American Board of Family Medicine (ABFM) Practice Exam

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In a patient on PPI, which calcium supplement should typically be avoided due to dependency on acidic conditions for absorption?

Calcium lactate
Calcium carbonate
Calcium gluconate
Oyster shell calcium

The correct answer is: Calcium carbonate

Calcium carbonate is typically avoided in patients on proton pump inhibitors (PPIs) because its absorption is significantly dependent on an acidic environment. Calcium carbonate requires stomach acid to dissociate calcium ions, which are then absorbed in the intestine. When a patient is on a PPI, the reduction of gastric acid can lead to insufficient dissociation of calcium carbonate, resulting in poor absorption. Patients taking PPIs are often recommended to consider alternative forms of calcium supplements that do not rely on acidity for absorption, such as calcium citrate or calcium lactate. These alternatives are better absorbed even in low-acid conditions, making them more suitable for individuals who have altered gastric acidity due to medication.