Pharm 62 Flashcards

-prazole

-tidine

-setron

A patient with chronic dyspepsia and stage 4 CKD asks about taking magnesium hydroxide/aluminum hydroxide daily. Which comorbidity makes long-term use inappropriate?

A. Hepatic insufficiency
B. Renal insufficiency
C. Pancreatic insufficiency
D. Adrenal insufficiency

Histamine binding at the parietal-cell H2 receptor primarily signals through which pathway?

A. Phospholipase C
B. Guanylyl cyclase
C. Tyrosine kinase
D. Adenylyl cyclase/cAMP

A patient takes an H2-receptor antagonist before bed for nocturnal acid symptoms. Which secretion pattern best matches this drug class?

A. Strong nocturnal, modest meal
B. Modest nocturnal, strong meal
C. Modest in both settings
D. Strong in both settings

Which H2-receptor antagonist has relatively little first-pass metabolism?

A. Famotidine
B. Ranitidine
C. Nizatidine
D. Cimetidine

A hospitalized patient on warfarin, phenytoin, and theophylline needs an H2 blocker. Which agent is most likely to cause cytochrome P450 interactions?

A. Famotidine
B. Cimetidine
C. Nizatidine
D. Ranitidine

A pregnant patient asks whether an H2-receptor antagonist is safe. Based on this material, why should this class be avoided?

A. Causes fetal bradycardia
B. Triggers premature labor
C. Worsens maternal hypotension
D. Crosses the placenta

Which adverse-effect pattern is most consistent with long-term H2-receptor antagonist use?

A. Nephrolithiasis and edema
B. Tremor and palpitations
C. Gynecomastia and galactorrhea
D. Constipation and ileus

A patient with symptomatic GERD has incomplete relief with an H2 blocker. Which drug class is preferred, and why?

A. PPIs; superior acid inhibition
B. Antacids; faster neutralization
C. Sucralfate; better adhesion
D. Misoprostol; stronger healing

A patient is diagnosed with Helicobacter pylori gastritis. Which acid-suppressing drug class should be part of treatment?

A. Antacids
B. Sucralfate
C. H2 antagonists
D. PPIs

Which regimen best matches first-line therapy for H. pylori infection with associated ulceration?

A. Omeprazole + tetracycline + bismuth
B. Omeprazole + clarithromycin + amoxicillin
C. Famotidine + clarithromycin + amoxicillin
D. Nizatidine + amoxicillin + metronidazole

How are proton pump inhibitors typically administered?

A. IV active salts
B. Sublingual active forms
C. Oral inactive prodrugs
D. Rectal buffered suspensions

Which proton pump inhibitor has the fastest onset of acid inhibition?

A. Omeprazole
B. Pantoprazole
C. Rabeprazole
D. Lansoprazole

Which acid-suppression profile best describes PPIs?

A. Modest nocturnal, strong meal
B. Strong nocturnal, modest meal
C. Modest in both settings
D. Strong in both settings

A patient with a gastrinoma has refractory hypersecretion. Which drug class is used for treatment?

A. H2 antagonists
B. PPIs
C. Antacids
D. Prokinetics

A patient on long-term PPI therapy develops macrocytic anemia and neuropathy. Which deficiency is most strongly associated?

A. Vitamin B12
B. Folate
C. Thiamine
D. Vitamin D

Long-term PPI therapy has been implicated in which skeletal complication?

A. Osteomalacia
B. Osteopetrosis
C. Osteoporosis
D. Osteitis fibrosa

A nursing-home patient on chronic PPIs develops severe antibiotic-associated diarrhea. Which infection risk is increased with PPI use?

A. Giardia lamblia
B. Clostridium difficile
C. Salmonella typhi
D. Shigella sonnei

Which adverse-effect pair has been associated with long-term PPI use?

A. Pancreatitis and seizure
B. Hepatitis and psychosis
C. Retinopathy and ataxia
D. Kidney damage and dementia

A patient stops prolonged PPI therapy and develops rebound acid-related symptoms. Hyperplasia of which gastric cell type helps explain this phenomenon?

A. Parietal cells
B. Chief cells
C. Mucous cells
D. Enterochromaffin cells

The cell hyperplasia seen after prolonged PPI therapy is driven by excess serum:

A. Secretin
B. Motilin
C. Gastrin
D. Somatostatin

Proton pump inhibitors are primarily metabolized by which cytochrome P450 enzymes?

