!DOCTYPE html PUBLIC “-//W3C//DTD XHTML 1.1//EN” “http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd”>

Gastrointestinal and Urinary Tract Pharmacology, Nutrition (Vitamins)

Acid secretion inhibitors (H₂ blockers, proton pump inhibitors, others)

Antacids

Antidiarrheals

Drugs affecting GI or urinary tract musculature

Emetics, antiemetics

Gallstone-dissolving drugs

Gastric mucotropic/cytoprotective protective drugs

Inflammatory bowel disease drugs

Laxatives, cathartics

Pancreatic enzyme replacement

Vitamins

Questions

339. A 65-year-old man will be undergoing elective total knee replacement surgery. He is urged to start taking a specified stool softener several days before surgery, and it will continue to be administered as needed for several days after the surgery. That is because of one of the drugs he will receive in the operative and post-op periods (listed below) routinely causes severe constipation. Which drug is that?

a. Ketorolac to supplement postoperative analgesia from morphine

b. Midazolam for sedation, anxiety relief, and induction of short-term amnesia

c. Morphine and/or a similar high-efficacy opioid for pain

d. Neostigmine as part of a protocol to reverse skeletal muscle paralysis

e. Ondansetron for management of postoperative nausea and vomiting

340. A patient with multiple medical problems is taking several drugs, including theophylline, warfarin, quinidine, and phenytoin. Despite the likelihood of interactions, dosages of each were adjusted carefully so their plasma concentrations and effects are acceptable. However, the patient suffers some GI distress and starts taking a drug provided by one of his “well-intentioned” friends. He presents with excessive or toxic effects from all his other medications, and blood tests reveal that plasma concentrations of all the prescribed drugs are high. Which drug did the patient most likely self-prescribe and take?

a. Antacid (typical magnesium-aluminum combination)

b. Cimetidine

c. Famotidine

d. Nizatidine

e. Ranitidine

341. A 53-year-old woman has been taking warfarin for prophylaxis of venous thromboembolism for the last 6 months. During that time the degree of anticoagulation, based on frequent measurements of her INR (International Normalized Ratio, an adjusted prothrombin time), has been in the desired therapeutic range, 2.5, and she suffered no adverse effects. Two weeks ago, she developed what she believed to be heartburn, and without consulting her MD began taking an over-the-counter medicine on a daily basis to control it. She presents in clinic today, reporting frequent epistaxis, and says her gums bleed when she brushes her teeth. Her INR is now 9, well above the normal therapeutic range and indicative of excess warfarin effects. Which of the following medicines most likely interacted with the warfarin to cause these signs and symptoms?

a. Bismuth salts (eg, Pepto-Bismol^®)

b. Calcium carbonate

c. Cimetidine

d. Esomeprazole

e. Magnesium-aluminum antacid combination

f. Nizatidine

342. Esomeprazole is one of the medications prescribed for a patient you are seeing today in the general medicine clinic. Which one of the following statements best describes the actions or effects of esomeprazole and other drugs in its class?

a. Cause strong systemic atropine-like (antimuscarinic) effects that limit their use in patients for whom atropine itself is contraindicated

b. Inhibit gastric acid secretion by simultaneously and competitively blocking the actions of the agonists histamine, acetylcholine, and gastrin, on their parietal cell membrane receptors

c. Neutralize gastric acid faster than any other classes of drugs indicated for peptic ulcer disease or gastroesophageal reflux disease (GERD)

d. Profoundly inhibit an ATPase located on parietal cell membranes, thereby inhibiting acid secretion

e. Tend to cause bradycardia by antagonizing the positive chronotropic effects of histamine on cardiac H₁ receptors

343. A 60-year-old man has episodes of severe gastric and esophageal pain that is ultimately linked to gastric acid. Which one of the following drugs or drug classes, whether available over-the-counter or prescribed, is most likely to relieve the acid-related symptoms the fastest when taken at usually effective/recommended doses?

a. Antacids (eg, magnesium-aluminum combinations)

b. Cimetidine (but not other drugs in its class)

c. H₂ blockers, any of them

d. Misoprostol

e. Proton pump inhibitors

344. Five days after starting self-medication for diarrhea and other GI complaints that arose after a trip to Central America, a very worried patient calls to report that his tongue has turned black. His stools have darkened too, but his description doesn’t at all fit with what would be expected if the patient had a bleed anywhere in the GI tract (eg, no “coffee grounds stools” suggestive of a gastric bleed.). Which drug most likely caused these signs?

a. Bismuth salts

b. Calcium carbonate

c. Cimetidine

d. Esomeprazole

e. Magnesium-aluminum antacid combination

f. Nizatidine

345. A patient who has been a high-dose alcohol abuser for many years presents with hepatic portal-systemic encephalopathy. What drug, given in relatively high doses, would be most suitable for the relief of some of the signs and symptoms of this condition, and the likely underlying biochemical anomalies?

