PUD PCol Quiz Flashcards
Match the pharmacologic class with an advantage and disadvantage of these agents:
Antacids
H2RAs
PPIs
Most potent inhibitor of acid secretion, good efficacy/safety, long duration of action, but expensive
Good efficacy, well tolerated and safe but doses need to be adjusted when renal function is impaired
Prompt acting, but short duration of action
Antacids - prompt acting, but short duration of action
H2RAs - good efficacy, well tolerated and safe but does need to be adjusted when renal function is impaired
PPIs - most potent inhibitor of acid secretion, good efficacy/safety, long duration of action, but expensive
Identify the preferred triple therapy of H. pylori infection:
A) Lansoprazole 30 mg PO BID with amoxicillin (1 g BID) and clarithromycin (500 mg BID) for 10-14 days
B) Famotidine 40 mg PO BID with amoxicillin 1 gm BID and clarithromycin 500 mg BID for 10-14 days
C) Pepto bismol every hour plus ranitidine 150 mg BID plus cipro 750 mg BID plus imipenem ` gm IV every 6 hours for 10-14 days
D) MAalox 30 mL PO every hour until sx improve
A
A patient 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) Ranitidine
B) Magnesium hydroxide
C) Aluminum hydroxide
D) Metoclopramide
B - a laxative that mildly stimulates the gut is suitable for a patient taking a smooth muscle relaxant drug like verapamil. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions
On your way to the next MCQ exam, you experience that feeling that an attack of diarrhea is imminent. Stopping 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 mepiridine?
A) Aluminum hydroxide
B) Diphenoxylate
C) Loperamide
D) Magnesium hydroxide
C - aluminum hydroxide is constipating but not related chemically to meperidine; magnesium hydroxide is a strong laxative. The 2 antidiarrheal drugs structurally related to opioids are diphenoxylate and loperamide. Loperamide is available OTC, diphenoxylate is mixed with atropine, and the product requires a prescription
List at least 5 examples of prescription and non prescription medications associated with liver injury.
OTC/non-rx: alcohol, acetaminophen (high doses), NSAIDs especially diclofenac (some NSAIDs are safer than others)
Rx: seizure meds (almost all, especially phenytoin), statins (high doses), amiodarone, allopurinol, methotrexate, antipsychotics
Portal hypertension: beta adrenergic antagonists are used to reduced portal pressure by reducing portal venous outflow and reducing CO thus reducing splanchnic blood flow. Which statement is most correct?
A) Metoprolol is preferred
B) Non-selective BB are preferred as use results in reduction of varices and improved mortality
C) Non-selective BB are preferred as use results in reduction of variceal bleeding and risk of rebleeding
D) Beta agonists such as isoproterenol are used to reduce portal pressure, and reduce risk of rebleeding
C - this is the same thing as saying non selective BBs are good for esophageal varices prophylaxis
When used to manage portal hypertension the dosing strategy for beta adrenergic antagonists is best described as:
A) Start at the maximum or target dose and down titrate once pressure is under control
B) Start with the lowest recommended starting dose, and titrate towards target efficacy dose while carefully monitoring heart rate
C) Start with metoprolol CL and switch to immediate release once target heart rate is reached
B
Ascites treatment - which statement is most correct?
A) Spironolactone is classified as an angiotensin receptor antagonist
B) Spironolactone is combined with a loop diuretic
C) The furosemide dose is 100 mg day to 40 mg per day for spironolactone
B
Cefotaxime, or ceftriaxone, or ampicillin/sulbactam are considered first line antibiotic treatments for SBP because:
A) Because of their activity against E coli and proteus
B) Because they are useful agents for patients having a documented severe allergic reaction to penicillin
C) Because of their activity against staph, strep, and atypical bacteria
D) Are only used when symptoms of infection are supported by a positive culture of ascitic fluid
A
Concerns about the overuse and adverse effects associated with PPIs have prompted deprescribing in some situations. Deprescribing PPIs is recommended in patients with which of the following conditions?
A) Barrett’s esophagus
B) Mild to moderate esophagitis
C) Documented history of bleeding GI ulcer
D) Chronic NSAID use with bleeding risk
B - deprescribing of PPIs is recommended in patients with the following conditions:
Mild to moderate esophagitis
GERD treated for 4-8 weeks (esophagitis healed, symptoms controlled)
Peptic ulcer disease treated for 2-12 weeks
Upper GI symptoms without endoscopy (asx for 3 consecutive days)
Stress ulcer prophylaxis treated beyond intensive care unit admission
Uncomplicated H. pylori infection treated for 2 weeks (asx)
PPI use should be continued in patients with the following conditions:
Barrett’s esophagus
Chronic NSAID use with bleeding risk
Severe esophagitis
Documented history of bleeding GI ulcer
