Abnormal 2022_Pharma

- Budesonide is an orally administered corticosteroid that may be useful

in the treatment of inflammatory bowel disease.

A. True B. False

- A 34 - year - old woman has irritable bowel syndrome with diarrhea that
is not responsive to conventional therapies . This patient needs to be
treated with immunosuppressant to address this autoimmune condition.

A. True B. False

- Alginate is a molecule that polymerizes in stomach acid and coats the

ulcer bed , resulting in accelerated healing and reduction of symptoms.

A. True B. False

- Ganciclovir is important in the treatment of infections caused by

Cytomegalovirus .The key to efficacy is the first step of phosphorylation
attributed to viral thymidine kinase.

A. True B. False

- Hepatotoxicity caused by high doses of Paracetamol is due to

depletion of phase 2 metabolic reaction with glucouridination.

A. True B. False

- A 55-year-old woman with type 1 diabetes of 40 years' duration complains of

severe bloating and abdominal distress, especially after meals. Evaluation
is consistent with diabetic gastroparesis. Which of the following is a
prokinetic drug that could be used in this situation?

(A) Alosetron
(B) Cimetidine
(C) Loperamide
(D) Metoclopramide
(E) Sucralfate

Of the drugs listed, only metoclopramide is considered a prokinetic agent (ie, one that increases
propulsive motility in the gut). The answer is D.
 - A patient who is taking verapamil for hypertension and angina has become
constipated. Which of the following drugs is an osmotic laxative that could
be used to treat the patient's constipation?

(A) Aluminum hydroxide

(B) Diphenoxylate
(C) Magnesium hydroxide
(D) Metoclopramide
(E) Ranitidine

A laxative that mildly stimulates the gut would be most suitable in a patient taking a smooth muscle
relaxant drug such as verapamil. By holding water in the intestine, magnesium hydroxide provides
additional bulk and stimulates increased contractions. A helpful mnemonic is magnesium "magnifies"
stool, aluminum hALts the stool. The answer is C

- A 40-year-old male CEO came to the emergency department with severe

burning chest pain radiating into his neck. His electrocardiogram was normal
and the test for troponin was negative. A diagnosis of GERD was made and
he was sent home with a prescription for a drug that inhibits stomach acid.
Which of the following is a drug that irreversibly inhibits the H+/K+ ATPase in
the parietal cells?

(A) Cimetidine
(B) Diphenoxylate
(C) Esomeprazole
(D) Metoclopramide
(E) Sulfasalazine

Esomeprazole, the (S) isomer of omeprazole, is a prodrug converting spontaneously in the parietal
cell canaliculus to a sulfonamide that irreversibly inactivates the proton pump. The answer is C.

- On your way to an examination, you experience the vulnerable feeling that an

attack of diarrhea is imminent. If you stopped at a drugstore, which one of
the following antidiarrheal drugs could you buy without a prescription
even though it is related chemically to the strong opioid analgesic meperidine?
(A) Aluminum hydroxide
(B) Diphenoxylate
(C) Loperamide
(D) Magnesium hydroxide
(E) Metoclopramide

Aluminum hydroxide is constipating but is not related chemically to meperidine; magnesium hydroxide
is a strong laxative. The 2 antidiarrheal drugs that are structurally related to opioids are diphenoxylate
and loperamide. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine
alkaloids, and the product (Lomotil, others) requires a prescription. The answer is C.
 - A 45-year-old man with a duodenal ulcer was treated with a combination of
drugs intended to heal the mucosal damage and to eradicate Helicobacter
pylori. Which of the following antibacterial drugs is used commonly to
eradicate intestinal H pylori?

(A) Cefazolin
(B) Ciprofloxacin
(C) Clarithromycin
(D) Clindamycin
(E) Vancomycin

The macrolide antibiotic clarithromycin is commonly used in antibiotic regimens designed to treat
duodenal ulcers caused by H pylori. The other antibiotics that are used include amoxicillin,
tetracycline, and metronidazole. Bismuth also has an antibacterial action. The answer is C.

- A patient is receiving highly emetogenic chemotherapy for metastatic

carcinoma. To prevent chemotherapy-induced nausea and vomiting, she
is likely to be treated with which of the following?
(A) Levodopa
(B) Methotrexate
(C) Misoprostol
(D) Ondansetron
(E) Sucralfate

The 5-HT3 receptor antagonists are highly effective at preventing chemotherapy-induced nausea and
vomiting, which can be a dose-limiting toxicity of anticancer drugs. The answer is D.

- Which of the following choices would be most appropriate in treating nausea

and vomiting associated with motion sickness?
A. diphenhydramine
B. brompheniramine
C. ondansetron
D. omeprazole
E. ranitidine

- Omeprazole would not be effective in the treatment of

A. gastroesophageal reflux disease.
B. peptic ulcer disease.
C. Zollinger-Ellison syndrome.
D. heartburn.
E. urticaria.

- Which of the following antiulcer medications is most likely to cause drug

interactions and endocrine side effects?
A. ranitidine
B. omeprazole
C. lansoprazole
D. cimetidine
E. famotidine

- Salwa is a 43 - year - old female with a chief complaint of hematemesis and

abdominal pain.Serology is positive for H. pylori.Which of the following
would be the best regimens to treat Salwa ?

A. Omeprazole 20 mg daily plus clarithromycin 500 mg b.i.d. for 14 days

B. Lansoprazole 30 mg b.i.d. plus tetracycline 500 mg q.i.d.for 14 days
C. Rabeprazole 20 mg b.i.d. plus amoxicillin 1 g b.i.d. plus clarithromycin 500
mg b.i.d. for 7 days
D. Esomeprazole 40 mg b.i.d. plus amoxicillin 500 mg b.i.d. plus clarithromycin 500
mg b.i.d. for 7 days
E. Pantoprazole 40 mg b.i.d. plus amoxicillin 1 g b.i.d. plus clarithromycin 500 mg
t.i.d. for 10 days

- All of the following statements concerning antacid therapy used in the

treatment of duodenal or gastric ulcers are correct except which one?