a. Diphenoxylate

b. Esomeprazole

c. Lactulose

d. Loperamide

e. Ondansetron

346. Fat-soluble vitamins, compared with their water-soluble counterparts, generally have a greater potential toxicity to the user when taken in excess. What property of those vitamins—A, D, E, and K—is basically the main reason for this finding?

a. Administered in larger doses

b. Avidly stored by the body

c. Capable of dissolving membrane phospholipids

d. Involved in more essential metabolic pathways

e. Metabolized much more slowly

347. A patient is transported from a distant hospital to your surgical service by air ambulance. He had abdominal surgery and in the postop care unit he received a drug that was clearly not indicated. The drug caused intense contraction of the detrusor and trigone muscles of his bladder. The first dose failed to cause emptying of the bladder, so a second dose was given. However, and unknown to his prior care team, he had a mass that rather significantly obstructed his urethra, and prior anatomical weakening in a portion of his bladder. Upon administration of the drug he first suffered retrograde urine flow (from his bladder, back to the kidneys via the ureters), causing renal damage. Soon thereafter his bladder ruptured into his peritoneum. Which drug or drug class most likely caused these adverse effects?

a. Albuterol

b. Atropine or a similar antimuscarinic

c. Bethanechol

d. Furosemide

e. Propranolol or a similar β-blocker

348. A patient presents with malaise, and skin and mucous membranes appear pale. Among the key findings from blood work are hypochromic, microcytic red cells and reduced red cell count/hematocrit; reduced reticulocyte count; and reduced total hemoglobin content. Which drug would be indicated, based on the presentation?

a. Cyanocobalamin (B₁₂)

b. Folic acid

c. Iron

d. Vitamin C

e. Vitamin D

349. A patient will start taking one of the drugs listed below. As we hand them the prescription we advise them not to take supplemental vitamin B₆ (pyridoxine), whether alone or as part of a multivitamin supplement, because the vitamin is likely to counteract a desired effect of the prescribed drug. To which drug does this advice apply?

a. Captopril for heart failure or hypertension

b. Haloperidol for Tourette syndrome

c. Levodopa/carbidopa for Parkinson disease

d. Niacin for hypertriglyceridemia

e. Phenytoin for epilepsy

350. A patient with tuberculosis is being treated with isoniazid. She develops paresthesias, muscle aches, and unsteadiness. Which vitamin needs to be given in supplemental doses in order to reverse these symptoms—or used from the outset to prevent them in high-risk patients?

a. Vitamin A

b. Vitamin B₁ (thiamine)

c. Vitamin B₆ (pyridoxine)

d. Vitamin C

e. Vitamin K

351. A patient has severe gastroesophageal reflux disease (GERD). In addition to providing some immediate symptom relief, for which you will prescribe usually effective doses of an OTC combination antacid product, you want to suppress gastric acid completely as possible. Which drug is best suited for achieving that goal?

a. Atropine

b. Calcium carbonate

c. Cimetidine

d. Esomeprazole

e. Misoprostol

352. An opioid abuser, seeking something to self-administer for subjective responses, gets a large amount of diphenoxylate and consumes it all at once. He is not likely to do this again because he has consumed a combination product that contains not only the diphenoxylate but also another drug that causes a host of unpleasant systemic responses. What is the other drug found in combination with the diphenoxylate?

a. Apomorphine

b. Atropine

c. Ipecac

d. Magnesium sulfate

e. Naltrexone

353. During a regular check-up, your patient states “You know, doc, sometimes after eating I get heartburn … you know, acid-indigestion.” Since the symptoms seem to be mild and infrequent, you suggest an empiric trial of an OTC antacid for prompt symptom relief, plus an oral anti-acid secretory drug for long-term control. You recommend several antacid brands for the patient to try. All the products you list are combination products that contain a magnesium salt and an aluminum salt. What is main rationale or reason why the vast majority of these products contain these two particular drugs or salts?

a. Al salts counteract the gastric mucosal-irritating effects of Mg salts

b. Al salts require activation by an Mg-dependent enzyme in order to inhibit the parietal cell proton pumps

c. Mg salts cause a diuresis that helps reduce systemic accumulation of the Al salt by increasing renal Al excretion

d. Mg salts potentiate the ability of Al salts to inhibit gastric acid secretion

e. Mg salts tend to cause a laxative effect (increased gut motility) that counteracts the tendency of an Al salt to cause constipation

354. A patient with multiple GI complaints is receiving ursodeoxycholic acid (ursodiol) as part of his drug regimen. What is the most likely purpose for which this drug is being given?

a. Dissolving cholesterol stones in the bile ducts

b. Enhancing intestinal digestion and absorption of dietary fats

c. Helping to reverse malabsorption of fat-soluble vitamins from the diet

d. Stimulating gastric acid secretion in achlorhydria

e. Suppressing steatorrhea and its consequences

355. Early-on in your general medicine clerkship you encounter a patient who is taking a proton pump inhibitor, bismuth, metronidazole, and tetracycline. What is the most likely condition for which this drug combination is being used?

