSWER promethazine
*adverse effects:* QTC prolongation, hypersensitivity rxns, *serotonin syndrome* (in
combo with other serotonergic agents), HA, constipation, drowsiness. - ANSWER
ondansetron (zofran)
*adverse effects:* altered cardiac conduction, anticholinergic SE, CNS depression,
EPS, photosensitivity
*BBW: can be very damaging to tissues if given IV* - ANSWER promethazine
*BBW: can be very damaging to tissues if given IV* - ANSWER promethazine
when should you use ondansetron? - ANSWER pts who are nauseas (antiemetic)
when should you use promethazine? - ANSWER pts who are nauseas (antiemetic)
What is the first line medication for treating IBS-D? - ANSWER loperamide
*OTC opioid agonist*
- Does NOT cross the BBB and has no analgesic properties or potential for addiction
- Given orally as 2 tabs after 1st loose stool, then 1 tab after each subsequent loose
stool - ANSWER loperamide
*BBW: Torsades de pointes, cardiac arrest, and death have been reported with higher
MOA: Competitively inhibits histamine at H2receptors of the gastric parietal cells -
leading to decreased acid suppression *(less activation of the H+/K+-ATPase (the proton
pump))
- reduce acid secretion stimulated by gastric and Ach - ANSWER H2 blockers
Cimetidine (Tagamet),Ranitidine (Zantac), Famotidine (Pepcid) - ANSWER H2 blockers
MOA: Inhibits acid secretion by *inhibiting the H+/K+-ATPase (proton pump)*
- block the final common pathway of acid secretion - ANSWER Proton pump inhibitors
Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid),
dexlansoprazole (Dexilant), rabeprazole (Aciphex), and pantoprazole (Protonix) -
ANSWER Proton pump inhibitors
*adverse effects:* (generally safe) but can cause diarrhea, constipation, HA, fatigue,
myalgia. Rare: blood dyscrasias. Cimetidine can cause ICU delirium - ANSWER H2
blockers
*adverse effects:* short serum half life, have rapid first pass and systemic hepatic
metabolism, N/V/D, HA
- linked to C.diff, pneumonia, osteoporotic fractures, rebound acid hypersecretion -
ANSWER Proton pump inhibitors
When should you use an H2 blocker or proton pump inhibitor? - ANSWER used to treat
indigestion and GERD by reducing effects of stomach acid on stomach or esophagus
h2: ok at lowering meal-time secretion, but good at nocturnal acid secretion
PPIs: good at both lowering mealtime secretion and nocturnal secretion
Which *H2 blocker* can cause confusion in the elderly and should be avoided? -
ANSWER Cimetidine
When should PPI's be taken in relation to mealtimes? - ANSWER *should be
administered on an empty stomach, 1 hour before a meal* so peak serum levels
coincide with the maximal activity of proton pump secretion
If you are treating for H.pylori infection and the patient has a penicillin allergy, what
medication can you prescribe? - ANSWER 4 drug regimen:
- PPI (ends in prazole)
- bismuth subsalicylate
, - *metronidazole* --INSTEAD OF AMOXICILLIN
- tetracycline
- clarithromycin
M: inhibits cell synthesis, DNA strand breakage (don't drink alcohol)
T: inhibits bacterial synthesis (stains teeth)
C: Macrolide inhibits protein synthesis
What are ondansetron and promethazine used for? - ANSWER antiemetic
MOA: *5-HT3 receptor antagonist that Blocks serotonin*, both peripherally on vagal
nerve terminals and centrally in the chemoreceptor trigger zone *(CTZ)* - ANSWER
ondansetron (zofran)
5-HT3 receptor antagonist - ANSWER ondansetron (zofran)
MOA: *1st generation antihistamine (H1)*
•Also blocks dopaminergic, muscarinic and alpha-adrenergic receptors in the brain
•Believed that *muscarinic blocking effect is responsible for antiemetic activity* -
ANSWER promethazine
*adverse effects:* QTC prolongation, hypersensitivity rxns, *serotonin syndrome* (in
combo with other serotonergic agents), HA, constipation, drowsiness. - ANSWER
ondansetron (zofran)
*adverse effects:* altered cardiac conduction, anticholinergic SE, CNS depression,
EPS, photosensitivity
*BBW: can be very damaging to tissues if given IV* - ANSWER promethazine
*BBW: can be very damaging to tissues if given IV* - ANSWER promethazine
when should you use ondansetron? - ANSWER pts who are nauseas (antiemetic)
when should you use promethazine? - ANSWER pts who are nauseas (antiemetic)
What is the first line medication for treating IBS-D? - ANSWER loperamide
*OTC opioid agonist*
- Does NOT cross the BBB and has no analgesic properties or potential for addiction
- Given orally as 2 tabs after 1st loose stool, then 1 tab after each subsequent loose
stool - ANSWER loperamide
*BBW: Torsades de pointes, cardiac arrest, and death have been reported with higher