(A) Antacids may be used to heal the ulcer but are ineffective in controlling
ulcer pain.
(B) Antacids neutralize acid and decrease the activity
of pepsin.
(C) If used alone for ulcer therapy, antacids should be administered 1 hr and 3 hrs
after meals and
before bedtime.
(D) If diarrhea occurs, the patient may alternate the antacid product with aluminum
hydroxide.
(E) Calcium carbonate should be avoided because it causes acid rebound and
induces constipation.

- As part of a comprehensive management strategy to treat peptic ulcer

disease, patients should be encouraged to do all of the following except
(A) decrease caffeine ingestion.
(B) eat only bland foods.
(C) stop smoking.
(D) avoid alcohol.
(E) avoid the use of milk as a treatment modality.

- A gastric ulcer patient requires close follow-up to document complete ulcer

healing because
(A) perforation into the intestine is common.
(B) spontaneous healing of the ulcer may occur in 30% to 50% of cases.
(C) there is the risk of the ulcer being cancerous.
(D) symptoms tend to be chronic and recur.
(E) weight loss may be severe in gastric ulcer patients.

___________________________________________________________________
- Parietal cells (secretory elements of the gastric mucosa) release acid and
intrinsic factors when activated by:

A) norepinephrine
B) atropine
C) histamine
D) none of the above

- Mechanism by which cimetidine (-dine (H2 Blocker) decrease gastric acid

secretion:
A) interferes with the gastric acid pump
B) blocks cAMP action by preventing protein phosphorylation
C) competes with histamine for H-2 receptor sites
D) competes with gastrin for H-2 receptor sites

- Antiulcer medication that has an antiandrogenic effect--may cause

gynecomastia (breast enlargement) in some patients:
A) ranitidine (Zantac)
B) cimetidine (Tagamet)
C) atropine
D) omeprazole (Prilosec)

Cimetidine-H2 blocker that can cause gynecomastia, impotence, and decreased sperm count. This
medication is known to inhibit CYP3A4, 2D6, 1A2

- Anti-gastric ulcer drug that binds to mucosal protein substrate and then forms
a gel that coats the ulcer.
A) bismuth compounds
B) misoprostol (Cytotec)
C) sucralfate (Carafate)
D) viscous lidocaine

- Anti-ulcer agent that blocks proton generations by parietal cells:

A) sucralfate
B) omeprazole (Prilosec)
C) ranitidine (Zantac)
D) bismuth compounds
Omeprazole (azole)
___________________________________________________________________

- A 45-year-old male who is obese presents to his primar care physician complaining
of postprandial epigastri pain. The pain does not appear after every meal. He has
noticed the pain especially after eating spicy foods and oatmeal. He is not currently
taking any medications. Which of the following drugs prevent acid secretion by
antagonizing a receptor?
(A) Aluminum hydroxide
(B) Fexofenadine
(C) Misoprostol
(D) Omeprazole
(E) Ranitidine

- A 47-year-old immigrant from Japan with a long history of untreated gastric ulcers
develops stomach cancer One drug in his initial treatment regimen is 5-fluorouracil
(5-FU) as well as ondansetron to control nausea. While receiving this drug, the
patient develops redness and numbness on the palms of his hands and soles of his
feet. How can this reaction be avoided?

(A) Do not coadminister ondansetron with 5-fluorouracil

(B) Give 5-FU by bolus rather than continuous infusion
(C) Give 5-FU by continuous infusion rather than bolus
(D) Give with leucovorin
(E) This is a rare, bizarre side effect of 5-FU and cannot be avoided

- A 37-year-old man complains of chest pain after meals. He says this pain has gone
on for a few months and gets only minimal relief from antacid tablets. The physician
prescribes a drug that will decrease the amount of acid secreted by binding to
and inhibiting an ATPase on the luminal surface of parietal cells. Which of the
following drugs works by this mechanism?
(A) Atropine
(B) Cimetidine
(C) Misoprostol
(D) Octreotide
(E) Omeprazole

- A 57-year-old man with chronic gastroesophageal reflux disease on cimetidine

presents to a new primary care physician. He states that he has been doing well and
has been taking this medication for about 15 years. Which of the following
statements is true about therapy with this agent?
(A) Dose adjustment is required in hepatic failure
(B) Has a long half-life
(C) 70% inactivated in the liver
(D) 30% excreted in the urine
 - A 37-year-old man with gastroesophageal reflux takes over-the-counter
cimetidine. He has no health care insurance and thus does not go to see a
physician. This patient must be aware of which of the following side effects of this
medication?
(A) Confusion
(B) Constipation
(C) Hallucinations
(D) Headache
(E) Muscular pain

- A 49-year-old man with a history of peptic ulcer disease and gastroesophageal

reflux disorder is being treated with cimetidine for approximately 20 years. He
now complains of breast swelling and breast discharge. What is the most likely
explanation for these findings?
(A) Abscess
(B) Antiandrogenic effect (endocrine effect)
(C) Inflammatory response
(D) Neoplastic process
(E) Overwhelming edema

- A 67-year-old woman with known peptic ulcer disease found at endoscopy to be on

maintenance treatment with misoprostol at 125% of the recommended dose. The
rationale behind this dose is to maximize which of the following?
(A) Decrease in gastric acid secretion
(B) Improve bicarbonate balance
(C) Improve gastric emptying
(D) Improve sphincter tone of the lower esophagus
(E) Lower gastric luminal pressures

