L 17: Pharmacology 1 : Drugs used in
peptic ulcer
1. What is a peptic ulcer?
a) A type of skin rash
b) A local defect or excavation of the surface of an organ or tissue
c) A bacterial infection in the stomach d) A type of cancer
2. Which of the following is NOT a defensive factor in peptic ulcer pathophysiology?
a) Mucus b) Bicarbonate c) Helicobacter pylori d) Prostaglandins
3. Which of the following is an aggressive factor in peptic ulcer development?
a) Blood flow b) Helicobacter pylori c) Bicarbonate d) Prostaglandins
4. What is the general treatment recommendation for peptic ulcers regarding diet?
a) Large, infrequent meals b) Small, frequent, regular meals
c) High intake of spicy foods d) Increased caffeine consumption
5. Which H2 receptor antagonist inhibits P450 and can lead to drug interactions?
a) Ranitidine b) Famotidine c) Cimetidine d) Nizatidine
6. Which H2 receptor antagonist has the fewest side effects due to not inhibiting P450?
a) Cimetidine b) Ranitidine c) Famotidine d) Nizatidine
7. Which H2 receptor antagonist is the most potent but has lower bioavailability?
a) Cimetidine b) Ranitidine
c) Famotidine d) Nizatidine
8. What is a common endocrinal effect of Cimetidine in males?
a) Increased libido b) Gynecomastia c) Hyperprolactinemia d) Galactorrhea
9. Which of the following is a CNS effect of Cimetidine?
a) Increased alertness
b) Enhanced memory
c) Improved speech
d) Confusion
10. What is a therapeutic use of H2 receptor antagonists?
a) Active duodenal ulcers
b) Treating skin infections
c) Managing diabetes
d) Reducing cholesterol
1-b 2-c 3-b 4-b 5-c 6-b 7-c 8-b 9-d 10-a
11. Which of the following is a side effect of H2 receptor antagonists?
a) Increased appetite b) Improved liver function
c) Hyperprolactinemia d) Enhanced blood flow
12. Why should H2 receptor antagonists be avoided during pregnancy?
a) They cause weight gain b) They cause dehydration
c) They increase blood pressure d) They cross the placenta and pass into milk
13. What can happen due to the sudden withdrawal of H2 receptor antagonists?
a) Improved digestion b) Rebound ulcers
c) Increased energy levels d) Reduced acid secretion
14. What percentage of acid secretion is inhibited by Cimetidine in the basal state?
a) 50% b) 70% c) 90% d) 100%
15. Which of the following is NOT an endocrinal effect of Cimetidine?
a) Gynecomastia b) Hyperprolactinemia
c) Increased libido d) Galactorrhea
16. What is a potential CNS effect of Cimetidine?
a) Improved memory
b) Hallucinations
c) Increased alertness
d) Enhanced coordination
17. Which condition is NOT a therapeutic use of H2 receptor antagonists?
a) GERD
b) Zollinger-Ellison syndrome
c) Diabetes mellitus
d) Prevention of stress ulcers
18. Which of the following is a side effect of H2 receptor antagonists?
a) Increased appetite
b) Agranulocytosis
c) Improved liver function
d) Enhanced blood flow
19. Why is Cimetidine avoided in pregnancy and lactation?
a) It causes weight gain
b) It crosses the placenta and passes into milk
c) It increases blood pressure
d) It causes dehydration
11-c 12-d 13-b 14-c 15-c 16-b 17-c 18-b 19-b
21. Which Proton Pump Inhibitor (PPI) has the highest bioavailability?
a) Omeprazole b) Rabeprazole c) Esomeprazole d) Lansoprazole
22. Which PPI is known for having the highest potency?
a) Pantoprazole b) Rabeprazole c) Lansoprazole d) Omeprazole
23. What is the mechanism of action of Proton Pump Inhibitors (PPIs)?
a) They block H2 receptors b) They act as anticholinergics
c) They increase gastric acid secretion d) They bind irreversibly to H+/K+ ATPase enzyme
24. How long does it take for full restoration of acid secretion after discontinuing PPIs?
a) 1-2 days b) 3-5 days c) 1 week d) 2 weeks
25. Which of the following is NOT a use of Proton Pump Inhibitors (PPIs)?
a) Gastric and duodenal ulcers resistant to H2-antagonists
b) Zollinger-Ellison Syndrome
c) Treating diabetes d) Severe gastroesophageal reflux disease (GERD)
