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  #1  
Old 10-02-2011
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A 64-year-old man presents to his docto rwith aching, burning pain after meals. He had been self-medicating for several months with antacids, but he found this to be increasingly ineffective. His physician decides to take him off the antacids and instead places him on a combination of ranitidine and sucralfate. Why is this combination a bad idea?
A. Ranitidine increases the toxicity of sucralfate
B. Ranitidine inhibits the action of sucralfate
C. Sucralfate and ranitidine coprecipitate
D. Sucralfate increases the toxicity of ranitidine
E. Sucralfate inhibits the action of ranitidine
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  #2  
Old 10-02-2011
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I guess it is E?
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Old 10-03-2011
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This should B. Ranitidine inhibits the action of sucralfate

Sucralfate need acidic environment to work.
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Old 10-03-2011
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•E. Sucralfate inhibits the action of ranitidine


Drug Interactions or Contraindications

Concomitant use of sucralfate may decrease the absorption and/or concentrations of some medications. It has been recommended to administer sucralfate 2 hours before or after any of the following:
fluoroquinolones (e.g. ciprofloxacin and enrofloxacin)
Tetracyclines
Theophylline
Digoxin
Cimetidine
Ketoconazole
levothyroxine
fat soluable vitamins (A, D, E, K)


http://ratguide.com/meds/miscellaneous/sucralfate.php
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Old 10-03-2011
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Correct ans is B
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Old 10-04-2011
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The correct answer is B. Sucralfate is a promising drug that is not presently in widespread use because it is incompatible with H2 antagonists such as cimetidine, ranitidine, famotidine and nizatidine. Sucralfate is aluminum sucrose sulfate, a sulfated disaccharide, which polymerizes and binds to ulcerated tissue. It forms a protective coating against acid, pepsin and bile, giving the tissue a chance to heal. Unfortunately, a low gastric pH is required for polymerization, meaning that sucralfate is incompatible with drugs that reduce gastric acidity, such as H2 blockers and antacids. The moral of the story is that you cannot assume that two medications that are individually helpful in a medical condition will be synergistic. Learning the mechanisms by which the drugs work will help you spot potential interactions and earn you points on the USMLE.
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