- A 37-year-old female with mild arthritis presents to the clinic for follow-up. She states
that she is doing much better because of doubling her dose of ibuprofen. Some days,
she even triples her dose throughout the day. The physician warns the patient
about peptic ulcers and bleeding from taking too much ibuprofen. She is offered
alternatives, but the patient refuses because the ibuprofen works so well. What is
the most appropriate therapy for this patient to prevent peptic ulcers?
(A) Bismuth
(B) Famotidine
(C) Lansoprazole
(D) Misoprostol
(E) Pirenzepine

- A 65 year old woman with a history of rheumatoid arthritis visits your clinic
complaining of increasing stomach pain that started several weeks ago. She
recently began taking a half dozen or more 400 mg ibuprofen tablets daily to
help control her progressively increasing arthritic symptoms. Her lab results
indicate a blood hemoglobin of 7 g/dl (normal 12-15 gm/dl), hematocrit 29%
 (normal 38-46%), as well as a guaiac-positive stool test. You discuss
treatment with a synthetic prostaglandin that would be contraindicated if
she were much younger & not on contraceptives. Which drug is this?
dronabinol
:-) misoprostol
omeprazole
ondansetron
sucralfate

- Choose the antiulcer drug that inhibits gastric acid secretion, stimulates gastric
mucus and bicarbonate secretion and has cytoprotective action on gastric
mucosa:
A. Misoprostol
B. Sucralfate
C. Carbenoxolone sodium
D. Colloidal bismuth subcitrate

- The use of misoprostol to prevent nonsteroidal anti-inflammatory

drug-induced ulcers could cause all of the following side effects except
A. fever.
B. gastrointestinal cramping.
C. hypertension.
D. headache/pain.
E. diarrhea.

- A 48-year-old male presents to the emergency department with chest pain for the
past 2 days. The pain is nonradiating and burning in nature. An ECG is normal, and
serial troponins are negative. The physician makes the diagnosis of GERD. What is
the most potent therapy for the prevention of GERD?
(A) Bismuth
(B) Famotidine
(C) Misoprostol
(D) Omeprazole
(E) Pirenzepine

- The most efficacious drug for inhibiting round the clock gastric acid output is:
A. Omeprazole
B. Cimetidine
C. Pirenzepine
D. Misoprostol

- The first choice drug for nonsteroidal antiinflammatory drug associated gastric
ulcer is:
A. Omeprazole
B. Misoprostol
C. Ranitidine
D. Sucralfate
- Examples of H2 (histamine receptor Type II) antagonists:

A) cimetidine (Tagamet)
B) ranitidine (Zantac)
C) nizatidine (Axid)
D) famotidine (Pepcid)
E) terfenadine
All of the above (end in -dine)

- The second-generation antihistamines (H1-receptor antagonists) are

generally considered nonsedating because they
A. are more selective for H1 receptors than the first-generation agents.
B. are metabolized faster than the first-generation agents.
C. actually function as H1 receptor inverse agonists.
D. do not cross the blood-brain barrier as easily as the first-generation agents.
E. are only applied topically and therefore do not enter the systemic circulation.

- A 37-year-old man complains of chest pain after meals. He says this pain has gone
on for a few months, and he gets only minimal relief from antacid tablets. The
physician prescribes a drug that will decrease the amount of acid secreted by
blocking a histamine receptor. Which of the following drugs works by this
mechanism?
(A) Atropine
(B) Cimetidine
(C) Misoprostol
(D) Octreotide
(E) Omeprazole

- More likely to affect the cytochrome P450 drug metabolizing system:

A) ranitidine
B) cimetidine

- Which histamine H2 blocker has most marked inhibitory effect on microsomal

cytochrome P-450 enzyme:
A. Cimetidine
B. Ranitidine
C. Roxatidine
D. Famotidine

- A 37 year old man who was started on methadone therapy for opioid addiction
a week ago is brought to the Emergency Department suffering from excessive
drowsiness and disorientation. During the physical exam you notice that his
breasts appear abnormally enlarged. He insists that he has not been taking
more methadone than prescribed, but admits that he has been taking an
 over-the-counter H2 blocker daily to prevent "stomach problems" for the past
year. You suspect a drug interaction may explain his current condition. Which
drug is most likely responsible?

a. cimetidine
b. famotidine
c. nizatidine
d. ranitidine

- Gynaecomastia can occur as a side effect of:

A. Bromocriptine
B. Cimetidine
C. Famotidine
D. Levodopa

- Exhibits the highest relative potency (compared to cimetidine):

a. Nizatidine
b. Famotidine
c. Ranitidine

- Ranitidine differs from cimetidine in the following respect:

A. It is less potent
B. It is shorter acting
C. It does not have antiandrogenic action
D. It produces more CNS side effects

- A 29-year-old woman presents with abdominal pain and diarrhea. Endoscopy

reveals the presence of peptic ulcers, and lab tests indicate the patient is
suffering from gastrin-secreting neuroendocrine tumor (Zollinger-Ellison
syndrome). Other than surgical therapy, which of the following treatments
would be most effective in reducing her symptoms?
a. magnesium hydroxide
b. misoprostol
c. nizatidine
* d. omeprazole
e. pirenzepine

- Which of the following agents would produce a long-term inhibition of reduced

gastric acid secretion through an irreversible mechanism?
A. rabeprazole
B. cimetidine
C. famotidine
D. nizatidine
E. nedocromil
 - IT is a 58-year-old male admitted to the intensive care unit with acute
respiratory failure and thrombocytopenia. He is at high risk for an upper
gastrointestinal bleed. Which of the following agents are approved by the
U.S. Food and Drug Administration (FDA) for the prevention of this type of
bleed?
(A) Sucralfate
(B) Famotidine
(C) Esomeprazole
(D) Lansoprazole
(E) Omeprazole

- Which statement concerning the drug misoprostol is true?

