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NBME 20 Answers

nbme20/Block 1/Question#24

A 50-year-old man comes to the physician because of ...

Omeprazole

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 +12  upvote downvote
submitted by justgettinby(12),

Itraconazole requires the acidic environment of the stomach to be absorbed. Omeprazole inhibits the H+/K+ pump of the stomach, thereby decreasing the acidity of the stomach. So when the patient takes Omeprazole and Itraconazole together, Itraconazole won't be absorbed into the body. That's why it has no effect.

It's recommended to take medications at least 2 hours prior to taking an antacid.

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +1  
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +1  




 -4  upvote downvote
submitted by hayayah(395),

Add on to the other comment: SICKFACES.COM (when I Am drinking Grapefruit juice) is the mnemonic for remembering the CYP450 Inhibitors:

  • S odium valproate
  • I soniazid
  • C imetidine
  • K etoconazole
  • F luconazole
  • A cute alcohol abuse
  • C hloramphenicol
  • E rythromycin/clarithromycin
  • S ulfonamides
  • C iprofloxacin
  • O meprazole
  • M etronidazole

  • A miodarone

  • Grapefruit juice
charcot_bouchard  Its not a cytochrome question. IK because i go t it wrong +  




 -5  upvote downvote
submitted by strugglebus(69),

This a CYP 450 inhibitor (SICKFACES.COM); its the O.

coccidioinmytitties  Azoles, as a class, are CYP450 inhibitors [fungal > human; to prevent conversion of lanosterol to ergosterol]. Justget is correct- a ↓pH is needed for absorption and PPI/H2RA/antacids are contraindicated. +