Memorizing Pharmacology Podcast: Prefixes, Suffixes, and Side Effects for Pharmacy and Nursing Pharmacology by Body System - Ep 5 Acid Reducer Drug Suffix PRAZOLE Pharmacology (Proton Pump Inhibitor Suffix)

Ep 5 Acid Reducer Drug Suffix PRAZOLE Pharmacology (Proton Pump Inhibitor Suffix)

07/12/21 • 17 min

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

Find the Memorizing Pharmacology book here: https://adbl.co/3wAZEmN

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

TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

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...

Find the Memorizing Pharmacology book here: https://adbl.co/3wAZEmN

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

TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Suffixes

Mechanism of Action (MOA)

Indications

Dosing

Clinical Considerations

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...

Previous Episode

Ep 4 Free Drug Suffix PDF

Link for Complete Drug Suffix PDF: https://www.memorizingpharm.com/drugsuffixpdf

Link for Memorizing Pharmacology Drug Suffixes by Body System: https://www.memorizingpharm.com/drug-prefixes-and-suffixes

In this episode, I review the PDFs you can trust to give you the correct drug prefixes, infixes, and suffixes (endings). You don't know what kind of grades the people who put up those free electronic notecards earned, you can trust this PDF.

Auto Generated Trasncript

all right welcome to the memorizing pharmacology podcast i wanted to uh talk about getting a drug suffix pdf i have a free one that i can direct you to that's very accurate and that's the real problem so first of all i just wanted to kind of i've gotten a couple emails about where people can find the audiobooks sometimes it's just easier to search by my name because i have 26 books that i've written but tony guerra t-o-n-y g-u-e-r-r-a again i'm a pharmacist that uh just you know appreciate everybody supporting me and i just wanted to kind of use this podcast as a way to give back so memorizing pharmacology kind of the introduction to the top 200 drugs and memorizing pharmacology mnemonics are the most popular strong residency interview questions answers and rationales a little bit more for somebody that's going into residency how to pronounce drug names if english isn't your first language it wasn't my first language so just a much different way to to know how to pronounce things if that's a struggle and then memorizing pharmacology questions answers and rationales books one to seven uh just let you know that one's pretty long it's 18 hours and if you really just want to kind of get into the weeds with pharmacology and get quizzed on it and have all that then that might be a good choice but those are the the top five but definitely memorizing pharmacology if you've never had pharmacology before so let's talk a little bit about the website so you can go to memorizingfarm.com you can access all my books the podcast if you need an online pharmacology class i do teach one and again it's at a community college so community college prices and you'll be in class with sometimes pre-nursing students nursing students pa students many students who just want to kind of understand pharmacology but again it's it's that community college price that a lot of people like so in terms of prefixes and suffixes what i did was i tried to make it a little bit easier just to find it on its own and i can put this in the show notes but it's forward slash memorizingfarm.com hyphen prefixes hyphen and hyphen suffixes now i know that's a mouthful memorizingfarm.com forward slash drug hyphen prefixes hyphen and hyphen suffixes this list is the one that comes from the books so all of the drugs that i've put in the memorizing pharmacology book and memorizing pharmacology mnemonics book these i have ordered by body system or drug class and the nice thing is that i do everything always in the same order and as i kind of talk through this podcast i'll talk about how if you've got a patient on you know 20 medications or 25 medications something like that maybe you're working with geriatrics what you want to definitely do is put that list in this order g-m-r-i-n-c-e or g-m rinse gastrointestinal musculoskeletal respiratory immune neuro cardioendocrine that way when you are studying for something it's always in the same place it's kind of like having seven different rooms in your house and you know exactly where those rooms are and what's in those rooms so you always know okay i'm going to the gastrointestinal room or the

musculoskeletal room or whatever it is okay so these you can find and i'll just go through gastrointestinal you can obviously read them but i want to make clear what what they are so liximab is the ending okay to a specific gi drug for ulcerative colitis crohn's disease peg comes from polyethylene glycol which is an over-the-counter product that's safe for young populations things like that but there are pegulated compounds which is a little bit different reason that you're using it and you know as i go through the episodes i'll start linking uh the episodes to this list prazol is the next one i'll be going over so episode 5 will be on the prazoles or the proton pump inhibitors and talking a little bit about how prazole can get if you'll see some of the electronic drug cards that have just ozo a-z-o-l-e and that's not correct that that'll get it wrong because if you have azole at the end then it could be presele from gi it could be conazole from immune which is a type of antifungal and if you're in the neuropsych section it could be piprazole which is an antipsychotic so what i really cared about was getting a list of drug prefixes and suffixes that you can trust and this one is the one th...

