GI Flashcards
QUESTION 1
You are a clinical pharmacist covering a gastroenterology ward round, and you are currently with the dietetics team. There is a patient who has malabsorption issues, so is being prescribed supplementary vitamins to make up for the deficit. Which of the following vitamins are not fat soluble?
A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin E
E) Vitamin K
B
Patients who are being treated for gastro-oesophageal reflux disease (GORD) are often told to try lifestyle factors prior to starting pharmacological treatment. In some cases, lifestyle factors are insufficient, so we start medication. Which of the following medications is commonly used to treat gastro-oesophageal reflux disease (GORD)?
A) Acetaminophen
B) Ibuprofen
C) Omeprazole
D) Metformin
E) Sucralfate
C
RATIONALE: OMEPRAZOLE IS THE MOST APPROPRIATE CHOICE HERE.
OPTIONS A AND B ARE NSAIDS, METFORMIN IS USED IN THE
MANAGEMENT OF DIABETES, OPTION E IS USED IN THE OPTION OF
ULCERATION.
You are the ward pharmacist on a gastroenterology ward. A patient has come in with a peptic ulcer. Which of the following drugs is a proton pump inhibitor used for the treatment of peptic ulcers?
A) Famotidine
B) Misoprostol
C) Ranitidine
D) Pantoprazole
E) Sucralfate
D- is the only PPP of these options
What is the primary mechanism of action of ondansetron in the management of nausea and vomiting?
A) Acetylcholinesterase inhibitor
B) Dopamine receptor antagonist
C) Gamma-aminobutyric acid (GABA) agonist
D) Histamine H2 receptor antagonist
E) Serotonin (5-HT3) receptor antagonist
E
RATIONALE: ONDANSETRON BLOCKS NAUSEA AND VOMITING BY 5-HT3
RECEPTOR ANTAGONISM AT TWO SPECIFIC SITES: (I) CENTRALLY, IN
THE AREA POSTREMA/NTS; AND (II) PERIPHERALLY ON VAGUS NERVE
TERMINALS.
What is the mechanism of action of metoclopramide in the management of gastroparesis?
A) Blockade of histamine H2 receptors which would otherwise cause constipation
B) Enhancement of gastric emptying through serotonin receptor antagonism
C) Inhibition of gastric acid secretion which would otherwise cause a delay in gastric emptying
D) Prokinetic activity via antagonism of dopamine receptors
E) Stimulation of gastric acid production which generates prokinetic action involved in digestion and absorption of nutrients
D
RATIONALE: METOCLOPRAMIDE PROMOTES GUT MOTILITY BY
INHIBITING PRESYNAPTIC AND POSTSYNAPTIC D2 RECEPTORS AS WELL
AS PRESYNAPTIC 5-HT4 RECEPTORS.
Which medication is commonly used to relieve heartburn and indigestion by neutralising gastric acid?
A) Aluminium hydroxide/magnesium hydroxide
B) Famotidine
C) Metoclopramide
D) Rabeprazole
E) Sucralfate
A
RATIONALE: ALUMINIUM HYDROXIDE/MAGNESIUM HYDROXIDE IS THE
ACTIVE INGREDIENT IN GAVISCON. ALL OF THE OTHER CHOICES ON
THIS LIST WOULD NOT BE USED TO RELIEVE HEARTBURN AS A WHEN
REQUIRED MEDICATION.
Which of the following drugs is a synthetic prostaglandin analogue used for the prevention of gastric ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs)?
A) Domperidone
B) Erythromycin
C) Loperamide
D) Misoprostol
E) Prochlorperazine
D
RATIONALE: MISOPROSTOL IS A SYNTHETIC PROSTAGLANDIN E1
ANALOG THAT INHIBITS BASAL AND NOCTURNAL GASTRIC ACID
SECRETION THROUGH DIRECT STIMULATION OF PROSTAGLANDIN E1
RECEPTORS ON PARIETAL CELLS IN THE STOMACH.
What is the primary mechanism of action of bismuth subsalicylate, a component of Pepto-Bismol, in the treatment of diarrhoea and upset stomach?
A) Coating and soothing the gastrointestinal tract
B) Disruption of bacterial cell membrane integrity
C) Enhancement of gastrointestinal motility
D) Inhibition of prostaglandin synthesis
E) Stimulation of gastric acid secretion
A
RATIONALE: THE MEDICINE FORMS A PROTECTIVE COATING OVER THE
OESOPHAGUS, AND PARTLY COATS THE STOMACH. IT ALSO HAS
WEAK ANTACID PROPERTIES THAT MAY HELP REDUCE TOO MUCH
STOMACH ACID.
Which of the following drugs is a macrolide antibiotic that can be used as an alternative therapy for Helicobacter pylori eradication?