26. Which side effect is associated with long-term use of PPIs?
a) Increased bone density b) Vitamin B12 deficiency
c) Improved electrolyte balance d) Reduced risk of infections
27. What is the primary mechanism of action of anticholinergics like Pirenzepine?
a) Blocking H2 receptors b) Inhibiting H+/K+ ATPase
c) Selective blockade of peripheral M1 muscarinic receptors
d) Increasing gastric acid secretion
28. In which scenario are anticholinergics like Pirenzepine most useful?
a) As a first-line treatment for GERD
b) As an adjuvant to H2 receptor antagonists in refractory cases
c) For treating Zollinger-Ellison Syndrome d) For reducing stress ulcers
29. Which of the following is a potential side effect of long-term Proton Pump Inhibitor (PPI) use?
a) Increased bone density
b) Osteoporosis
c) Improved electrolyte balance
d) Reduced risk of stomach infections
30. Why are Proton Pump Inhibitors (PPIs) formulated as enteric-coated preparations?
a) To enhance their potency To enhance their potency
b) To prevent rapid metabolism in the liver
c) To enhance their potency
d) To allow immediate absorption in the stomach
21-d 22-b 23-d 24-b 25-c 26-b 27-c 28-b 29-b 30-a
31. What is the mechanism of action of Sucralfate?
a) Inhibits acid production at the parietal cell
b) Forms complex gels with mucus, creating a protective layer
c) Directly neutralizes stomach acid d) Stimulates gastric acid secretion
32. What is the recommended dose of Sucralfate?
a) 1 gm every 4 hours b) 2 gm every 12 hours
c) 500 mg every 8 hours d) 1 gm every 6 hours on an empty stomach
33. Why should Sucralfate not be paired with PPIs?
a) It requires an acidic medium to function b) PPIs enhance its absorption
c) PPIs reduce its bioavailability d) increases acid secretion when used with PPIs
34. What is a major adverse effect of Sucralfate?
a) Diarrhea b) Dry mouth and constipation
c) Hypokalemia d) Hypertension
35. What is the mechanism of action of Colloidal Bismuth Compounds?
a) Systemic inhibition of gastric acid production
b) Binding with mucus and proteins at the ulcer base
c) Stimulating histamine release d) Blocking H+/K+ ATPase directly
36. What is a common adverse effect of Colloidal Bismuth Compounds?
a) Hepatotoxicity
b) Hyperkalemia
c) Black discoloration of stool and teeth
d) Respiratory depression
37. Which of the following drugs should be avoided in renal failure?
a) Omeprazole b) Metronidazole c) Sucralfate d) Clarithromycin
38. What is the primary adverse effect of Carbenoxolone?
a) Hypotension b) Na+ retention and hypokalemia
c) Hyperglycemia d) Anemia
39. What is the ideal combination for an antacid to prevent diarrhea and constipation?
a) Magnesium hydroxide alone
b) Aluminum hydroxide alone
c) A mix of aluminum hydroxide and magnesium hydroxide
d) Calcium carbonate alone
40. Which antacid is most likely to cause diarrhea?
a) Aluminum hydroxide
b) Magnesium hydroxide
c) Calcium carbonate
d) Sucralfate
31-b 32-d 33-a 34-b 35-b 36-c 37-c 38-b 39-c 40-b
41. What is the mechanism of action of Vanoprazan (Vanosprire)?
a) Directly inhibits pepsin
b) Blocks H+/K+ ATPase enzyme in a potassium competitive manner
c) Forms a protective barrier on ulcers d) Increases mucus secretion
42. Why is Vanoprazan considered superior to PPIs?
a) It acts 300 times more potently b) It increases acid secretion
c) It reduces mucus production d) It works as an H2-receptor antagonist
43. What is an advantage of Vanoprazan over PPIs?
a) It must be taken before meals b) It is affected by CYP 450
c) It is not required to be taken before meals d) It has a short duration of action
44. What is the standard treatment regimen for peptic ulcer?
a) Omeprazole + Amoxicillin + Metronidazole b) Sucralfate + Bismuth + Clarithromycin
c) Carbenoxolone + Calcium Carbonate + Magnesium Hydroxide
d) Tetracycline + Metronidazole + Vanoprazan
45. How long does an ulcer take to heal completely?
a) 1-2 weeks b) 4-8 weeks c) 12-16 weeks d) 6 months
46. How long should a patient receive prophylaxis after ulcer healing?
a) 2-4 weeks b) 4-6 months c) 6-12 months d) Lifetime
47. What is the mechanism of action of Rebamipide (Mucosta)?
a) Direct inhibition of gastric acid secretion
b) Stimulates the production of endogenous PG in gastric mucosa
c) Blocks H2-receptors d) Increases bile salt excretion
48. Which of the following is a major adverse effect of chronic use of Colloidal Bismuth Compounds in
renal failure patients?
a) Hepatic toxicity b) Nephrotoxicity c) Encephalopathy d) Hypokalemia
49. What is the primary benefit of using a combination of Aluminum Hydroxide and Magnesium
Hydroxide as an antacid?
a) Enhances gastric acid secretion
b) Improves drug absorption
c) Increases bicarbonate production
d) Prevents both diarrhea and constipation
50. What is the primary reason Carbenoxolone is contraindicated in cardiac patients?
a) It leads to sodium retention and edema
b) It causes bradycardia
c) It directly damages the myocardium
d) It increases heart rate significantly
41-b 42-a 43-c 44-a 45-b 46-c 47-b 48-c 49-d 50-a