A. It is effective for protecting patients from NSAIDinduced gastric ulcers.
B. It frequently produces dose-related diarrhea.
C. It is contraindicated in women who are pregnant.
D. It is a prostaglandin.
E. Concomitant use with magnesium antacids increases the likelihood for
constipation.

- Reflux esophagitis responds best to:

A) famotidine (Pepcid)
B) cimetidine (Tagamet)
C) omeprazole (Prilosec)
D) sucralfate (Carafate)

Cimetidine and famotidine, H-2 histamine receptor antagonists, are effective in reducing acid and
increasing reflux pH. Esophagitis healing occurs in patients treated with H-2 blockers. Many patients
are hypersecretors and are not responsive to normal doses of H-2 blockers. Omeprazole prevents
acid secretion in these patients with clinical trials supporting the superiority of omeprazole compared
to ranitidine. Antacids can control symptoms but are not effective in promoting healing.

- During your 3rd year clinical rotation you are introduced to JR, a 56 year old
oil executive who has been a chain smoker (1/2 pack per day for 20 years),
and for the past few years has been experiencing a midepigastric upper
abdominal pain that is diminished by eating or taking Tums tablets. JR drinks
three or four glasses of single malt Scotch every evening, as well as an
occasional two martini lunch. JR has been taking 10-20 full strength aspirin
tablets per week for stress-related headaches. He is unaware of any signs of
blood in the stool. JR is advised to replace his aspirin with
acetaminophen, reduce his drinking and smoking, and is advised to
start taking famotidine 40 mg bid. In terms of treating his peptic ulcer
disease, what beneficial goal would you hope to achieve with this therapy?
a. eradication of H. pylori
 b. neutralize gastric acid
c. protect the gastroduodenal mucosa
d. reduce the amount of acid secretion

- A patient with a history of dyspepsia has a positive urea breath test and a
positive stool antigen test for the presence of H. pylori. While multiple
treatment regimens have been evaluated for this type of infection, the most
common regimen being used in areas where antibiotic resistance is low is
"triple therapy" consisting of a proton pump inhibitor (PPI), amoxicillin
and an additional drug. Which drug is the most common 3rd component
used for triple therapy?
a. cimetidine
b. clarithromycin
c. loperamide
d. metronidazole
e. pirenzepine

- A 44 year old woman arrives in your clinic complaining of chronic stomach

pain. She has a 5 year history of recurrent peptic ulcer disease, and has not
experienced adequate relief despite aggressive treatment for H. pylori as well
as ranitidine taken daily before bed time. Her lab results are normal except for
an elevated fasting serum gastrin level of 4,567 pg/ml (normal: 1-1000 pg/ml).
Endoscopic exam reveals the presence of both esophageal and
duodenal ulcerations. What drug would you use to best treat PD's
condition?

A. dronabinol
B. :-) omeprazole
C. ondansetron
D. ranitidine
E. sucralfate

- A 42 year old man has been experiencing heartburn like pain after meals,
especially when reclining on his sofa after a meal. His symptoms are relieved
by antacids. You discuss therapeutic options, which include either a H2
receptor antagonist or a proton pump inhibitor as a drug of first choice. You
also discuss the use of an additional agent that can provide a protective
coating over necrotic tissue, which can help with healing of ulcers. What
agent has this mechanism of action?

A. calcium carbonate
B. diphenoxylate
C. loperamide
D. pirenzepine
E. sucralfate
 - Most effective in treating Zollinger-Ellison syndrome (caused by gastrin secreting
tumors)
A) sucralfate (Carafate)
B) omeprazole (Prilosec)
C) famotidine (Pepcid)
D) misoprostol (Cytotec)

- Among the proton pump inhibitors, this agent exhibits a relatively more
rapid onset of gastric acid inhibition compared to other oral preparations.
- Lansoprazole
- Dexlansoprazole
- Rabeprazole
- Omeprazole

- A 45-year-old man with a duodenal ulcer and laboratory evidence of

He/icobttmr py!Dri infection was treated with omeprazole. clarithromycin, and
amoxicillin. Endoscopy revealed rapid change of the ulcer. Which of the
following is the most accurate description of the mechanism of
omeprazole therapeutic action?
(A) Activation of prostaglandin E receptors
(B) Formation of protective coating ova the ulcer bed
(C) Inhibition of bacterial protein synthesis
(D) Inhibition ofH2 histamine receptors
(E) Irreversible inactivation of H+/ k+ ATPase

- All of the following provide acid suppression similar to omeprazole 20 mg

every day except:

(A) dexlansoprazole 30 mg every day.

(B) pantoprazole 40 mg every day.
(C) rabeprazole 20 mg every day.
(D) ranitidine 150 mg twice a day.
(E) all provide equivalent acid suppression.

- A 45-year-old long-haul trucker suffers from seasonal allergies. He asks

advice on which over-the-counter product is best to relieve his symptoms.
Which of the following choices is the best recommendation for this patient?
A. diphenhydramine
B. promethazine
C. clemastine
D. chlorpheniramine
E. loratadine
 - A 78-year-old woman with osteoporosis and occasional gastroesophageal reflux
presents to her primary care physician for follow-up. Physical examination of the
heart, lungs, and abdomen are unremarkable. Which of the following agents would
be best to treat both of her underlying conditions?
(A) Aluminum hydroxide
(B) Calcium carbonate
(C) Magnesium hydroxide
(D) Sodium bicarbonate
(E) Warm milk

- A 47-year-old man with a history of NSAID-induced ulcers has been placed on

sucralfate. He has been on the medicine for 1 year and does complain of
intermittent chest pressure after meals. Upper endoscopy is performed. Which of the
following findings is most likely to occur?
(A) Duodenitis
(B) Duodenal perforation
(C) Gastric ulcers that appear unhealed
(D) Normal gastric epithelium
(E) Normal lower esophageal epithelium

Sucralfate should not be administered with PPIs, H2 antagonists,or antacids. Little of the drug is absorbed
systemically. It is very well tolerated, but it can interfere with the absorption of other drugs by binding to them.
This agent does not prevent NSAID-induced ulcers, and it does not heal gastric ulcers.