Next Episode

Ep 6 Steroid Drug Suffixes Sone and son (Corticosteroid suffix)

Find the Memorizing Pharmacology book here: https://adbl.co/3wAZEmN

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

TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Suffixes -sone, -son- (GI)

Because we’re working through the seven major body systems starting with gastrointestinal, I’m going to hold off on talking about steroids for asthma and other respiratory conditions, but there are respiratory and inhaled steroids available such as fluticasone, a component in Advair and budesonide which is a component in Symbicort, both longer acting steroids.

First, let’s talk about the difference between an official stem and a useful drug suffix. An official stem is on the big list I have at memorizingpharm.com/drugsuffix PDF as these 800 or so are the agreed upon stems for medications by the governing bodies that decide such things.

However, there are common endings that are still useful like -sone, s-o-n-e and son, s-o-n. For example, you can see -sone at the end of fluticasone and prednisone. However, budesonide (Enterocort) and ciclesonide (Alvesco) have son, s-o-n, as an infix, in the middle of the word. There are very few infixes in common English. So, look for the letters as an ending or in the middle.

However, if you look on the big drug suffix list, pred, p-r-e-d is on the list. That’s because prednisone is actually the prodrug for prednisolone, p-r-e-d-n-i-s-o-l-o-n-e which has neither sone, s-o-n-e nor son, s-o-n, but we want to show they have a relationship. Officially pred is for prednisone and prednisolone derivatives. Prednisone can be used for a very powerful medicine for an acute flare up, but it’s not one that a patient can use long-term without significant side effects, so we’ll talk about that and budesonide (Enterocort) is a steroid for Crohn's disease and ulcerative colitis. Crohn’s disease can throughout the small or large intestine and rectum. Ulcerative colitis (UC) typically is at the end of the GI tract and the colon. The letter “U” which starts “Ulcerative colitis” is almost at the end of the alphabet to help you remember the difference. Since UC is at the end of the GI tract, that’s a good candidate for rectal formulations.

The reason we use steroids is that they reduce prostaglandin and kinin action, which are important inflammation modulators. Our target therapy length for these conditions might be 4 to 8 weeks.

Side Effects

In the short term, you will see insomnia and stomach upset. That makes sense, the body releases cortisol when you are stressed putting blood glucose in the blood stream, all of that fight or flight action will keep you awake with too much steroid.

That is also an important issue with long term use and the raising of diabetics blood sugar. For example, if there is a diabetic patient with UC we have the problem of needing steroid but raising blood glucose as a side effect. Other notable side effects include increased risk of osteoporosis, affecting the bone strength and immunosuppression. When the immune system is reduced, the chance of infection increases.

The liver breaks down budesonide very quickly which is good for a localized condition, it doesn’t stay in the body as long. However, prednisone, does not break down as quickly which is good for a condition that might affect the whole body like lupus erythematosus.

Interactions

Remember we want to try to put our interactions and drugs on the patient chart in the GMRINCE order, GI, musculoskeletal, respiratory, immune, neuro/psych and endocrine. So, when you look at a CYP3A4 inhibitor chart and see dozens of medicines, try to order and group them. Here are some examples:

Immune - Antibiotics/Antifungals

CYP3A4 inhibition can affect macrolide antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), and erythromycin (E-Mycin). Note their suffix is thromycin, t-h-r-o-m-y-c-i-n vs. just mycin, m-y-c-i-n.

While we call azole antifungals, “azole antifungals,” the actual stem is -conazole, c-o-n-a-z-o-l-e. Remember we talked about differentiating fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole (Sporanox), with proton pump inhibitors esomeprazole and the -prazole ending and the antipsychotics, -piprazole such as aripiprazole.

Cardio

Verapamil (Calan) is a calcium channel blocker with the pamil, p-a-m-i-l ending.

Endocrine

We discussed the issue of diabetes and increased blood sugar earlier.