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NBME 20 Answers

nbme20/Block 1/Question#24 (reveal difficulty score)
A 50-year-old man comes to the physician ...
Omeprazole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm 

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 +26 
submitted by โˆ—justgettinby(26)
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erIoaocazlnt uriesqre teh cdacii otimvernnen of eth msocath ot eb oreda.sbb oOerlpezma ihiisbnt eht K++/H pmpu of eht o,asmcth etyberh scarneidge eht aiyctid of teh thsma.oc oS hwne eth ttiaepn aekst lzOmeopare adn ocaItzrneola trg,eteoh Inoazoealtcr tonw' eb dbsbeora otin the b.doy tash'T yhw it sah on .efftce

sIt' nedoemrdcme ot akte otncseiamdi ta alste 2 ushor opirr to nkigta an dtn.iaac

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/ +4
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2
chandlerbas  just itraconazole and posaconazole +5
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +14
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +1
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +



 +8 
submitted by nadhq(8)
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I ylihhg dbout atht swrtrie fo tshi eoqutsin pecxet us ot wnok eth iaronlte etbenwe ncalroeiazot adn PIP tbu hreatr fi a atpnite sha a udlimugrt ginreme (igucldnni a P,I)P if hrete is no 450p aleredt sfuft iggon nad ugrd ibsabronot is fvdcietee we hlsdou eb iisuosscup of het PPsI. iLek a enrlgae eurl ro toesihmng leik ah.tt

Oehs,itrew fi hyet ectepx su to onkw het fspiiecc oletarin ebewtne teh ..two. hme htsi ntseoqui kcssu elayrl arhd .nteh




 +1 
submitted by โˆ—stepwarrior(29)
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htis is acrlyle tohenar one of teosh patr qusoitnse for oivrrensehkt




 +0 
submitted by โˆ—amy(4)
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Fonud htis ni ted:autop erlaOemzop rdgu n,onoariimtf so ti nca og tobh zst:.ony.coa.arIwa el." ortnoP mupP srIhoiibnt mya ineceasr teh rsmeu nctaitnorecon fo zoateclrIona. nrotoP mPpu sbhnIitior mya arsdecee eht umres onoieracnctnt of nzacoletIroa. gMemanea:tn Eporxues to loTsrua darbn lantearczooi mya be dnreseaci by IPsP; csrioden oriocalaenzt oeds rnicutdeo. xrsEpoeu to Sraxpnoo drnab onetizocaarl scsaulpe yam be eedadcrse yb P.sIP eGvi Saxopnro dabnr olioaenztcra ta atsle 2 rhs oerfeb ro 2 rsh afrte sPPI Rsik D: seodnCri prheaty m"iifcdoanoit

oFr otncoozaklee, it idd yas IPP easesrecd tis emsru eevll




 +0 
submitted by andremosq(9)
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Teh aspauelntcde oorainflutm fo alinaeztoocr hsa nebe acidtaeoss hiwt wide ivtiayairlb ni pamsla ntoescaircnotn due to ativilrybia ni ronobtiasp mrfo hte tglnatretsisonai I()G artt.c

talpdaEseucn atcnoiazroel qreeusir na ciidac Hp ni eht ctosham ofr het rporpe diotsilnsou nda potrionbsa in the mdnoduue al(lsm ts.einn)ite

onroPt mupp hiiironbt matsidcione can earsiecn hte gstirac Hp dna ryebeth cearedse het istdionlosu fo the ulacpes dan hte otanum fo azoilantrceo balaeliav ofr rspitonoba fmro het IG tract ofr teymscsi yie.revdl

yytnAobnh: J. tsuiB, MD, mDahPr, F,NAL AFAH




 -11 
submitted by โˆ—strugglebus(188)
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Tshi a YPC 405 iioithnrb (FIOSMESKCAC.C); ist hte .O

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



 -13 
submitted by โˆ—hayayah(1210)
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dAd no ot the ohtre nm:cmeot KCI.SOAFCMSEC hIwen( Am nriikndg ueGirarftp cjeiu) si het eommnicn for irrngmeemeb eth 0P4YC5 bn:ortiiIsh

  • S odium ltaapreov
  • I iaiozdsn
  • C eeimtdini
  • K toaoloecnez
  • F luczoalneo
  • A utce aloohlc ausbe
  • C ohricophnellma
  • E rnrc/cttmicyilrrnhaomhyyoi
  • S lmundiaeosf
  • C laofciornxpi
  • O lpemzreao
  • M erzodoteanil

  • A noeiaodrm

  • riaeftpurG ciuej
charcot_bouchard  Its not a cytochrome question. IK because i go t it wrong +1
waterloo  both azoles and PPI inhibit cytochrome P450. So one isn't causing the other's lack of effect. +9
stepwarrior  Nope. Inhibiting CYP450 would enhance the effect of itraconazole, so that can't be the mechanism. +2



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