Cardiovascular drugs: clopidogrel and proton pump inhibitors: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular drugs: clopidogrel and proton pump inhibitors

Sample item

A 60-year-old woman after coronary stenting is on aspirin and clopidogrel and has reflux symptoms for which omeprazole is prescribed. What is the best approach?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Change to pantoprazole, since omeprazole inhibits CYP2C19 needed to activate clopidogrel

Clopidogrel is a prodrug that irreversibly blocks the platelet P2Y12 receptor after hepatic activation, which depends partly on CYP2C19. Omeprazole and esomeprazole inhibit CYP2C19 and reduce the active metabolite, so the combination should be avoided. A gastroprotective agent is still advisable on dual antiplatelet therapy, and pantoprazole interacts minimally.

Option by option

  • A. Double the aspirin dose to compensate for reduced clopidogrel effect

    A higher aspirin dose raises bleeding risk and does not restore P2Y12 blockade.

  • B. Stop clopidogrel and switch to warfarin

    Warfarin is not a substitute for dual antiplatelet therapy after stenting.

  • C. Change to pantoprazole, since omeprazole inhibits CYP2C19 needed to activate clopidogrel (correct)

    Correct. Pantoprazole preserves clopidogrel activation while giving gastroprotection.

  • D. Continue omeprazole, since clopidogrel is administered in its active form

    Clopidogrel is a prodrug and needs activation, which omeprazole impairs.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Change to pantoprazole, since omeprazole inhibits CYP2C19 needed to activate clopidogrel. Clopidogrel is a prodrug that irreversibly blocks the platelet P2Y12 receptor after hepatic activation, which depends partly on CYP2C19.

Why is "Double the aspirin dose to compensate for reduced clopidogrel effect" not the answer?

A higher aspirin dose raises bleeding risk and does not restore P2Y12 blockade.

Why is "Stop clopidogrel and switch to warfarin" not the answer?

Warfarin is not a substitute for dual antiplatelet therapy after stenting.

Why is "Continue omeprazole, since clopidogrel is administered in its active…" not the answer?

Clopidogrel is a prodrug and needs activation, which omeprazole impairs.

What concept does this question test?

It tests Cardiovascular drugs: clopidogrel and proton pump inhibitors in Pharmacology. Omeprazole and esomeprazole inhibit CYP2C19 and reduce the active metabolite, so the combination should be avoided. A gastroprotective agent is still advisable on dual antiplatelet therapy, and pantoprazole interacts minimally.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular drugs: clopidogrel and proton pump inhibitors?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.