a. Antibiotic-associated pseudomembranous colitis

b. Irritable bowel syndrome (IBS)

c. Refractory or recurrent, and severe, gastric or duodenal ulcers secondary to H. pylori

d. “Traveler’s diarrhea,” severe, Escherichia coli-induced, from drinking contaminated water

e. Ulcers that occur in response to long-term, high-dose NSAID therapy for arthritis

356. Several brand-name and store-brand “pink medications,” administered orally and available without prescription, are widely used to help alleviate occasional and short-lived nausea and vomiting, nonspecific GI distress, and diarrhea. They are also recommended for prophylaxis of “traveler’s diarrhea,” which typically is caused by ingestion of foods or beverages contaminated with E. coli. These products contain bismuth subsalicylate, and because of the presence of an aspirin-like compound (a salicylate) they should not be taken by or administered to certain patients. Which patient-related factor or comorbidity contraindicates use of this drug or product?

a. Essential hypertension

b. Flu, chickenpox, or other viral illness in a child or adolescent

c. Hot flashes and other signs/symptoms of menopause

d. Prostatic hypertrophy or glaucoma in elderly men

e. Rheumatoid or osteoarthritis

f. Severe seasonal allergy signs and symptoms

357. A patient has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and large amounts of alcohol, he experiences significant GI distress. He takes an over-the-counter heartburn remedy. Within a minute or two he develops what he will later describe as a “bad bloated feeling.” Several of the ulcers have begun to bleed and he experiences searing pain.

The patient becomes profoundly hypotensive from upper GI blood loss and is transported to the hospital. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had been literally stretched apart, causing additional tissue damage that led to the hemorrhage. Which drug or product did the patient most likely take?

a. An aluminum salt

b. An aluminum-magnesium combination antacid product

c. Magnesium hydroxide

d. Ranitidine

e. Sodium bicarbonate

358. You have a patient who has been consuming extraordinarily large amounts of alcohol for several years, and is generally malnourished. He abruptly stops his alcohol intake and goes into acute alcohol withdrawal. Pertinent signs and symptoms include nystagmus and bizarre ocular movements, and confusion (Wernicke encephalopathy). Although this patient’s alcohol consumption pattern has been accompanied by poor nutrient intake overall, you need to manage the encephalopathy. Which drug is most appropriate for this use?

a. α-tocopherol (vitamin E)

b. Cyanocobalamin (vitamin B₁₂)

c. Folic acid

d. Phytonadione (vitamin K)

e. Thiamine (vitamin B₁)

359. A patient has steatorrhea secondary to cystic fibrosis. Which drug usually is considered the most reasonable and usually effective drug for managing the fatty stools?

a. Atorvastatin (or any other HMG Co-A-reductase inhibitor)

b. Cimetidine (or an alternative, eg, famotidine)

c. Bile salts

d. Metoclopramide

e. Pancrelipase

360. You are meeting with a woman in whom pregnancy has just been confirmed, and as part of your holistic patient education you give her explicit advice to avoid taking supplements of a particular vitamin, especially in high doses, because it is highly teratogenic. You also note the need to avoid any drugs that are derivatives of this nutrient during pregnancy, for the same reason. To which one of the following vitamins does this precaution apply?

a. A

b. B₁₂

c. C

d. E

e. Folic acid

361. A patient being cared for by the gastroenterology service is being treated with sulfasalazine. What is the most likely purpose for which it is being given?

a. Antibiotic-associated pseudomembranous colitis

b. E. coli-induced diarrhea

c. Gastric H. pylori infections

d. Inflammatory bowel disease

e. NSAID-induced gastric ulcer prophylaxis

362. A patient with renal failure is undergoing periodic hemodialysis while awaiting a transplant. Between dialysis sessions we want to reduce the body’s phosphate load by reducing dietary phosphate absorption and removing some phosphate already in the blood. Which drug would be most suitable for this purpose?

a. Aluminum hydroxide

b. Bismuth subsalicylate

c. Magnesium hydroxide/oxide

d. Sodium bicarbonate

e. Sucralfate

363. A woman has severe irritable bowel syndrome (IBS) characterized by frequent, profuse, and symptomatic diarrhea. She has not responded to first-line therapies and is started on alosetron. What is the most worrisome adverse effect associated with this drug?

a. Cardiac arrhythmias (serious, eg, ventricular fibrillation)

b. Constipation, bowel impaction, ischemic colitis

c. Parkinsonian extrapyramidal reactions

d. Pulmonary fibrosis

e. Renal failure

364. A patient undergoing cancer chemotherapy gets ondansetron for prophylaxis of drug-induced nausea and vomiting. Which best describes this drug’s main mechanism of action in this setting?

a. Activates μ-type opioid receptors in the chemoreceptor trigger zone (CTZ)

b. Blocks central serotonin (5-HT₃) receptors

c. Blocks dopamine receptors

d. Blocks histamine H₁ receptors in the brainstem and inner ear

e. Suppresses gastric motility and acid secretion via muscarinic blockade

Stay updated, free articles. Join our Telegram channel

Join