A. CYP2D6 and CYP1A2
B. CYP2C19 and CYP3A4
C. CYP2E1 and CYP2D6
D. CYP2C9 and CYP1A2

PPI therapy should be monitored carefully in patients taking which antiplatelet drug?

A. Aspirin
B. Ticagrelor
C. Dipyridamole
D. Clopidogrel

A patient on clopidogrel starts omeprazole for reflux. What is the most important pharmacologic concern?

A. Increased clopidogrel renal clearance
B. Reduced clopidogrel CYP2C19 activation
C. Increased platelet P2Y12 binding
D. Reduced aspirin enterohepatic cycling

A patient with a painful duodenal ulcer is prescribed a drug that adheres to the lesion and shields it from acid and pepsin. Which drug was most likely given?

A. Misoprostol
B. Bismuth subsalicylate
C. Sucralfate
D. Metoclopramide

Sucralfate is best classified as which type of agent?

A. Proton pump inhibitor
B. Mucosal protective agent
C. Dopamine antagonist
D. Motilin agonist

Misoprostol is an analog of which mediator?

A. PGE1
B. PGI2
C. TXA2
D. LTC4

Which patient should not receive misoprostol (given to prevent gastric ulcers in pts using NSAIDs)?

A. Man with GERD
B. Woman with pregnancy
C. Teen with diarrhea
D. Elder with ulcer history

Bismuth subsalicylate is commonly included in treatment for which condition?

A. Achalasia
B. Appendicitis
C. H. pylori infection
D. Ulcerative colitis

A backpacker develops traveler’s diarrhea. Which regimen from this material is appropriate?

A. Bismuth subsalicylate 2–4x daily
B. Sucralfate before each meal
C. Omeprazole every other day
D. Misoprostol at bedtime

Which neurotransmitter activates 5-HT1P receptors on intrinsic primary afferent nerves?

A. Acetylcholine
B. Dopamine
C. Serotonin
D. Histamine

Activation of 5-HT1P pathways in the gut most directly does what?

A. Inhibits gut motility
B. Stimulates gut motility
C. Reduces pancreatic secretion
D. Blocks enteric reflexes

Metoclopramide and domperidone primarily act by blocking which receptor?

A. Muscarinic M3
B. Dopamine D2
C. Histamine H1
D. Serotonin 5-HT3

A diabetic patient has early satiety, nausea, and delayed gastric emptying. Which drug pair is specifically used for this condition?

A. Misoprostol and sucralfate
B. Senna and bisacodyl
C. Erythromycin and PEG
D. Metoclopramide and domperidone

Metoclopramide and domperidone are especially useful because they are potent:

A. Antidiarrheals
B. Antisecretories
C. Antiemetics
D. Antispasmodics

A patient treated with metoclopramide develops restlessness, somnolence, and abnormal involuntary movements after prolonged use. Which adverse-effect set best fits?

A. Rash, cough, edema
B. Drowsiness, anxiety, tardive dyskinesia
C. Constipation, insomnia, tremor
D. Fever, jaundice, tinnitus

Which macrolide promotes formation of the migrating motor complex by stimulating motilin receptors?

A. Azithromycin
B. Clarithromycin
C. Erythromycin
D. Fidaxomicin

Psyllium, methylcellulose, and polycarbophil are which type of laxatives?

A. Osmotic
B. Stimulant
C. Bulk-forming
D. Stool softeners

Docusate and mineral oil are best classified as:

A. Stool softeners
B. Bulk agents
C. Secretagogues
D. Opioid antagonists

Magnesium hydroxide and sorbitol belong to which laxative class?

A. Lubricant
B. Osmotic
C. Bulk-forming
D. Stimulant

A patient is instructed to take polyethylene glycol before a GI procedure. Which procedure is being prepared for?

A. ERCP
B. Endoscopy
C. Cholecystectomy
D. Paracentesis

Aloe, senna, cascara, and bisacodyl are what?

A. Bulk-forming
B. Osmotic
C. Stool softeners
D. Stimulant laxatives

Lubiprostone improves constipation by stimulating which target?

A. Type 2 chloride channels
B. Sodium-glucose cotransporters
C. Gastric H+/K+ ATPase
D. Colonic μ-opioid receptors

Lubiprostone acts primarily in which GI region according to this material?

A. Esophagus
B. Stomach
C. Colon
D. Small bowel

Naldemedine, naloxegol, methylnaltrexone, and alvimopan treat constipation by blocking which receptors?

