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PODA IV Exam 2 PUD

Total questions: 65

Worksheet time: 36mins

Name
Class
Date
1.

WOTF is the MOA for an H2RA?

a)

Decrease in cAMP production

b)

Decrease in intracellular Ca++

c)

Increase in CAMP production

d)

Increase in intracellular Ca++

e)

Irreversible inhibition of proton pump

2.

WOTF would be an appropriate treatment modality for a patient who suffers frequent episodes of mild to moderate GERD?

a)

Antacid + alginic acid

b)

H2RA antacid

c)

H2RA IOW dose

d)

H2RA standard dose

e)

Low dose PPI

3.

WOTF chemical modifications, made in more recently developed H2•receptor antagonists (famotidine), make them less likely to alter CYP metabolism?

a)

Histamine derivatives with intact imidazole ring structure

b)

Histamine derivatives with addition of CH3-group at the imidazole ring C-4 position

c)

Histamine derivatives with substituted hetero atomic ring structure to replace the imidazole ring

d)

Histamine derivatives with an S-atom substituted at X

e)

Histamine derivatives with a cyanoguanidine substituted at Y

4.

A patient wants to know WOTF Trade name drugs is considered "mirror drug"

a)

Aciphex

b)

Nexium

c)

Prevacid

d)

Prilosec

e)

Protonix

5.

WOTF drugs may be used at increasing the LES pressure and only used if a patient becomes refractory to other treatment?

a)

Cisapride

b)

Levosulpiride

c)

Metoclopramide

d)

Revaspratan

e)

Sorapratan

6.

This patient also asks you why PPIs should be taken 30-60 min prior to a meal on an empty stomach

a)

Need an acidic environment for their rearrangement in to active drugs

b)

Need acidic pH for their ionization

c)

Need longer time to be fully absorbed

d)

They have characteristic PK/PD

e)

They are slowly metabolized by CYP450 system into their active form

7.

Which H2RA is associated with the most adverse effects?

a)

Cimetidine

b)

Famotidine

c)

Nizatidine

d)

Rabeprazole

e)

Ranitidine

8.

If you were to prescribe a quinolone-antibiotic to a GERD patient, who is taking an antacid and a PPI along with other drugs, such as metformin and cholesterol, you will advise this patient to temporarily:

a)

Suspend antacid

b)

Suspend metformin

c)

Suspend pravastatin

d)

Suspend PPI

e)

Take PPI after food

9.

WOTF are TRUE about the mechanisms of acid secretion?

a)

Antacids inhibit acid secretion by inhibiting protein pumps

b)

G- and M3-receptos activate proton pump by stimulation of Ca++

c)

H2 Receptors activate protein pump by stimulation of cAMP

d)

PG receptors inhibit proton pump by decreasing cAMP

e)

PG receptors are coupled to GS class Of GTP binding protein

10.

WOTF is TRUE about misoprostol?

a)

It is a PGEI receptor antagonist

b)

It is an ester of PGEI

c)

It increases LES contraction

d)

It increases cAMP production

e)

It directly inhibits proton pumps

11.

DJ is a 39•year old, 130•KG, G7-inch tall man presents with complaints of indigestion. He describes a burning sensation behind his breastbone and some belching that is often associated with acid taste in the back of his mouth. He indicates that his symptoms began a few months ago. and they occur frequently a few times a day. It worsens after eating a large or spicy meal. Also, if he eats too close to his bedtime, the burning keeps him up at night. He is using Mylanta for these symptoms and states that it works fairly well, but he has to take frequent doses, as the symptoms return quickly. He asks if there is some other medication that he could take to prevent his symptoms. He does not take any other supplements or medications.

Which of the following is a BEST pharmacological option (s) for ors condition?

a)

Antacids (oral) (used for infrequent symptoms)

b)

H,RA (used for infrequent symptoms)

c)

PPI (used for frequent symptoms)

12.

Side effects of Mylanta include

a)

Diarrhea

b)

Headache

c)

Indigestion

d)

Nausea

e)

Ulceration

13.

MOA of Ranitidine

a)

Activation of cAMP

b)

Activation Of H', K' ATPase

c)

Elevation Of intracellular Cae

d)

Inhibition Of cAMP

e)

Increase in mucus secretion

14.

