front 1 -prazole | back 1 PPIs |
front 2 -tidine | back 2 H2 blockers |
front 3 -setron | back 3 5-HT3 antagonists |
front 4 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 | back 4 B. Renal insufficiency |
front 5 Histamine binding at the parietal-cell H2 receptor primarily signals through which pathway? A. Phospholipase C | back 5 D. Adenylyl cyclase/cAMP |
front 6 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 | back 6 A. Strong nocturnal, modest meal |
front 7 Which H2-receptor antagonist has relatively little first-pass metabolism? A. Famotidine | back 7 C. Nizatidine |
front 8 A hospitalized patient on warfarin, phenytoin, and theophylline needs an H2 blocker. Which agent is most likely to cause cytochrome P450 interactions? A. Famotidine | back 8 B. Cimetidine |
front 9 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 | back 9 D. Crosses the placenta |
front 10 Which adverse-effect pattern is most consistent with long-term H2-receptor antagonist use? A. Nephrolithiasis and edema | back 10 C. Gynecomastia and galactorrhea |
front 11 A patient with symptomatic GERD has incomplete relief with an H2 blocker. Which drug class is preferred, and why? A. PPIs; superior acid inhibition | back 11 A. PPIs; superior acid inhibition |
front 12 A patient is diagnosed with Helicobacter pylori gastritis. Which acid-suppressing drug class should be part of treatment? A. Antacids | back 12 D. PPIs |
front 13 Which regimen best matches first-line therapy for H. pylori infection with associated ulceration? A. Omeprazole + tetracycline + bismuth | back 13 B. Omeprazole + clarithromycin + amoxicillin |
front 14 How are proton pump inhibitors typically administered? A. IV active salts | back 14 C. Oral inactive prodrugs |
front 15 Which proton pump inhibitor has the fastest onset of acid inhibition? A. Omeprazole | back 15 A. Omeprazole |
front 16 Which acid-suppression profile best describes PPIs? A. Modest nocturnal, strong meal | back 16 D. Strong in both settings |
front 17 A patient with a gastrinoma has refractory hypersecretion. Which drug class is used for treatment? A. H2 antagonists | back 17 B. PPIs |
front 18 A patient on long-term PPI therapy develops macrocytic anemia and neuropathy. Which deficiency is most strongly associated? A. Vitamin B12 | back 18 A. Vitamin B12 |
front 19 Long-term PPI therapy has been implicated in which skeletal complication? A. Osteomalacia | back 19 C. Osteoporosis |
front 20 A nursing-home patient on chronic PPIs develops severe antibiotic-associated diarrhea. Which infection risk is increased with PPI use? A. Giardia lamblia | back 20 B. Clostridium difficile |
front 21 Which adverse-effect pair has been associated with long-term PPI use? A. Pancreatitis and seizure | back 21 D. Kidney damage and dementia |
front 22 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 | back 22 A. Parietal cells |
front 23 The cell hyperplasia seen after prolonged PPI therapy is driven by excess serum: A. Secretin | back 23 C. Gastrin |
front 24 Proton pump inhibitors are primarily metabolized by which cytochrome P450 enzymes? A. CYP2D6 and CYP1A2 | back 24 B. CYP2C19 and CYP3A4 |
front 25 PPI therapy should be monitored carefully in patients taking which antiplatelet drug? A. Aspirin | back 25 D. Clopidogrel |
front 26 A patient on clopidogrel starts omeprazole for reflux. What is the most important pharmacologic concern? A. Increased clopidogrel renal clearance | back 26 B. Reduced clopidogrel CYP2C19 activation |
front 27 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 | back 27 C. Sucralfate |
front 28 Sucralfate is best classified as which type of agent? A. Proton pump inhibitor | back 28 B. Mucosal protective agent |
front 29 Misoprostol is an analog of which mediator? A. PGE1 | back 29 A. PGE1 |
front 30 Which patient should not receive misoprostol (given to prevent gastric ulcers in pts using NSAIDs)? A. Man with GERD | back 30 B. Woman with pregnancy |
front 31 Bismuth subsalicylate is commonly included in treatment for which condition? A. Achalasia | back 31 C. H. pylori infection |
front 32 A backpacker develops traveler’s diarrhea. Which regimen from this material is appropriate? A. Bismuth subsalicylate 2–4x daily | back 32 A. Bismuth subsalicylate 2–4x daily |
front 33 Which neurotransmitter activates 5-HT1P receptors on intrinsic primary afferent nerves? A. Acetylcholine | back 33 C. Serotonin |
