Memorizing Pharmacology Podcast: Prefixes, Suffixes, and Side Effects for Pharmacy and Nursing Pharmacology by Body System

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The body system we continue to cover is gastrointestinal and omeprazole, esomeprazole, lansoprazole, pantoprazole are all proton pump inhibitors PPIs. 

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Suffixes

Omeprazole (Prilosec) with the -prazole suffix, p-r-a-z-o-l-e suffix is a true proton pump inhibitor, abbreviated PPI. We want to watch out for aripiprazole (Abilify) and brexpiprazole (Rexulti) which are antipsychotics, not PPIs but have the -piprazole ending, p-i-p-r-a-z-o-l-e. Also, some drug cards say the ending is -azole, but that is not an actual suffix, that is a chemical group, using that ending might have you confuse antifungals like fluconazole (Diflucan) for PPIs, so again, the PPI suffix is -prazole.

You will notice that omeprazole (Prilosec) and esomeprazole (Nexium) are very similar and it’s that omeprazole contains two molecules, a left and right mirror image and esomeprazole only contains the left-handed image. In Latin, left is sinister, so the “es, e-s” represents that only left-handed side. Why does that matter? That left-handed molecule is the active molecule.

Mechanism of Action (MOA)

PPIs or “prazoles” work by blocking your stomach’s parietal cells which normally release hydrogen ions contributing to the stomachs’ acidity. This, without the proton pump inhibitor, could lead to heartburn or possible GI ulceration. The proton pump inhibitor blocks the hydrogen/potassium ATPase pump preventing protons from going in the stomach. This raises the pH, making it more basic, and removes the excessive acid.

Indications

We then use proton pump inhibitors to manage heartburn, gastroesophageal reflux disease (GERD), peptic ulcer disease, and Barrett's esophagus. Barrett’s esophagus is a condition where the acid reflux damages the esophagus causes it to redden. Many times patients who are on chronic NSAIDs or anticoagulants have a higher GI bleed risk and a proton pump inhibitor is for prophylaxis rather than active treatment.

Dosing

Traditional dosing is to give the PPI 30 to 60 minutes before breakfast. A concern comes when the medication does not seem to work, but it is not the medication, rather, the patient is taking with or even after breakfast. Make sure you know which is which. Also, H2 blockers work a bit more quickly, so the patient might expect a similar timetable with a PPI, let them know that it will take a bit longer.

Clinical Considerations

Acute use for a few weeks, especially with over-the-counter lengths of time, usually 2 weeks, tends to cause few side effects. Long term, however, we have concerns of B-12 deficiency, increased fracture risk, C. Diff, an opportunistic infection. Again, B-12 deficiency comes because the now less acidic stomach does not do as good a job at absorbing B-12.

Before we start this section, here’s a reminder contrasting enzyme inhibition and enzyme induction. A drug that inhibits and enzyme blocks the enzyme somewhat increasing drug levels making the patient toxic. A drug that induces and enzyme, makes the enzyme work better reducing drug levels and making the patient subtherapeutic.

CYP2C19 inhibition can happen with citalopram (Celexa) and escitalopram (Lexapro), so in this case the antidepressant drug levels can go up leading to QTc prolongation. That’s why we have dosing maximums on citalopram of 20 milligrams daily with someone on omeprazole.

CYP2C19 induction with omeprazole and clopidogrel (Plavix) is one class example as clopidogrel is a pro-drug and by inducing the enzyme to break down more clopidogrel, the enzyme lowers clopidogrel levels. A pro-drug is one that is not quite the drug yet, the liver may have to metabolize it into a drug. Clopidogrel itself is an antiplatelet drug, so reducing the effectiveness of an antiplatelet drug while trying to prevent myocardial infarction (heart attacks) and strokes.

Note, prescribers can use cilostazol (Pletal) for intermittent claudication, a problem with blood flow in the legs where they might be in pain for short distances and the drug allows them to walk further is also a concern. Using lansoprazole or a similar PPI might create a favorable effect.

Some drugs need an acidic environment for absorption like iron supplements and lowering the acidity runs counter to the best situation for iron. Adding ascorbic acid, vitamin C can help.