A) Amoxicillin
B) Azithromycin
C) Clarithromycin
D) Gentamicin
E) Tobramycin
C
RATIONALE: CLARITHROMYCIN IS THE ONLY MACROLIDE THAT IS
LICENSED FOR THE USE OF TREATING HELICOBACTER PYLORI.
What is the primary mechanism of action of sucralfate, a medication used for the treatment of duodenal ulcers?
A) Antagonism of histamine receptors
B) Enhancement of gastric emptying
C) Formation of a protective barrier over ulcers
D) Inhibition of gastric acid secretion
E) Stimulation of mucus production
C
RATIONALE: SUCRALFATE EXHIBITS ITS ACTION BY FORMING A
PROTECTIVE LAYER, INCREASING BICARBONATE PRODUCTION,
EXHIBITING ANTI-PEPTIC EFFECTS, PROMOTING TISSUE GROWTH,
REGENERATION, AND REPAIR.
Which medication is a synthetic immunosuppressive agent used for the induction and maintenance therapy of Crohn’s disease and ulcerative colitis, particularly in patients who have failed other treatments?
A) Adalimumab
B) Methotrexate
C) Sulfasalazine
D) Tacrolimus
E) Vedolizumab
E
RATIONALE: THE QUESTION IMPLIES THAT OTHER TREATMENTS HAVE
FAILED. SULFASALAZINE AND BUDESONIDE ARE LIKELY TO HAVE BEEN
USED PREVIOUSLY. THERE IS NO EVIDENCE FOR USING
METHOTREXATE IN INDUCING OR MAINTAINING REMISSION, EVEN
THOUGH IT IS USED IN PRACTICE. TACROLIMUS IS NOT USED BUT
CICLOSPORIN IS. VEDOLIZUMAB IS THE MOST APPROPRIATE CHOICE.
Which vitamin is essential for the synthesis of clotting factors in the liver?
A) Vitamin A
B) Vitamin B12
C) Vitamin C
D) Vitamin D
E) Vitamin K
E
RATIONALE: PROTHROMBIN IS A VITAMIN K-DEPENDENT PROTEIN
DIRECTLY INVOLVED WITH BLOOD CLOTTING. OSTEOCALCIN IS
ANOTHER PROTEIN THAT REQUIRES VITAMIN K TO PRODUCE
HEALTHY BONE TISSUE
You are a community pharmacist, and it is the middle of the afternoon. You receive a call from a newly qualified doctor who has a mother and child in her consultation room. She explains that the child is 7 years old and has h. pylori and wants your opinion on what a suitable treatment regimen would be. The child has no allergies. The following regimen is not a suitable regimen for a child aged 7 years old for H. Pylori
A) Amoxicillin 500mg twice daily and Clarithromycin 500mg twice daily with Omeprazole 20mg twice daily
B) Amoxicillin 500mg three times daily and Clarithromycin 500mg twice daily with Omeprazole 20mg twice daily
C) Clarithromycin 500mg twice daily and Metronidazole 100mg twice daily with Omeprazole 20mg twice daily
D) Clarithromycin 500mg twice daily and Metronidazole 200mg twice daily with Omeprazole 20mg twice daily
E) Metronidazole 200mg three times daily with amoxicillin 250mg three times daily with omeprazole 20mg twice daily
C
RATIONALE: SEE BNFC. OPTION C IS THE ONLY ONE WITH
INCORRECT DOSING FOR THIS AGE BRACKET (I.E. 100MG OF
METRONIDAZOLE RATHER THAN 200MG).
You are a pharmacist working on a gastroenterology ward. Which of the following medications is a bile acid sequestrant used to lower cholesterol levels and occasionally used off-label for the treatment of chronic diarrhoea?
A) Cholestyramine
B) Diphenoxylate/atropine
C) Docusate sodium
D) Loperamide
E) Prucalopride
A
RATIONALE:CHOLESTYRAMINE IS A BILE ACID SEQUESTRANT MAINLY
USED TO TREAT HIGH CHOLESTEROL BUT IT CAN ALSO BE USED
OFF-LABEL TO TREAT BILE ACID DIARRHEA. THE DRUG IS TAKEN BY
MOUTH AND WORKS BY CLEARING EXCESS BILE ACID FROM THE
BODY. MANY CASES OF CHRONIC DIARRHEA ARE CAUSED BY BILE
ACID MALABSORPTION
A patient has been newly started on oxycodone modified release tablets following an elective total knee replacement. As part of the orthopaedic proforma, patients are prescribed laxatives to avoid constipation associated with analgesia. Which medication is a synthetic opioid agonist used for the treatment of opioid-induced constipation?