Under normal conditions, which of the following would activate the proton pump by elevating parietal cells intracellular Ca++?

a)

Acetylcholine

b)

Gastrin

c)

Prostaglandin

15.

The increased selectivity in the newer H,RAs, such as ranitidine, is mainly due to the following chemical modifications:

a)

Adding a CH3 group at C-4 in the imidazole ring

b)

Presence of an intact imidazole ring

c)

Replacement of imidazole ring with a hetero atomic ring

d)

Presence of an S-atom

e)

Presence of N-cyanoguanidine

16.

Which Of the following is NOT true about PPIs?

a)

They are pro-drugs

b)

They need an acidic medium for activation

c)

They are irreversible inhibitors of proton pumps

d)

They are reversible inhibitors of proton pumps

e)

They are primarily metabolized by liver CYPS

17.

A dosage reduction of PPIs should be considered for patients with:

a)

Hepatic impairment

b)

Gastric bypass surgery

c)

Renal insufficiency

18.

If you prescribe a patient , a PPI for long term you WOUld also ask him to take a supplement of:

a)

Vitamin A

b)

Vitamin B6

c)

Vitamin B12

d)

Vitamin C

e)

Vitamin D

19.

In patients with Infrequent and moderate heartburn condition you should not

a)

antacid alginic acid

b)

H 2 RA- antacid

c)

H 2RA- low dose

d)

H2RA- standard

e)

PPI

20.

The patient also wants to kruyw which of followirw is TRUE about the mechamsm of actim of H2RA

a)

Act by block"w histamine binding to ECL cell H2 receptors

b)

Act by blocking histamine binding to parietal cell H2 receptor

c)

Act by CAMP level on cdls

d)

Effective in meal-related acid regurgitation symptoms

e)

Ineffective on acid secretion stimulated by gastrin and acetylcholine

21.

True or False: PPIs should be taken after a meal

a)

True

b)

False

22.

Which of the following drugs act by blocking the cAMP-med iated stimulation Of proton pumps in GERD?

a)

Esomeprazole

b)

Famotidine

c)

Misoprostol

d)

Omeprazole

e)

Rabeprazole

23.

The H2A receptor antagonist, such as Cimetidine, act by inhibiting the acid secretion mediated by

a)

Acetylcholine

b)

Gastrin

c)

Histamine

d)

PG1

24.

Which Of the following trade name is considered mirror drug

a)

Aciphex

b)

Nexium

c)

Prevacid

d)

Prilosec

e)

Protonix

25.

Which Of the following may be used to increase LES pressure and only if this patient becomes refractory to other treatments?

a)

Cisapride

b)

Levosulfide

c)

Metoclopramide

d)

Rabeprazole

e)

Soraprazan

26.

Which of the following best describes the reason less than 100% oral bioavailability for the majority Of H2RA such as cimetidine, ranitidine, famotidine

a)

Poor GI permeability

b)

Hepatic impairment

c)

Renal impairment

d)

Diarrhea

e)

First hepatic metabolism

27.

If you were to choose other drugs such as misoprostol analog to treat this patient because

a)

It is an antagonist of PGEI

b)

It increases mucus secretion

c)

It increases LES contraction

d)

It increases camp production

e)

It indirectly inhibits proton pump

28.

Which of the following is true about the mechanism of acid secretion? Select all that apply

a)

Antacids inhibit acid secretion by inhibiting proton pump

b)

Chi and Mg receptors activate proton pump by stimulation of Ca++

c)

H2 receptors activate proton pump by stimulation of camp

d)

PG receptors inhibit proton pump by decreasing camp

e)

PG receptors are coupled to G. class Of GT binding proteins

29.

The GIT functions and dysfunctions that are of pharmacologic importance include all below except

a)

Gastric acid secretion into the lumen of GI

b)

Increased in the motility of the bowel

c)

Excretion of contents in the lumen

d)

Excessive production of 5HT by the mast cell

e)

Over production of ACh and or gastrin by the adrenal gland

30.

The main pathophysiologic conditions of GIT include all below EXCEPT

a)

Peptic Ulcer

b)

Disturbance of acid excretion

c)

Chronic Inflammatory bowel disease

d)

Hyperprolactinemia

e)

Cushing’s syndrome

31.

