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1. What is the mechanism of action (MOA) of H2 receptor antagonists?
A. Directly neutralize existing stomach acid
B. Inhibit acid secretion by gastric parietal cells by blocking histamine at H2
receptors
C. Coat the stomach lining to physically block acid contact
D. Increase gastric emptying rate
Answer: B
**Why:** H2 receptor antagonists block histamine's action on the H2 receptors of
gastric parietal cells, which reduces acid secretion. They are suitable for longer-
term use compared to antacids.
2. What are the clinical indications for H2 receptor antagonists?
A. Hypertension and heart failure
B. GERD, heartburn, and peptic ulcer disease (PUD)
C. Diabetes and thyroid disorders
D. Asthma and COPD
Answer: B
,**Why:** By reducing gastric acid secretion, H2 blockers relieve symptoms and
promote healing in GERD, heartburn, and PUD.
3. What is the mechanism of action (MOA) of proton pump inhibitors (PPIs)?
A. Block histamine receptors on parietal cells
B. Suppress gastric acid secretion, reducing acid production by as much as 90%
C. Neutralize acid already present in the stomach
D. Stimulate mucus production to protect the stomach lining
Answer: B
**Why:** PPIs irreversibly block the H+/K+ ATPase (proton pump) in parietal cells,
the final step in acid production, making them the most potent acid suppressors.
They are acid-labile, so they must be enteric coated to survive stomach acid
before absorption
4. What are the risks of long-term PPI use?
A. Nutrient deficiencies (iron, B12, calcium), increased fracture risk, increased CKD
risk, increased infection risk (e.g., C. diff, Salmonella, Campylobacter), and
increased gastric cancer risk
B. Only mild, temporary headache
C. Increased risk of hyperacidity rebound only
D. No significant long-term risks
Answer: A
**Why:** Chronically reduced stomach acid impairs nutrient absorption, weakens
bone density, burdens the kidneys, and lowers the stomach's natural defense
against ingested pathogens, raising infection and other risks.
,5. What are the indications for PPIs?
A. Only for occasional heartburn
B. Duodenal and gastric ulcers; GERD
C. Hypertension and arrhythmias
D. Seasonal allergies
Answer: B
**Why:** PPIs are used to treat and heal duodenal and gastric ulcers and to
manage GERD due to their potent acid-suppressing effect
6. What are important administration concerns with antacid use?
A. Antacids can decrease absorption of other drugs (interacting with weak
acids/bases); should not be given with enteric-coated medications (they destroy
the coating); administration should be separated by at least 2 hours from other
drugs
B. Antacids should always be taken at the same time as all other medications
C. Antacids have no interactions with other drugs
D. Antacids should be given with enteric-coated medications to enhance
absorption
Answer: A
**Why:** Antacids alter gastric pH, which can interfere with the absorption of
other weak acid/base drugs, and can prematurely dissolve enteric coatings meant
to protect medications from stomach acid — so timing separation (≥2 hours) from
other drugs is recommended.
, MOA: H2 Receptor antagonists - Correct Answer: inhibit acid secretion by
gastric parietal cells blocking histamine at histamine 2 receptors (can be used for
longer term use)
Clinical indications: H2 Receptor Antagonists - Correct Answer: GERD,
heartburn, PUD
MOA: PPIs - Correct Answer: suppress gastric acid secretion, can reduce
secretion of acid as much as 90% **they are acid-labile so must be enteric coated
What are risks of PPIs when used long-term? - Correct Answer: 1) nutrient
deficiencies with iron, B12, and calcium absorption interference
2) increased risk for fracture
3) increased risk for CKD
4) increased risk for infections such as C. diff, Salmonella, Campylobacter
(decreased stomach acid decreased the bodies natural defenses)
5) increased risk of gastric cancers
Indications: PPIs - Correct Answer: Duodenal and gastric ulcers; GERD
What are some administration concerns relative to antacid use? - Correct
Answer: 1) antacids can decrease absorption of other drugs, they interact with
weak acids or bases which disrupts absorption
2) Don't give antacids with enteric coated medications as they destroy the coating