- A 43-year-old man with a history of peptic ulcer disease has developed

hypersensitivity to H2 blockers. He now complains of worsening of his dyspepsia.
Physical examination reveals mild tenderness on the midepigastric region. If
misoprostol is prescribed to this patient,which of the following mechanisms of
action would be most plausible for this agent?
(A) Enhance mucosal resistance
(B) Inhibition of gastrin secretion
(C) Inhibition of proton pump secretion
(D) Inhibition of somatostatin release
(E) Inhibition of uric acid secretion
- Monotherapy effectiveness in eradication of H. pylori-- bismuth compounds
A) 5%
B) 20%
C) 50%
D) 90%

- Eradication of H. pylori effectiveness for bismuth compounds when using

combination with antibiotics:
A) 5%
B) 20%
C) 50%
D) 80%
E) 95%
 - Drug(s) used in eradication of Helicobacter pylori infection:

A) bismuth compounds
B) metronidazole (Flagyl)
C) clarithromycin (Biaxin)
D) omeprazole (Prilosec)
E) amoxicillin (Amoxil Polymox)
All of the Above:
Triple Therapy: PAC (pac man eats H pylori)

P-PPI (omeprazole)
A-Amoxicillin
C-Clarithromycin

Alternative: PBTM (PAC--Bites--Too--Much)

P-PPI-Omeprazole
B-Bismuth
T-Tetracycline
M-Metronidazole (Flagyl)

- Omeprazole and lansoprazole approved for clinical treatment of:

A) duodenal ulcer
B) erosive gastritis
C) Zollinger-Ellison syndrome and other gastric acid hypersecretory states
All of the Above

- Side effect profile-- antiulcer medication: urinary retention, blurred vision,

xerostomia,:

A) ranitidine (Zantac)
B) atropine
C) nifedipine (Procardia, Adalat)
D) sucralfate (Carafate)

- Only class of antiulcer drugs that can eradicate Helicobacter pylori and
cure associated gastritis:

A) sucralfate (Carafate)
B) colloidal bismuth
C) H2 blockers
D) Anticholinergic agents
 - Antacid: melt-alkali syndrome:

A) aluminum hydroxide
B) magnesium hydroxide
C) calcium carbonate
D) sodium bicarbonate

- Antacid: effective, but associated with systemic alkalosis

A) calcium carbonate
B) sodium bicarbonate
C) magnesium hydroxide
D) aluminum hydroxide

- Antacid: most likely to cause systemic phosphate depletion:

A) sodium bicarbonate
B) calcium carbonate
C) magnesium hydroxide
D) aluminum hydroxide

- Mechanism of action: cytoprotection, binds to the ulcer base, antibacterial

effect:

A) metronidazole (Flagyl)
B) tetracycline (Achromycin)
C) bismuth compounds
D) ranitidine (Zantac)
E) omeprazole (Prilosec)
Bismuth Compounds-barrier formation and stimulation of mucosal bicarb and PGE2
and also works to impede growth of H pylori

- Peptic ulcer disease: select the correct mechanism and associated drug
relationship:
A) Acid neutralization: calcium carbonate
B) Cytoprotection: bismuth
C) Antibacterial: bismuth
D) A, B, & C

- Antacid: constipation

A) aluminum hydroxide
B) magnesium hydroxide
 - Most successful protocol for eradication of H. pylori/treatment of peptic ulcer
disease:
A) bismuth monotherapy
B) therapy using bismuth compounds, metronidazole (Flagyl), and amoxicillin
(Amoxil Polymox) in combination -triple therapy
C) bismuth compounds and amoxicillin (Amoxil Polymox)
D) all of the above equally effective
Therapy with bismuth, metronidazole, amoxicillin

PAC (triple therapy)

PBTM

- Antacid: loose stools ( diarrhea)

A) aluminum hydroxide
B) magnesium hydroxide
C) both
D) neither

- Used in management of acid-peptic ulcer disease: Least likely to produce side

effects.
A) atropine
B) scopolamine
C) pirenzepine
D) all produce about equal side effects.
Pirenzepine, a newer, more selective antimuscarinic drug, has the fewest side-effects compared to
atropine or scopolamine. At doses used in treating ulcer patients, a comparatively low incidence of dry
mouth and blurred vision occurs. The low lipid solubility effect of pirenzepine may explain less central
effects.

