GERD/PUD Blackboard quiz

How long should initial PPI therapy be trialed before reassessment?

8 weeks

___ is a molecule that polymerizes in stomach acid and coats the ulcer bed, resulting in accelerated healing and reduction of symptoms.

Sucralfate (Carafate)

What diagnostic tests could be performed to confirm H. pylori infection?

Urea breath test; Stool antigen test

Which of the following best explains the pathophysiology of GERD?

GERD occurs when the lower esophageal sphincter (LES) is weakened or relaxed, allowing gastric contents to flow backward into the esophagus.

The main disadvantage of proton pump inhibitors is that patients often develop tolerance.

False

What should the pharmacist recommend for the man's wife who has GI upset and a prior ulcer while taking naproxen?

Consider using acetaminophen in place of naproxen

Which of the following is an aggressive factor of PUD?

Acid secretion

What lifestyle changes should John make to manage his condition?

Reduce spicy or fatty foods; Eat smaller meals; Reduce caffeinated beverages; Smoking cessation

Famotidine (Pepcid) drastically reduces both fasting and meal stimulated acid secretion.

False

Which ring is a surrogate for the imidazole of histamine for H2 receptor antagonists?

Thiazole

Famotidine inhibits which of the following?

Histamine binding to parietal cells

What is the recommended first line treatment for H. pylori induced PUD for a treatment naïve patient?

Quadruple bismuth therapy

What is the most appropriate recommendation for Susan with suspected PUD and ibuprofen use?

Advise Susan to stop taking ibuprofen and start a proton pump inhibitor (PPI) while recommending follow-up with her PCP for further evaluation.

Name the symptoms that contribute to the likelihood of PUD.

Epigastric pain relieved by eating; Worse pain on an empty stomach; History of dark stools (possible GI bleeding); Risk factors such as smoking, alcohol use, stress, and NSAID use

Which of the following is an atypical symptom of GERD?

Hoarseness

Which drug acts as a prostaglandin to stimulate secretion of mucus in the stomach?

Misoprostol

What is the most appropriate next step in management of John's GERD symptoms?

Start a proton pump inhibitor (PPI) and recommend lifestyle modifications including weight loss, smoking cessation, and dietary changes.

Which peptic ulcer type is defined by worse pain at night and pain relieved by food?

Duodenal ulcer

Which medication causes a black tongue in PUD therapy?

Bismuth subsalicylate

Which drug displays interactions from metabolism at CYP3A4?

Lansoprazole

Which of the following helps differentiate gastric vs duodenal ulcers?

Gastric ulcer pain worsens after eating, while duodenal ulcer pain improves temporarily with food intake.

Which of the following best fits symptomatic reflux without erosive disease?

NERD

Which group is one of the pharmacophore features of proton pump inhibitors?

Benzimidazole

Which of the following is NOT one of the three conserved structural features of proton pump inhibitors such as Prilosec?

A sulfenamide

Which drug acts as a covalent inhibitor of the H+/K+ ATPase pump?

Esomeprazole

What should the pharmacist recommend for the patient with black and bloody stool who thinks it is GERD?

Refer the patient to the ED or her PCP

Monitoring and follow up: How long should John be treated and how do you confirm eradication?

14 days, test 4 weeks after completion of therapy

What first line medication would you recommend?

Pantoprazole 20 mg daily AC

What would you consider to be John's diagnosis/main condition described?

GERD

What should the pharmacist counsel patient AB on regarding famotidine?

Famotidine can cause constipation or diarrhea

What should he do for treatment if H. pylori is still present?

Repeat the same treatment

Which of the following is true of cimetidine?

It is associated with hormonal abnormalities

What diagnostic test measures esophageal pressure through a tube placed through the nose?

Manometry

Which statement about speed of relief for acid reflux makes sense based on drug mechanisms?

Mylanta works fast because it is a base that rapidly neutralizes stomach acid.