Select the THREE commonly diagnosed Ulcer diseases

a)

Peptic ulcer

b)

Duodenal ulcer

c)

Esophageal

d)

Zollinger-Ellison syndrome

32.

Factors involved in the pathogenesis /or worsening of peptic ulcer disease include all of these below EXCEPT

a)

Excessive Histamine secretion

b)

Excessive Gastrin production

c)

Excessive Acetylcholine secretion

d)

Long term administration of NSAID

e)

Misoprostol administration

33.

Which one(s) of these are the principal physiologic agonists for gastric acid secretion?

a)

Ach

b)

Gastrin

c)

Histamine

d)

NE

e)

5HT

34.

Select the INCORRECT statement(s)

a)

Ach activates the muscarinic receptor on the parietal cells

b)

To release Ca++ which

c)

Stimulates protein kinase which

d)

Activates the H+ /K+ ATPase and this

e)

Decreases the secretion of gastric acid from parietal cells to the GIT lumen

35.

Select the incorrect statement

a)

Histamine released from mast cells stimulates the H2 receptor on parietal cell membrane which

b)

Activates GS proteins on parietal cell membrane to release adenylyl cyclase

c)

Adenyl cyclase converts ATP to cAMP

d)

cAMP activates protein kinase which

e)

Inhibits the proton pump- H + /K+ATPase and the secretion of H+ into the lumen

36.

Select the INCORRECT statement(s) Acetylcholine

a)

Is a transmitter in the cholinergic neuronal system

b)

Is a transmitter in the parasympathetic nervous system

c)

Ach receptors include M1, M2, M3

d)

Ach is a transmitter in the post-ganglionic sympathetic neuron

e)

Ach activates the β1 receptor in the heart to cause tachycardia

37.

Select the INCORRECT statement(s)

a)

Ach activates muscarinic receptor that is couple to Ca++ channels allowing entry of extracellular Ca++ into the parietal cell

b)

Gastrin is released from the gastrin cells which circulates through the blood to act on gastrin receptor on the parietal cells

c)

Activation of gastrin receptors on the parietal cells mobilizes intracellular Ca++ inside the parietal cell

d)

Histamine stimulates Gs protein directly on H2 receptors, converting adenyl cyclase to cAMP

e)

Histamine stimulates G1 protein on H2 receptors on the parietal cell converting adenylyl cyclase to cAMP

38.

Select the INCORRECT statement(s) In the one-cell hypothesis of gastric acid secretion in peptic Ulcer disease:

a)

Ach can act directly on the muscarinic receptor, increasing Ca++ concentration in the parietal cell to enhance H/K ATPase effect and H + secretion

b)

Gastrin can act on gastrin receptor to increase Ca++ in the parietal cell and enhance HCl release

c)

Ach and gastrin can act directly by activation of their respective receptors on the parietal cells to increase Ca++ concentration in the parietal cell

d)

Ach and gastrin are inhibitors of their respective receptors on the parietal cell in the one- cell hypothesis

e)

Ach is excitatory and gastrin is inhibitory in the one-cell hypothesis

39.

In the two cell-hypothesis of gastric acid secretion, in PUD: Select INCORRECT statement

a)

Ach may act directly via stimulation of muscarinic receptor on mast cell to increase histamine release

b)

Gastrin may act directly on gastrin receptor on mast cell stimulating the release of histamine

c)

Ach and gastrin can directly act on their respective receptors on parietal cells and on M1 and Greceptor on mast cells to enhance gastric acid secretion

d)

Secretion of histamine from the parietal cells has nothing to do with Ach and gastrin

e)

Secretion of histamine from parietal cell is the responsibility of PGE2

40.

Select the INCORRECT step in the pathogenesis of PUD

a)

Histamine activates Gs protein to release adenylyl cyclase from parietal cell membrane

b)

Adenylyl cyclase activates ATP, converting it to cAMP

c)

cAMP activates protein kinase which activates H+ /K+ ATPase

d)

cAMP directly activates the proton pump to increase H+ secretion.

e)

H+ /K+ ATPase is synonymous with proton pump inhibitor

41.