front 34 Activation of 5-HT1P pathways in the gut most directly does what? A. Inhibits gut motility | back 34 B. Stimulates gut motility |
front 35 Metoclopramide and domperidone primarily act by blocking which receptor? A. Muscarinic M3 | back 35 B. Dopamine D2 |
front 36 A diabetic patient has early satiety, nausea, and delayed gastric emptying. Which drug pair is specifically used for this condition? A. Misoprostol and sucralfate | back 36 D. Metoclopramide and domperidone |
front 37 Metoclopramide and domperidone are especially useful because they are potent: A. Antidiarrheals | back 37 C. Antiemetics |
front 38 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 | back 38 B. Drowsiness, anxiety, tardive dyskinesia |
front 39 Which macrolide promotes formation of the migrating motor complex by stimulating motilin receptors? A. Azithromycin | back 39 C. Erythromycin |
front 40 Psyllium, methylcellulose, and polycarbophil are which type of laxatives? A. Osmotic | back 40 C. Bulk-forming |
front 41 Docusate and mineral oil are best classified as: A. Stool softeners | back 41 A. Stool softeners |
front 42 Magnesium hydroxide and sorbitol belong to which laxative class? A. Lubricant | back 42 B. Osmotic |
front 43 A patient is instructed to take polyethylene glycol before a GI procedure. Which procedure is being prepared for? A. ERCP | back 43 B. Endoscopy |
front 44 Aloe, senna, cascara, and bisacodyl are what? A. Bulk-forming | back 44 D. Stimulant laxatives |
front 45 Lubiprostone improves constipation by stimulating which target? A. Type 2 chloride channels | back 45 A. Type 2 chloride channels |
front 46 Lubiprostone acts primarily in which GI region according to this material? A. Esophagus | back 46 D. Small bowel |
front 47 Naldemedine, naloxegol, methylnaltrexone, and alvimopan treat constipation by blocking which receptors? A. Central κ-opioid | back 47 B. Peripheral μ-opioid |
front 48 A patient develops severe constipation after chronic opioid therapy but should maintain analgesia. Which drug class is most appropriate? A. Peripheral μ antagonists | back 48 A. Peripheral μ antagonists |
front 49 A patient with opioid-induced constipation is started on naloxegol. Which cytochrome system is most important for its metabolism? A. CYP2D6 | back 49 B. CYP3A4 |
front 50 A patient with chronic idiopathic constipation is prescribed a selective serotonin agonist that enhances motility. Which drug fits this description? A. Alosetron | back 50 C. Prucalopride |
front 51 Bile salt-binding resins Cholestyramine, colestipol and colesevelam are used to treat? | back 51 diarrhea |
front 52 Prucalopride acts primarily at which receptor? A. 5-HT1A | back 52 D. 5-HT4 |
front 53 Prucalopride is indicated for treatment of: A. Diarrhea | back 53 B. Constipation |
front 54 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 | back 54 A. Loperamide, eluxadoline, diphenoxylate |
front 55 Which opioid agonist for diarrhea does not cross the CNS barrier? A. Diphenoxylate | back 55 D. Loperamide |
front 56 Which antidiarrheal opioid can cross the CNS barrier? A. Loperamide | back 56 B. Diphenoxylate |
front 57 Diphenoxylate is administered with which agent to reduce abuse potential? A. Meclizine | back 57 C. Atropine |
front 58 A patient with Crohn disease affecting the terminal ileum develops bile salt malabsorption with chronic diarrhea. Which treatment is most appropriate? A. Cholestyramine | back 58 A. Cholestyramine |
front 59 Which therapy is considered front-line for neuroendocrine tumors based on this material? A. Octreotide and resection | back 59 A. Octreotide and resection |
front 60 A patient started on octreotide develops bulky, greasy stools. Which GI adverse effect is most likely? A. Constipation | back 60 C. Steatorrhea |
front 61 Dicyclomine and hyoscyamine belong to which drug class? A. Antispasmodic anticholinergics | back 61 A. Antispasmodic anticholinergics |
front 62 Dicyclomine and hyoscyamine reduce spasm primarily by blocking which receptor? A. M1 | back 62 C. M3 |
front 63 Which 5-HT3 antagonist is specifically indicated for IBS? A. Ondansetron | back 63 B. Alosetron |
front 64 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 | back 64 A. 5-HT3 antagonists |
front 65 Ondansetron is best classified as a: A. NK1 antagonist | back 65 D. 5-HT3 antagonist |
front 66 A patient with baseline QT prolongation needs antiemetic therapy. Which drug class from this material should be avoided? A. H1 antagonists | back 66 B. 5-HT3 antagonists |