- H-2 receptor antagonist:

A) famotidine (Pepcid)
B) ranitidine (Zantac)
C) nizatidine (Axid)
D) all of the above.
All-- (-dine)

- May produce hyperplasia of enterochromaffin-like cells:

A) ranitidine (Zantac)
B) omeprazole (Prilosec)
C) cimetidine (Tagamet)
D) sucralfate
Omeprazole-- inhibits secretion by irreversible blockade of the hydrogen/potassium pump. Decreased
gastric acidity leads to a two to four fold hypergastrinemia in some patients and a small percentage of
these patients may exhibit exocrine hyperplasia.
 - Duration of suppression of acid secretion following administration of proton
pump inhibitors (e.g. omeprazole):
a. 8 hours
b. 12 hours
c. Up to 1 to 2 days
d. Greater than four days

- Associated following extended treatment with proton pump inhibitors:

- Rebound acid hypersecretion
- Acid secretion does not return to pretreatment levels, which may account for
long-term protection even in the absence of proton pump drug administration.
- Both
- Neither

- This/these proton pump inhibitors can be administered parenterally if the oral

route of administration is not an option.
a. Pantoprazole
b. Esomeprazole sodium
c. Both
d. Neither

- Hepatic disease and possible effect on esomeprazole and lansoprazole

clearance.
a. Reduced clearance
b. Increased clearance
c. No effect on clearance

- All of the following symptoms associated with gastroesophageal reflux may

be treated with nonprescription agents except
(A) burning sensation located in the lower chest.
(B) pain that is worse after meals.
(C) pain or difficulty when swallowing.
(D) pain that is worse in a recumbent position.

- Which of the following is an appropriate non pharmacological

recommendation for patients with gastroesophageal reflux?
(A) Eat larger but fewer meals.
(B) Avoid meals high in protein.
(C) Eat evening meals at least 3 hrs before bed.
(D) Prop the head up with two pillows at night.

- A 33-year-old woman who is obese complains of postprandial, burning chest pain.

Her physician prescribes pantoprazole. Pantoprazole may impair absorption of
which of the following nutrients?
(A) Calcium
(B) Carbohydrates
(C) Fatty acids
(D) Vitamin A
(E) Vitamin D

- Most widely used antacid in treating ulcer disease:

A) sodium bicarbonate
B) calcium carbonate
C) magnesium hydroxide
D) aluminum hydroxide
E) combination of aluminum hydroxide and magnesium hydroxide

- Treatment of gastric a disease: atropine vs.H2-receptor blockers -- atropine is:

A) more effective than H2 receptor blockers
B) less effective than H2 receptor blockers
C) equally effective
Less effective

Order of effectiveness; PPI - H2 antagonists - Ach blockers

- A 34-year-old construction worker injured his right leg while on the job. His medical
history includes poorly controlled Type-2 diabetes mellitus. He now presents with
cellulitis in his right leg, for which he is given empiric IV vancomycin. He also
complains of nausea, for which he is given an antiemetic. Which of the following
antiemetics is also an antihistamine?
(A) Droperidol
(B) Famotidine
(C) Loratadine
(D) Ondansetron
(E) Promethazine

- A 27-year-old man complains of occasional heartburn. His physician makes a few

suggestions of diet and lifestyle changes he could make as well as some medications
he can take for symptom management. The patient decides to try a magnesium
hydroxide (MgOH) preparation. Which of the following is a side effect of MgOH that
the physician should warn him about?
(A) Constipation
(B) Diarrhea
(C) Headache
(D) Impotence
(E) Seizures
 - A 58-year-old man with a history of occasional GERD presents to the clinic with
diarrhea for the past 3 months. He has not been sick and feeling quite well otherwise.
Further history uncovers that 3 months ago, he switched the type of antacid he uses
for reflux. He stopped the antacid and calls back 1 month later, saying he has not had
diarrhea since then. Which of the following antacids was most likely causing the
patient’s diarrhea?
(A) Aluminum hydroxide
(B) Bismuth
(C) Calcium carbonate
(D) Magnesium hydroxide
(E) Sodium bicarbonate

- All of the following are acceptable uses of magnesium hydroxide except

(A) heartburn.
(B) dyspepsia.
(C) hemorrhoids.
(D) constipation.

- A 42-year-old woman with irritable bowel syndrome with diarrhea predominance

presents to her primary care physician for treatment. The physician suggests an
exercise regimen, dietary modifications, and a bulk laxative. The likely mechanism
of action of this agent would involve which of the following?
(A) Gel formation in the intestine
(B) Neuromodulation of the S3 nerve root
(C) Nonabsorbable salt
(D) Osmotic laxative
(E) Stimulation of the cholinergic nervous system

- A 45-year-old man who is obese complains of postprandial epigastric pain. The pain
does not appear after every meal. He has noticed the pain especially after eating
spicy foods. He is not currently taking any medications. You suspect
gastroesophageal reflux disease (GERD) and want to try a drug that will lower the
amount of acid in his stomach. Which of the following drugs chemically elevates
the pH?
(A) Aluminum hydroxide
(B) Fexofenadine
(C) Misoprostol
(D) Omeprazole
(E) Ranitidine

- A patient with new onset Irritable Bowel Syndrome (abdominal bloating with
constipation) requires a medication to help reduce her symptoms which flare up
now and then. Which would be the most appropriate drug of first choice to reduce
her occassional symptoms?
a. colesevelam
b. diphenoxylate mono-therapy
c. imipramine
d. polyethylene glycol
e. rifaximin

- Which drug is most likely to be useful in the treatment of inflammatory

bowel disease?

(A) Diphenhydramine
(B) Diphenoxylate
(C) Mesalamine
(D) Ondansetron
(E) Ursodiol

Mesalamine is a form of 5-aminosalicylic acid that is active in the large intestine and thereby provides
a local anti-inflammatory effect that is useful in inflammatory bowel disease. The answer is C.

- Which of the following antihistamines is used for the treatment of emesis?

A. fexofenadine
B. doxylamine
C. chlorpheniramine
D. promethazine
E. desloratadine

- Correct statements concerning cigarette smoking and ulcer disease:

(I) Smoking delays healing of gastric and duodenal ulcers.
(II) Nicotine decreases biliary and pancreatic bicarbonate secretion.
(III) Smoking accelerates the emptying of stomach acid into the duodenum.