Select the INCORRECT statement(s)

a)

Histamine, Ach, and Gastrin exacerbate/increase, while PGE inhibits gastric acid secretions

b)

NSAID like aspirin, increases gastric acid secretion while PGE inhibits secretion

c)

H. pylori infection of the mucosa results in inflammation, diminution of mucosal defenses, gastritis, ulcer diseases and gastric adenocarcinoma

d)

NSAID increases gastric acid secretion by blocking PGE synthesis

e)

The role of NSAID in the pathogenesis of PUD is that it promotes PGE synthesis

42.

H. pylori associated gastritis and PUD treatment may involve the use of these approaches EXCEPT ONE

a)

Complete elimination of H. pylori from the GIT

b)

Treatment with combinations of H2 antagonists or PPI drugs

c)

Treatment with hydroxychloroquine sulfate

d)

Treatment with proton pump inhibitors which have direct antimicrobial properties against H. pylori

e)

Clarithromycin, amoxicillin, tetracycline and amoxicillin in different combination can be used with H2 blockers

43.

Select the INCORRECT statement. Misoprostol:

a)

Is a PGE2 analogue

b)

Reduces gastric acid secretion by the epithelial cells.

c)

Increases bicarbonate secretion in the GIT

d)

Increases mucus secretion in the GIT

e)

Reduces bicarbonate secretion but increases mucus secretion

44.

All these drugs are classified as H2 receptor blockers EXCEPT ONE

a)

Cimetidine

b)

Ranitidine

c)

Famotidine

d)

Nizatidine

e)

Omeprazole

45.

Which one of these is the most potent of the H2 receptor inhibitors?

a)

Cimetidine

b)

Ranitidine

c)

Famotidine

d)

Nizatidine

e)

Omeprazole

46.

Cimetidine inhibits cytochrome P450 enzyme which metabolizes phenytoin in the liver. Select the INCORRECT statement with regards to this cimetidine effect.

a)

The plasma concentration of phenytoin will increase

b)

The clearance of phenytoin from the system will be delayed.

c)

The T 1/2 of phenytoin will increase

d)

The T 1/2 of phenytoin will shorten

e)

Plasma concentration of phenytoin may increase

47.

All these drugs are proton pump inhibitors EXCEPT ONE

a)

Tagamet

b)

Prilosec

c)

Omeprazole

d)

Esomeprazole

e)

Lanosoprazole

48.

The side effects of cimetidine may include all of these EXCEPT ONE

a)

Gynecomastia

b)

Gynecomastia

c)

Agranulocytosis

d)

Decrease libido associated with antiandrogenic activity

e)

Decreased prolactin production

49.

A physician asks you to recommend pharmacological options available for treating PUD , GERD Your options would include all of these EXCEPT one

a)

Antacids which neutralize gastric acid

b)

H2 receptor blockers to reduce gastric acid secretion

c)

Proton pump inhibitors which reduce gastric acid secretion

d)

Agents which eliminates mucosal defenses

e)

Prokinetic agents which stimulates Ach receptors in myenteric plexus to increase esophageal sphincter tone and therefore decrease reflux

50.

Which one(s) of these are classified as prokinetic drugs?

a)

Cisapride (Propulsid)

b)

Metoclopramide (Reglan)

c)

Misoprostol (Cytotec)

d)

Sulcrafate ( Carafate)

e)

Lansoprazole ( Prevacid )

51.

A patient diagnosed with PUD is treated with Dicyclomine. After few weeks of treatment, patient developed side effects which all appear like the side effects of anticholinergic drug. Which one of these side effects of is NOT an anticholinergic side effect of the drug?

a)

Dry mouth

b)

Blurred vision

c)

Tachycardia

d)

Tachycardia

e)

Diarrhea

52.

Select the INCORRECT statement(s)

a)

Proton Pump inhibitors are metabolized in the liver by CYP2C19 and CYP3A4

b)

Pantoprazole can be given IV to patients who are not able to tolerate oral pantoprazole

c)

Ranitidine is given IV to treat hypersecretory conditions and to patients unable to tolerate it p.o

d)

Dexlansoprazole is a second generation H2 receptor inhibitor

e)

Dexlansoprazole is a proton pump inhibitor for management of PUD, gastric acid hypersecretion, and H. pylori gastrointestinal tract infection

53.