front 67 Aprepitant prevents nausea and vomiting by antagonizing which receptor? A. D2 | back 67 B. NK1 |
front 68 Which pair of H1 antagonists is used for motion sickness and emesis? A. Ondansetron and alosetron | back 68 C. Meclizine and diphenhydramine |
front 69 5-aminosalicylic acid is indicated for: A. IBS only | back 69 C. IBD including Crohn disease |
front 70 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 | back 70 B. Sulfasalazine |
front 71 Sulfasalazine is most appropriately indicated for which condition? A. Primary biliary cirrhosis | back 71 C. Inflammatory bowel disease |
front 72 A man being treated for IBD reports reduced fertility during therapy. Which adverse effect is classically associated with sulfasalazine? A. Gynecomastia | back 72 B. Oligospermia |
front 73 Sulfasalazine impairs absorption of which vitamin, requiring supplementation? A. Vitamin B12 | back 73 C. Folate |
front 74 Which glucocorticoid is specifically indicated in the treatment of IBD? A. Prednisone | back 74 D. Budesonide |
front 75 Which pair of purine analogs is used for IBD immunosuppression? A. Methotrexate and leflunomide | back 75 B. Azathioprine and 6-mercaptopurine |
front 76 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 | back 76 D. Allopurinol |
front 77 Azathioprine and 6-mercaptopurine are primarily metabolized by which enzyme? A. Dihydrofolate reductase | back 77 B. Xanthine oxidase |
front 78 Why does allopurinol contraindicate the use of azathioprine or 6-mercaptopurine in this material? A. It induces CYP3A4 | back 78 C. It inhibits xanthine oxidase |
front 79 Which adverse-effect triad is most characteristic of azathioprine and 6-mercaptopurine? A. Seizures, rash, nephritis | back 79 B. Nausea, hepatotoxicity, bone marrow depression |
front 80 Infliximab, golimumab, and adalimumab are used in IBD with therapeutic targeting of which T-helper subset? A. Th1 | back 80 A. Th1 |
front 81 Infliximab and adalimumab act by which mechanism? A. Anti-IL-5 antibodies | back 81 B. Anti-TNF monoclonal antibodies |
front 82 Which biologic is best classified as an anti-integrin antibody? A. Adalimumab | back 82 C. Natalizumab |
front 83 A patient on natalizumab develops progressive neurologic decline due to viral reactivation. Which complication is most concerning? A. HSV encephalitis | back 83 D. JC virus causing PML |
front 84 First-line pharmacotherapy for primary biliary cirrhosis is: A. Ursodiol | back 84 B. Obeticholic acid |
front 85 Obeticholic acid is used to treat which disease? A. Ulcerative colitis | back 85 B. Primary biliary cirrhosis |
front 86 A patient with primary biliary cirrhosis starts a synthetic bile acid and develops severe itching. Which drug most likely caused this? A. Ursodiol | back 86 C. Obeticholic acid |
front 87 Which dual-drug regimen can be used for variceal hemorrhage? A. Ursodiol and budesonide | back 87 B. Octreotide and vasopressin |
front 88 what histamine receptor (H1/H2/H3/H4) antagonist is useful to prevent vomiting? | back 88 H1 |
front 89 what antimuscarinic drug is useful to prevent vomiting? (it starts with an S) | back 89 scopalamine |
front 90 What drug is useful in the treatment of Zollinger-Ellison syndrome? | back 90 PPIs |
front 91 anticholingerics, serotonin, antagonists are used in ____ | back 91 IBS |
front 92 Ursodiol is used for the prevention of _____ in obese patients undergoing rapid weight loss | back 92 gallstones |
front 93 promote the eradication of H. pylori via direct antimicrobial properties & by increasing intragastric pH which decreased the MIC of antibiotics against H. pylori | back 93 PPIs |
front 94 for H2 antagonists: Cimetidine, ranitidine and famotidine all undergo ______ metabolism | back 94 first-pass |
front 95 What cells contain receptors for gastrin (CCK-B), histamine (H2) and acetylcholine (M3)? | back 95 Parietal |
front 96 What neurotransmitter decreases the intensity of esophageal and gastric contractions? | back 96 Dopamine |
front 97 Magnesium hydroxide (milk of magnesia), sorbital and lactulose are ____ laxatives | back 97 osmotic |
front 98 Histamine binds to the _____ receptor on the parietal cell which stimulates acid secretion by the H+/K+ ATPase | back 98 H2 |
front 99 ______ system is important in motion sickness and is rich in muscarinic (M1) and histamine H1 receptors | back 99 vestibular |
front 100 what drug causes black stool? | back 100 bismuth |