- When administered at the same time, antacids can decrease the therapeutic efficacy like:
sucralfate ,ranitidine, cimetidine

- Directions for questions 9–13: Each description in this section is most closely associated with
one of the following agents. Each agent is used only once. Choose the best answer, A–E.
A Sodium bicarbonate
B Aluminum hydroxide
C Calcium carbonate
D Magnesium hydroxide
E Propantheline

- May cause diarrhea D Magnesium hydroxide

- Cannot be used by patients with heart failure A Sodium bicarbonate
- If used with milk and an alkaline substance can cause milk-alkali syndrome
- C Calcium carbonate
- May cause dry mouth E Propantheline
- Can be alternated with an antacid mixture to control diarrhea.B Aluminum hydroxide
 - Which laxative should not be used to treat acute constipation because of
its slow onset of action?
(A) glycerin
(B) bisacodyl suppository
(C) psyllium
(D) milk of magnesia

- All of the following statements about emollient stool softener laxatives are
true except which one?

(A) They are not first-line treatment for the typical individual with acute constipation.
(B) They are appropriate for individuals who should not strain by passing a hard
stool.
(C) They are known as surfactants and include docusate calcium and docusate
sodium.
(D) They are highly associated with the development of acute phosphate
nephropathy.

- Which of the following statements adequately describes bulk-forming

laxatives?
(A) They can cause diarrhea if not taken with at least 8 oz of water.
(B) They are derived from polysaccharides and resemble fiber in mechanism of
action.
(C) They have a relatively fast onset of action of 4 to 8 hrs and duration of 12 to 24
hrs.
(D) They produce a more complete evacuation of the bowels than stimulant
products.

- a 35-year-old male presents to his physician with a primary complaint of

abdominal pain and frequent bowel movements over the past few weeks.
Upon examination and routine laboratory testing, he is found to have a
low-grade fever and an elevated erythrocyte sedimentation rate. Further
questioning reveals he is having four to five loose bowel movements each
day. The patient is a past smoker. Stool antigen tests are negative for known
GI pathogens. Physical examination and colonoscopy reveal contiguous
inflammation of the rectum and most of the descending colon. The physician
diagnosis is mild to moderate ulcerative colitis. Which therapy would be the
most effective for inducing remission?
(A) Topical corticosteroids
(B) Topical 5-ASA
(C) Oral budesonide
(D) Topical 5-ASA plus oral 5-ASA
 - Once remission is achieved, which therapy is most appropriate for
maintenance?
(A) Sulfasalazine 2 g/day
(B) Balsalazide 2 g/day
(C) Olsalazine 4 g/day
(D) Topical corticosteroids

- An 18-year-old female with newly diagnosed mild Crohn’s disease within the
ileum returns to her physician for her first follow-up since starting treatment.
Three weeks ago she started oral sulfasalazine 4 g/day and azathioprine
25 mg/day. Since starting these meds, her symptoms have not improved.
If anything, they are slightly worse. She is ambulatory with no signs of toxicity
(blood per rectum, pain, anemia, etc.) or weight loss. What would be a logical
next step in therapy?

(A) Stop azathioprine and begin IV corticosteroids

(B) Stop sulfasalazine and begin oral budesonide 9 mg/day
(C) Stop azathioprine and begin prednisone 40 mg orally per day
(D) Stop sulfasalazine and begin Lialda® 4.8 gm/day

- A man with diarrhea-predominant IBS is experiencing interruption of his

work as a truck driver secondary to frequent bouts of diarrhea. He states his
symptoms are worse after eating, especially fried foods. His physician
discusses the possible benefit of avoiding fat in his diet. The patient agrees to
try but also asks for something to uses in emergencies.
- What would be the most appropriate therapy to use?
(A) Alosetron 0.5 mg b.i.d.
(B) Hyoscyamine 0.15 mg PO p.r.n.
(C) Loperamide 4 mg then 2 mg p.r.n. up to 16 mg/day
(D) Fluoxetine 40 mg q.d.

- Which of the following is the most appropriate initial therapy for a woman
with severe constipation predominant IBS?
(A) A restrictive bland diet
(B) Tegaserod 6 mg PO b.i.d.
(C) Alosetron 1 mg PO b.i.d.
(D) Psyllium 2.5 g in divided doses

- Which of the following drugs, based on its mechanism of action, is effective

in treating diarrhea-predominant irritable bowel syndrome (IBS)?
A. misoprostol
B. naratriptan
C. alosetron
D. cetirizine
E. rabeprazole

- A 34-year-old woman has irritable bowel syndrome with diarrhea that is not
responsive to conventional therapies. Despite the small risk of severe
constipation and ischemic colitis, the patient decides to begin therapy with
alosetron. Alosetron has which of the following receptor actions?

(A) 5-HT3 receptor antagonist

(B) 5-HT4 receptor agonist
(C) D2 receptor antagonist
(D) NK1 receptor antagonist
(E) Muscarinic receptor antagonist

Serotonin plays a major regulatory role in the enteric nervous system, and the potent 5-HT3 receptor
antagonist alosetron has shown efficacy in treating women with IBS that is accompanied by diarrhea.
The answer is A.

- Which drug stimulates chloride secretion into the gut lumen and is used for
irritable bowel syndrome?
(G) Metoclopramide
(H) Mineral oil
(I) Omeprazole
(J) Linaclotide
(K) Pancrelipase
(L) Sucralfate

Linaclotide is approved for the treatment of chronic constipation and IBS with predominant
constipation. Linaclotide activates guanylyl cyclase-C on the luminal intestinal epithelial surface, which
leads to activation of the cystic fibrosis transmembrane conductance regulator (CFTR) leading to
increased chloride-rich secretion and acceleration of intestinal transit. The answer is J.