Cefuroxime (Ceftin) is a second-generation cephalosporin antibiotic with good gram-positive coverage, but one might change to another antibiotic if they see omeprazole in the chart.

Mesalamine (Pentasa) for ulcerative colitis and itraconazole (Sporanox) a...

An overview of pharmacology concepts. If you are interested in taking a pharmacology course stop by https://www.memorizingpharm.com/

An overview of over-the-counter pharmacology Part 1, if you are looking for the book, you can find it here https://www.audible.com/pd/B09JVBHRXK/?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

The Classroom Cardio Lecture Part 2 of 3, you can complete the quizzes here https://residency.teachable.com/p/mobile

In this episode, I provide a video version of a mnemonic in my book Memorizing Pharmacology Mnemonics which you can find here: https://adbl.co/3wAZEmN

Auto Generated Transcript:

hey welcome to episode 2 of the memorizing pharmacology podcast and just as we went over h2 blockers in the first episode and talked about suffixes and prefixes and those kinds of things some students want something a little bit more advanced and what i did was i created a video that represents what's in memorizing pharmacology mnemonics so in terms of the order memorizing pharmacology a relaxed approach that's really a top 200 drug book that it's a little bit more than seven hours but definitely can be done in a weekend if you need to prepare for pharmacology class or kind of catch up with it if you want a little bit more advanced book then memorizing pharmacology mnemonics that's definitely a great choice as well because this one is really going to help you so it's going to be about a 10 minute video going over antacids not only how to remember a number of the popular antacids which don't have stems don't have prefixes or suffixes because the generic name and chemical name are the same we've got sodiums and calciums and aluminums and so forth but again check this out and enjoy the show

hey i just wanted to tell you about a new book i wrote what i wanted to do was create a review for my students that will allow them to prepare for their final exam but i'm doing that in a quite a different way in that i'm not just saying here are the questions you need to know the answers or even giving necessarily just a plain review what i'm doing is i'm really helping get past the just understanding part so often professors are very good at helping a student understand but they don't always give them the tools that they need to memorize something for an exam because in the exams or on the nclex naplex usmle we're getting to those big exams that's when we really have to have our memory down so that we can do the higher level understanding and working through but let me show you how it works so the book is called memorizing pharmacology mnemonics and i changed the title a bunch of times i think this is what i'm going to stick with memorizing pharmacology mnemonics pharmacology questions and answers for the future nurse doctor physician assistant and pharmacist and chemist this is the kindle edition and i put all of those different professions in there i'm not trying to exclude anybody else that wants to read it but i put them all in there because we're inter-professional now we're working on outcomes not necessarily worried while we are worried about our individual exams i think pharmacology crosses across those and the courses i have i have pre-meds and pre-pharmacy and pre-nursing or nursing and uh pre-physician assistant pre-dental uh physical therapy and i have all these different groups and when i just talk about one group then i exclude the others so i wanted to make sure to include everybody in this interprofessional book you can read it two ways you can just skim the 131 mnemonics in there and you'll see what they look like and just look at the slide say oh okay i'm getting antacids i just want to put that in my head then h2 blockers then proton pump inhibitors and you know from my past books that everything in is in a memorizable order so you can memorize the entire book and entire you know bank of slides as well or you can read it slow and you can go through each drug class but what i've done is i've created a question and answer format so it's not just here 131 mnemonics the big mistake people makes make is that a mnemonic is an answer so if you're just reading a book with mnemonics you're just reading a book with answers you don't have the questions right so the mnemonic that you know maybe has morphine as the word and all the side effects of morphine never bothers to ask you and engage your brain and say what are the side effects of morphine so i've kind of fixed that part and as you go through the book i've used page breaks so that it goes question and that's all you see on the page and then you can flip to the answer and then go back to the question if you didn't quite remember it back and forth and then move on to the next one so again it can be read fast or it can be read slow and i get this inspiration from the i take piano every once in a while and then there's always a fast and a slow version of each of those and you can get it here obviously you can't link from the picture but i'll put the link in the video bottom so let's get started here's the first question name four antacids and four side effects or interactions that concern you about antacids and so what you might do is start thinking um well tums is an antacid and

let's see i i heard that it might cause constipation and you have this very roundabout way of learning it and what i wanted to do is no h...