A) Alosetron
B) Diphenoxylate/atropine
C) Linaclotide
D) Methylnaltrexone
E) Naloxegol
E
RATIONALE: WHEN ADMINISTERED AT THE RECOMMENDED DOSE
LEVELS, NALOXEGOL FUNCTIONS AS A PERIPHERALLY-ACTING MU-
OPIOID RECEPTOR ANTAGONIST IN TISSUES SUCH AS THE
GASTROINTESTINAL TRACT, THEREBY DECREASING THE
CONSTIPATING EFFECTS OF OPIOIDS.
Which of the following is a water-soluble vitamin that plays a role in the formation of coenzymes involved in energy metabolism?
A) Vitamin A
B) Vitamin B1 (Thiamine)
C) Vitamin C
D) Vitamin D
E) Vitamin E
C
RATIONALE: C
RATIONALE: VITAMIN C IS THE ONLY WATER SOLUBLE
VITAMIN.
Whilst working on the gastroenterology ward as a clinical pharmacist, you’ve noticed that you often come across many patients who present with alcohol excess. Many of these patients are initially started on Pabrinex, before being stepped down to high dose oral thiamine. Which complication does the use of thiamine prevent?
A) Alcohol withdrawal
B) Hepatic failure
C) Jaundice
D) Peripheral neuropathy
E) Wernicke’s Encephalopathy
E
RATIONALE: THIAMINE DEPLETION IS RELATED TO
WERNICKE’S ENCEPHALOPATHY. JAUNDICE AND HEPATIC
FAILURE ARE RELATED TO ALCOHOL EXCESS, BUT HIGH DOSE
THIAMINE IS NOT USED PRIMARILY TO PREVENT THIS.
ALCOHOL WITHDRAWAL IS MANAGED ACUTELY WITH
CHLORDIAZEPOXIDE, OR IN SEVERE HEPATIC IMPAIRMENT,
OXAZEPAM.
What is the best description of the primary mechanism of action of prucalopride, a medication used for the treatment of chronic idiopathic constipation?
A) Antagonism of muscarinic receptors
B) Blockade of opioid receptors
C) Enhancement of gastric motility
D) Inhibition of serotonin reuptake
E) Stimulation of serotonin 5-HT4 receptors
C
RATIONALE: PRUCALOPRIDE IS USED TO TREAT CHRONIC
IDIOPATHIC (UNKNOWN CAUSE) CONSTIPATION (CIC). IT
WORKS BY INCREASING PERISTALSIS (CONTRACTIONS) IN
THE COLON, LEADING TO AN INCREASE IN THE NUMBER OF
BOWEL MOVEMENTS. THIS IS THOUGHT TO BE THE PRIMARY
MECHANISM UNDERLYING THE PROKINETIC EFFECTS OF 5-
HT4 RECEPTOR AGONISTS.
Which of the following antibiotics is not associated with an elevated risk of causing the secondary gastrointestinal infection clostridium difficile?
A) Cefalexin
B) Ciprofloxacin
C) Clarithromycin
D) Clindamycin
E) Co-amoxiclav
C
RATIONALE: CO-AMOXICLAV, CLINDAMYCIN, CEPHALOSPORINS AND
QUINOLONES (E.G. CIPROFLOXACIN) ARE THE FOUR C’S RELATED TO AN
INCREASE IN C DIFFICILE RISK. CLARITHROMYCIN IS NOT.
A 30-year-old gentleman presents to your community pharmacy complaining of constipation. After performing a consultation, you can rule out any red flags that would indicate a need for an urgent referral. The patient explains that he would like something convenient that he can take at night that will solve the problem by the morning. Based on the patient’s request, which of the following laxatives would be the most appropriate choice?
A) Glycerol suppositories
B) Ispaghula Husk sachets
C) Lactulose
D) Macrogol sachets (Movicol/Laxido)
E) Sennoside tablets
E
RATIONALE: SENNA WOULD BE THE MOST APPROPRIATE
CHOICE. GLYCEROL SUPPOSITORIES WOULD WORK TOO
QUICKLY AND WOULD DISTURB THE PATIENT’S SLEEP.
ISPAGHULA HUSK SHOULD NEVER BE TAKEN BEFORE BED.
LACTULOSE CAN TAKE UP TO 72 HOURS TO WORK, AND
MACROGOL SACHETS CAN TAKE 24-48 HOURS TO WORK.
What is the primary mechanism of action of budesonide, a corticosteroid used for the treatment of Crohn’s disease and ulcerative colitis?
A) Enhancement of gastrointestinal motility
B) Inhibition of leukotriene synthesis
C) Inhibition of prostaglandin synthesis
D) Modulation of inflammation within the intestinal mucosa
E) Suppression of interleukin-1 (IL-1) production
D
RATIONALE: BUDESONIDE IS IN A CLASS OF MEDICATIONS
CALLED CORTICOSTEROIDS. IT WORKS BY DECREASING
INFLAMMATION (SWELLING) IN THE DIGESTIVE TRACT OF THOSE
WHO HAVE CROHN’S DISEASE OR ULCERATIVE COLITIS.