- Julie is a 23 year old medical student with a 5 year history of test anxiety who
is diagnosed with Irritable Bowel Syndrome (IBS). For the past 6 months
she has been suffering from abdominal pain and cramps associated with
frequent episodes of diarrhea (~30-40% of her bowel movements). In addition
to diet modification & regular exercise, what would be a drug of first choice
to help reduce her diarrhea?
a. alosetron
b. loperamide
c. lubiprostone
d. mesalamine

- A 26 year old man with Type 1 diabetes comes to your endocrinology clinic
with a chief complaint of a 3 month history of postprandial fullness, nausea,
and occasional vomiting that are not relieved by antacids or cimetidine. He
 mentions experiencing occasional bouts of orthostatic hypotension, as well as
hypoglycemic symptoms after eating a meal, although his measured glucose
levels at the time have been high. A tentative diagnosis of diabetic
gastroparesis caused by autonomic neuropathy is made. What is a drug of
choice for treating his symptoms?
a. castor oil
b. dimenhydrinate
c. docusate sodium
d. metoclopramide
e. ondansetron

- An 18-year-old female with diabetes presents to the clinic for her annual visit.
Over the past year, she has experienced daily nausea and occasional
vomiting. She has learned that eating small amounts of food at a time helps to
decrease the frequency of vomiting. She is diagnosed with diabetic
gastroparesis and started on metoclopramide. What is a side effect of
metoclopramide?
(A) Dry mouth
(B) Gynecomastia
(C) Headache
(D) Increased risk of abortion
(E) Tardive dyskinesia

- A physician prescribes metoclopramide for gastroparesis associated with

diabetes. During a follow-up visit a few weeks later, the patient complains of
experiencing increased drowsiness, diarrhea, Parkinsonian-like rigidity,
and continuous muscle spasms (extrapyramidal symptoms). Blockade of
which receptor subtype is primarily responsible for these side effects?
a. dopamine receptors
b. histamine (H2 receptors
c. muscarinic receptors
d. prostaglandin receptors
e. the proton pump

- You discuss the treatment of your patient's gastroparesis in more detail. You mention
that the drug of choice has 5 different Black Box warnings. However, its beneficial
effects include increasing the rate of GI emptying, central antiemetic effects, and a
reduction of acid reflux due to strengthening esophageal sphincter tone. What
receptor subtype does this drug antagonize to produce these multiple effects?
a. cholinergic (nicotinic)
b. :-) dopamine (D2)
c. histamine
d. serotinergic
___________________________________________________________________
- Proton pump inhibitors should been administered prior to the first meal of the day
since the amount of proton pump ( H+, K+-ATPase) increases following fasting.
True
False

- Following proton pump discontinuation, as long as 3-4 days is required before

normal acid secretion is reinitiated.
True
False

- Proton pump inhibitors exhibit very limited renal clearance and exhibit
first-pass as well as subsequent liver metabolism.
True
False

- Due to the short half-life of a single injection of one of the intravenous

formulations of pantoprazole and esomeprazole, maximal proton pump
inhibition during the first 1-2 days of treatment requires either repeated bolus
injections or continuous infusion.
True
False

- Baking soda (sodium bicarbonate) reacts with hydrochloric acid (HCl)

resulting in sodium chloride and carbon dioxide production.
True
False

- Reduces basal unstimulated gastric acid secretion; enhanced mucosal resistance to

injury-- prostaglandins (PGE1/PGE2)

A) true
B) false

- Castor oil is no longer recommended as a laxative given its unpleasant taste in

potential toxicities on intestinal epithelium and enteric neurons.
True
False

- Nizatidine and famotidine exhibit limited effects on the liver microsomal cytochrome
P450 system, thus limiting drug-drug interactions by this mechanism.
True
False
 - H2 receptor blockers decrease acid secretion induced by histamine but acid
secretion due to gastrin or cholinomimetic drugs is unaffected.
True
False

- CNS side effects associated with H2 receptor antagonists administration are

considered relatively common.
True
False

- Proton pump inhibitor dose rejection is typically required in patients with renal
insufficiency or mild-to-moderate hepatic disease.
True
False

- Chronic renal disease including renal failure results in proton pump inhibitor
drug accumulation following daily dosing.
True
False
- The bioavailability of proton pump inhibitors is enhanced by food and
therefore should be administered following a meal.
True
False

- H2 receptor blockers suppress meal-induced acid secretion while maintaining normal

basal gastric acid secretion.
True
False

- Metoclopramide may be appropriate in patients exhibiting gastroparesis.

True
False

- Metoclopramide effect on gastroparesis may result in gastric emptying improvement

to a moderate degree.
True
False

- Metoclopramide (Reglan) due to important safety issues has a limited role in treating
GERD in children.
True
False

- Metoclopramide when administered for extended periods of time may induce tardive
dyskinesias.
True
False
 - Domperidone and metoclopramide can both prevent and treat emesis.
True
False

- Domperidone may be used to promote postpartum lactation.

True
False

- A synthetic fiber, bulk-forming laxative: polycarbophil

True
False

- Digestion of plant fiber in the colon by bacteria can cause flatus and bloating.
True
False

- Some laxative preparations promote intraluminal fluid retention, sometimes by

osmotic mechanisms.
True
False

- Mineral oil administered for stool softening is appropriate for regular use:
True
False

- "Heavy" mineral oil should not be taken at bedtime to limit the likelihood of the rare
complication of lipid pneumonitis secondary to aspiration.
True
False

- Dietary fiber composition influences fiber effects on bowel movement. Insoluble,

poorly fermentable fiber tend to be most effective in managing constipation.
True
False

- Bisacodyl: may be safe for acute as well as long-term use

True
False