A. Central κ-opioid
B. Peripheral μ-opioid
C. Peripheral D2
D. Central 5-HT3

A patient develops severe constipation after chronic opioid therapy but should maintain analgesia. Which drug class is most appropriate?

A. Peripheral μ antagonists
B. Bulk-forming laxatives
C. Motilin agonists
D. H2 antagonists

A patient with opioid-induced constipation is started on naloxegol. Which cytochrome system is most important for its metabolism?

A. CYP2D6
B. CYP3A4
C. CYP2C19
D. CYP1A2

A patient with chronic idiopathic constipation is prescribed a selective serotonin agonist that enhances motility. Which drug fits this description?

A. Alosetron
B. Ondansetron
C. Prucalopride
D. Aprepitant

Bile salt-binding resins Cholestyramine, colestipol and colesevelam are used to treat?

Prucalopride acts primarily at which receptor?

A. 5-HT1A
B. 5-HT2
C. 5-HT3
D. 5-HT4

Prucalopride is indicated for treatment of:

A. Diarrhea
B. Constipation
C. Steatorrhea
D. Emesis

A patient with diarrhea-predominant IBS is prescribed an opioid agonist used for intestinal slowing. Which set contains only such drugs?

A. Loperamide, eluxadoline, diphenoxylate
B. Alosetron, ondansetron, prucalopride
C. Octreotide, cholestyramine, atropine
D. Meclizine, diphenhydramine, aprepitant

Which opioid agonist for diarrhea does not cross the CNS barrier?

A. Diphenoxylate
B. Eluxadoline
C. Morphine
D. Loperamide

Which antidiarrheal opioid can cross the CNS barrier?

A. Loperamide
B. Diphenoxylate
C. Eluxadoline
D. Cholestyramine

Diphenoxylate is administered with which agent to reduce abuse potential?

A. Meclizine
B. Octreotide
C. Atropine
D. Ondansetron

A patient with Crohn disease affecting the terminal ileum develops bile salt malabsorption with chronic diarrhea. Which treatment is most appropriate?

A. Cholestyramine
B. Prucalopride
C. Ondansetron
D. Diphenoxylate

Which therapy is considered front-line for neuroendocrine tumors based on this material?

A. Octreotide and resection
B. Cholestyramine and steroids
C. Ondansetron and biopsy
D. Alosetron and radiation

A patient started on octreotide develops bulky, greasy stools. Which GI adverse effect is most likely?

A. Constipation
B. Hematochezia
C. Steatorrhea
D. Dysphagia

Dicyclomine and hyoscyamine belong to which drug class?

A. Antispasmodic anticholinergics
B. 5-HT3 antagonists
C. NK1 antagonists
D. Bulk laxatives

Dicyclomine and hyoscyamine reduce spasm primarily by blocking which receptor?

A. M1
B. M2
C. M3
D. H1

Which 5-HT3 antagonist is specifically indicated for IBS?

A. Ondansetron
B. Alosetron
C. Aprepitant
D. Prucalopride

A patient receiving cisplatin develops severe nausea after chemotherapy. Which drug class is classically used here, as well as for postoperative vomiting?

A. 5-HT3 antagonists
B. M3 antagonists
C. μ-opioid agonists
D. Bulk-forming laxatives

Ondansetron is best classified as a:

A. NK1 antagonist
B. 5-HT4 agonist
C. H1 antagonist
D. 5-HT3 antagonist

A patient with baseline QT prolongation needs antiemetic therapy. Which drug class from this material should be avoided?

A. H1 antagonists
B. 5-HT3 antagonists
C. Anticholinergics
D. Bile acid resins

Aprepitant prevents nausea and vomiting by antagonizing which receptor?

A. D2
B. NK1
C. H1
D. M3

Which pair of H1 antagonists is used for motion sickness and emesis?

A. Ondansetron and alosetron
B. Dicyclomine and hyoscyamine
C. Meclizine and diphenhydramine
D. Loperamide and atropine

5-aminosalicylic acid is indicated for:

A. IBS only
B. Peptic ulcer disease
C. IBD including Crohn disease
D. Traveler’s diarrhea

A patient with inflammatory bowel disease is started on a drug that serves mainly to deliver 5-aminosalicylic acid to the distal ileum. Which drug was prescribed?

A. Budesonide
B. Sulfasalazine
C. Azathioprine
D. Ursodiol

Sulfasalazine is most appropriately indicated for which condition?