Which medication is a non-absorbable synthetic disaccharide used for the treatment of hepatic encephalopathy?
A) Lactulose
B) Mesalazine
C) Misoprostol
D) Rifaximin
E) Sulfasalazine
A
RATIONALE: LACTULOSE IS USED IN PREVENTING AND
TREATING CLINICAL PORTAL-SYSTEMIC ENCEPHALOPATHY. ITS
CHIEF MECHANISM OF ACTION IS BY DECREASING THE
INTESTINAL PRODUCTION AND ABSORPTION OF AMMONIA
A 59-year-old patient presents to your community pharmacy complaining of gastroesophageal reflux disease. She explains that when this happens, she normally has Gaviscon and it tends to clear right up, however on this occasion, it hasn’t. Upon further questioning, you can elucidate that she’s lost a bit of weight in the past two weeks, however she puts that down to a decrease in appetite due to the persistent GORD. The most appropriate option would be to:
A) Explain that Gaviscon isn’t suitable for long term use and recommend that she purchase Esomeprazole over the counter. Start at a low dose of 20mg daily, and up titrate
B) Explain that Gaviscon isn’t suitable for long term use and recommend that she make an appointment with her GP to obtain Pantoprazole 40mg daily
C) Explain that Gaviscon isn’t suitable for long term use and recommend that she make an appointment with her GP to obtain Famotidine 20mg daily at night. Whilst a proton pump inhibitor is useful, prolonged use can increase the risk of osteoporosis, which she would be susceptible to give her age
D) Make an urgent referral to the GP
E) Supply her with Gaviscon and reiterate that she can use this after meals and before bedtime to optimise the efficacy of the medication
D
RATIONALE: SYMPTOMS OF GASTROESOPHAGEAL REFLUX
DISEASE AND UNEXPLAINED WEIGHT LOSS IN SOMEONE
OVER THE AGE OF 55 ARE BOTH RED FLAGS THAT WOULD
WARRANT URGENT REFERRALS TO RULE OUT EITHER
STOMACH CANCER OR OESOPHAGEAL CANCER. A PPI COULD
MASK THIS WHICH WOULD MAKE OPTIONS A AND B
INAPPROPRIATE. E WOULD ALSO BE INAPPROPRIATE, AND C
IS A REFERRAL, BUT FOR THE WRONG REASONS.
Which medication is commonly used as an antacid to neutralise gastric acid in conditions such as heartburn and acid indigestion?
A) Aluminium hydroxide
B) Calcium carbonate
C) Magnesium hydroxide
D) Sodium bicarbonate
E) Sucralfate
B
RATIONALE: CALCIUM CARBONATE IS AN IONIC COMPOUND USED AS A
CALCIUM SUPPLEMENT OR ANTACID USED FOR THE SYMPTOMATIC
RELIEF OF HEARTBURN, ACID INDIGESTION, AND SOUR STOMACH.
You are a ward pharmacist reviewing a patient’s drug chart. The patient has been started on aspirin and clopidogrel for a month as dual therapy following a STEMI, however the patient discloses that he cannot have aspirin due to a previous peptic ulcer. The doctor asks for your opinion as to what the best option is
A) Instead of aspirin and clopidogrel, commence the patient on warfarin. There is no evidence to indicate warfarin is contraindicated in peptic ulcer disease. Warfarin would also fully anticoagulated the patient
B) Refer the patient to gastroenterology for their expert opinion
C) The patient cannot have aspirin – he will have to continue clopidogrel alone
D) The patient cannot miss his aspirin – if he takes aspirin on a full stomach, he should be able to manage as the pH of the stomach rises in the fed state
E) The patient should be started on lansoprazole concomitant with aspirin and clopidogrel to mitigate the risk of a further peptic ulcer
E
RATIONALE: E IS THE ONLY OPTION THAT IS EVIDENCE
BASED. THERE IS NO EVIDENCE TO SUGGEST USING WARFARIN
IN PLACE OF DUAL ANTIPLATELET THERAPY FOLLOWING A
STEMI IS APPROPRIATE. A REFERRAL TO GASTROENTEROLOGY
WOULD BE INAPPROPRIATE. SINGLE ANTIPLATELET THERAPY
WOULD NOT BE APPROPRIATE EITHER, AND YOU CANNOT
GUARANTEE THE PATIENT WILL NOT HAVE COMPLICATIONS
BY TAKING ASPIRIN ON A FULL STOMACH - THIS APPROACH IS
ALSO DEPENDENT ON THE PATIENT EATING. A PPI WOULD BE
THE MOST APPROPRIATE