Misoprostol. Select the INCORRECT statement

a)

Is used to manage peptic ulcer

b)

Is used to manage duodenal ulcer

c)

DO not used in peptic or duodenal ulcers caused by long term administration of NSAID.

d)

Misoprostol can cause unwanted uterine contractions

e)

Its main use is to counteract the damaging effects of NSAID on the gastric mucosa

54.

Select the incorrect statement: Omeprazole a PPI

a)

Is the drug of choice for Zollinger-Ellison syndrome resulting from gastrin-secretion

b)

Like other PPIs, it is the most effective agent for GERD

c)

Like other PPIs, it is the most effective agent for GERD

d)

PPIs are more effective than H2 receptors blockers for treating PUD and GERD

e)

Esomeprazole and not Pantoprazole is a PPI

55.

These drugs are used to treat ulcers associated with H. pylori infection except one

a)

Cimetidine + Clarithromycin + Amoxicillin

b)

Omeprazole + metronidazole + Clarithromycin

c)

Famotidine + Amoxicillin + Bismuth chealate

d)

Rabeprazole + Famotidine + Clarithromycin

e)

Aspirin + Colchicine + NSAID

56.

Select the INCORRECT statement about Metoclopramide

a)

Is an antiemetic drug

b)

Can stimulate gastric motility

c)

Causes a marked acceleration of gastric emptying

d)

Is effective in paralytic ileus

e)

Not effective in paralytic ileus

57.

Select the incorrect statement:

The adverse effects of metoclopramide include all of these except one

a)

Anxiety

b)

Insomnia

c)

Extrapyramidal symptoms

d)

Increased in prolactin levels

e)

Does not increase prolactin levels

58.

Antacids may include all of the following except one?

a)

Sodium bicarbonate

b)

Aluminum hydroxide

c)

Magnesium hydroxide

d)

Calcium carbonate

e)

Sucralfate

59.

Choose Mechanism of Action that matches the drug category

Proton Pump Inhibitor (PPI)

a)

Block H2 Receptor, decrease H secretion

b)

Neutralize secreted H+

c)

Protects mucosal barrier

d)

Inhibit H+ K + ATPAase, decrease H+ secretion

e)

Inhibits cAMP, decrease H+ secretion

60.

Choose Mechanism of Action that matches the drug category

H2 receptor antagonists

a)

Blocks H2 receptors, decrease H+ secretion

b)

Blocks muscarinic receptors, decrease H+ secretion

c)

Inhibit cAMP, decrease H+ secretion

d)

Inhibit H+ K + ATPase, decrease H secretion

e)

Protect mucosal barrier

61.

Choose Mechanism of Action that matches the drug category

Muscarinic Antagonist

a)

Block H2 receptor, decrease H secretion

b)

Block muscarinic receptors, decrease H+ secretion

c)

Inhibit cAMP, decrease H+ secretion

d)

Inhibit H+ K + - ATPase, decrease secretion

e)

Neutralize secreted H+

62.

Choose Mechanism of Action that matches the drug category

Prostaglandins

a)

Block H + receptor, decrease H+ secretion

b)

Blocks muscarinic receptors,decrease H+ secretion

c)

Inhibits cAMP, decrease H + secretion

d)

Inhibit H+ -K + - ATPase, decrease H+ secretion

e)

Neutralize secreted H+

63.

Choose Mechanism of Action that matches the drug category

Antacid

a)

Block H+ receptor, decrease H+ secretion

b)

Blocks muscarinic receptors, decrease H+ secretion

c)

Inhibit cAMP, decrease H + secretion

d)

Inhibit H-K-ATPase, decrease H+ secretion

e)

Neutralize secreted H +

64.

The GIT functions and disfunctions that are of pharmacologic importance include:

a)

Gastric acid secretion

b)

Motility of the bowel

c)

Excretion of contents

d)

Neuroleptic Malignant syndrome

e)

Cushing’s syndrome

65.

The main pathophysiologic conditions of GIT include

a)

Peptic Ulcer

b)

Disturbance of excretion

c)

Chronic Inflammatory bowel disease

d)

Hyperprolactinemia

e)

Cushing’s syndrome

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