A. Primary biliary cirrhosis
B. Variceal hemorrhage
C. Inflammatory bowel disease
D. Gout prophylaxis

A man being treated for IBD reports reduced fertility during therapy. Which adverse effect is classically associated with sulfasalazine?

A. Gynecomastia
B. Oligospermia
C. Priapism
D. Hematuria

Sulfasalazine impairs absorption of which vitamin, requiring supplementation?

A. Vitamin B12
B. Vitamin B6
C. Folate
D. Vitamin K

Which glucocorticoid is specifically indicated in the treatment of IBD?

A. Prednisone
B. Dexamethasone
C. Hydrocortisone
D. Budesonide

Which pair of purine analogs is used for IBD immunosuppression?

A. Methotrexate and leflunomide
B. Azathioprine and 6-mercaptopurine
C. Cyclophosphamide and busulfan
D. Mycophenolate and tacrolimus

A patient taking azathioprine for Crohn disease is started on a gout medication and soon develops drug accumulation toxicity. Which added drug most likely caused this interaction?

A. Colchicine
B. Probenecid
C. Febuxostat
D. Allopurinol

Azathioprine and 6-mercaptopurine are primarily metabolized by which enzyme?

A. Dihydrofolate reductase
B. Xanthine oxidase
C. CYP3A4
D. Thiopurine methyltransferase

Why does allopurinol contraindicate the use of azathioprine or 6-mercaptopurine in this material?

A. It induces CYP3A4
B. It blocks renal excretion
C. It inhibits xanthine oxidase
D. It displaces albumin binding

Which adverse-effect triad is most characteristic of azathioprine and 6-mercaptopurine?

A. Seizures, rash, nephritis
B. Nausea, hepatotoxicity, bone marrow depression
C. Cough, edema, hyperglycemia
D. Constipation, neuropathy, tinnitus

Infliximab, golimumab, and adalimumab are used in IBD with therapeutic targeting of which T-helper subset?

A. Th1
B. Th2
C. Th17
D. Treg

Infliximab and adalimumab act by which mechanism?

A. Anti-IL-5 antibodies
B. Anti-TNF monoclonal antibodies
C. Anti-CD20 antibodies
D. Anti-integrin antibodies

Which biologic is best classified as an anti-integrin antibody?

A. Adalimumab
B. Golimumab
C. Natalizumab
D. Infliximab

A patient on natalizumab develops progressive neurologic decline due to viral reactivation. Which complication is most concerning?

A. HSV encephalitis
B. CMV colitis
C. EBV lymphoma
D. JC virus causing PML

First-line pharmacotherapy for primary biliary cirrhosis is:

A. Ursodiol
B. Obeticholic acid
C. Budesonide
D. Octreotide

Obeticholic acid is used to treat which disease?

A. Ulcerative colitis
B. Primary biliary cirrhosis
C. Variceal hemorrhage
D. Pancreatic insufficiency

A patient with primary biliary cirrhosis starts a synthetic bile acid and develops severe itching. Which drug most likely caused this?

A. Ursodiol
B. Sulfasalazine
C. Obeticholic acid
D. Azathioprine

Which dual-drug regimen can be used for variceal hemorrhage?

A. Ursodiol and budesonide
B. Octreotide and vasopressin
C. Infliximab and natalizumab
D. Sulfasalazine and folate

what histamine receptor (H1/H2/H3/H4) antagonist is useful to prevent vomiting?

what antimuscarinic drug is useful to prevent vomiting? (it starts with an S)

What drug is useful in the treatment of Zollinger-Ellison syndrome?

anticholingerics, serotonin, antagonists are used in ____

Ursodiol is used for the prevention of _____ in obese patients undergoing rapid weight loss

promote the eradication of H. pylori via direct antimicrobial properties & by increasing intragastric pH which decreased the MIC of antibiotics against H. pylori

for H2 antagonists: Cimetidine, ranitidine and famotidine all undergo ______ metabolism

What cells contain receptors for gastrin (CCK-B), histamine (H2) and acetylcholine (M3)?

What neurotransmitter decreases the intensity of esophageal and gastric contractions?

Magnesium hydroxide (milk of magnesia), sorbital and lactulose are ____ laxatives

Histamine binds to the _____ receptor on the parietal cell which stimulates acid secretion by the H+/K+ ATPase

______ system is important in motion sickness and is rich in muscarinic (M1) and histamine H1 receptors

what drug causes black stool?