Reflux esophagitis: pharmacological treatment MCQs With Answer

Reflux esophagitis: pharmacological treatment MCQs With Answer

This quiz collection is tailored for M.Pharm students studying Pharmacotherapeutics I (MPP 102T). It focuses on the pharmacological management of reflux esophagitis — covering mechanisms of action, comparative efficacy, dosing principles, adverse effects, drug interactions, and special-population considerations. Questions range from basic pharmacology of antacids, H2-receptor antagonists and proton pump inhibitors to advanced topics such as nocturnal acid breakthrough, PPI pharmacokinetics, prokinetic adjuncts, alginates, and long-term safety issues. Designed to deepen understanding rather than rote recall, these MCQs will prepare you for exams and clinical reasoning about optimal drug selection and monitoring in reflux esophagitis.

Q1. Which class of drugs provides the most consistent mucosal healing in moderate to severe reflux esophagitis?

• Antacids
• H2‑receptor antagonists
• Proton pump inhibitors (PPIs)
• Alginate-based formulations

Correct Answer: Proton pump inhibitors (PPIs)

Q2. What is the primary mechanism by which proton pump inhibitors reduce gastric acid secretion?

• Competitive blockade of H2 receptors on parietal cells
• Neutralization of gastric acid by weak bases
• Irreversible inhibition of the H+/K+ ATPase (proton pump)
• Stimulation of prostaglandin synthesis to protect mucosa

Correct Answer: Irreversible inhibition of the H+/K+ ATPase (proton pump)

Q3. Which PPI is most strongly associated with clinically relevant inhibition of CYP2C19 and potential interaction with clopidogrel?

• Pantoprazole
• Lansoprazole
• Esomeprazole
• Omeprazole

Correct Answer: Omeprazole

Q4. Which property best explains why PPIs should be taken 30–60 minutes before a meal?

• They require acidic gastric pH for activation
• Their absorption is enhanced by food
• Parietal cell proton pumps are maximally active after a meal
• They cause rapid gastric emptying when given with food

Correct Answer: Parietal cell proton pumps are maximally active after a meal

Q5. Which adverse effect is most clearly associated with long-term PPI therapy?

• Gynecomastia
• Hypomagnesemia
• Extrapyramidal symptoms
• Neuroleptic malignant syndrome

Correct Answer: Hypomagnesemia

Q6. Which H2-receptor antagonist has the highest propensity for CYP450-mediated drug interactions and antiandrogenic side effects?

• Ranitidine
• Famotidine
• Cimetidine
• Nizatidine

Correct Answer: Cimetidine

Q7. For immediate symptomatic relief of heartburn in reflux esophagitis, which agent class provides the fastest onset?

• Oral PPIs
• Intravenous PPIs
• Antacids
• H2-receptor antagonists

Correct Answer: Antacids

Q8. Which prokinetic agent is associated with central nervous system adverse effects (e.g., extrapyramidal symptoms) and is therefore limited in prolonged use for reflux?

• Metoclopramide
• Domperidone
• Cisapride
• Baclofen

Correct Answer: Metoclopramide

Q9. Alginate formulations (e.g., Gaviscon) relieve reflux symptoms primarily by which mechanism?

• Neutralizing gastric acid with hydroxide salts
• Forming a viscous raft that floats on gastric contents
• Inhibiting the H+/K+ ATPase
• Enhancing lower esophageal sphincter contraction via cholinergic stimulation

Correct Answer: Forming a viscous raft that floats on gastric contents

Q10. Which statement about H2-receptor antagonists in reflux esophagitis is correct?

• They permanently inactivate proton pumps.
• They frequently cause severe hypomagnesemia with short-term use.
• Tachyphylaxis can develop with continuous H2 antagonist therapy.
• They are superior to PPIs for healing erosive esophagitis.

Correct Answer: Tachyphylaxis can develop with continuous H2 antagonist therapy.

Q11. Which PPI is available as an intravenous preparation commonly used in hospitalized patients with severe reflux esophagitis or bleeding?

• Esomeprazole
• Lansoprazole (IV)
• Pantoprazole (IV)
• Rabeprazole (IV)

Correct Answer: Pantoprazole (IV)

Q12. Which medication reduces transient lower esophageal sphincter relaxations by acting as a GABA-B receptor agonist and can be used as adjunctive therapy in reflux refractory to acid suppression?

• Baclofen
• Domperidone
• Sucralfate
• Alginates

Correct Answer: Baclofen

Q13. Which adverse cardiovascular risk led to withdrawal or severe restriction of cisapride, a prokinetic previously used for reflux?

• Hypertension
• QT prolongation and ventricular arrhythmias
• Thromboembolism
• Bradycardia from beta-blockade

Correct Answer: QT prolongation and ventricular arrhythmias

Q14. Which strategy is recommended to minimize rebound acid hypersecretion when stopping long-term PPI therapy?

• Immediate cessation without taper
• Switch directly to full-dose H2 antagonist
• Gradual dose tapering or step-down to H2 blocker/antacid
• Increase PPI dose for one week then stop abruptly

Correct Answer: Gradual dose tapering or step-down to H2 blocker/antacid

Q15. Which statement about PPIs’ pharmacokinetics is true?

• They have very long plasma half-lives reflecting long duration of action.
• They require metabolic activation in the acidic canaliculus of parietal cells.
• They are competitive reversible H+/K+ ATPase inhibitors.
• They are primarily renally excreted unchanged.

Correct Answer: They require metabolic activation in the acidic canaliculus of parietal cells.

Q16. In a patient with reflux esophagitis who also needs dual antiplatelet therapy including clopidogrel, which acid suppression approach is generally preferred to minimize interaction risk?

• Omeprazole coadministration without adjustment
• Use pantoprazole or famotidine instead of omeprazole
• Double the PPI dose to overcome interaction
• Stop clopidogrel and replace with a PPI

Correct Answer: Use pantoprazole or famotidine instead of omeprazole

Q17. Which mucosal protective agent binds to ulcerated mucosa and can be used as adjunctive therapy in reflux esophagitis but has limited acid-suppressing effect?

• Sucralfate
• Misoprostol
• Baclofen
• Magnesium hydroxide

Correct Answer: Sucralfate

Q18. Which of the following is a correct statement regarding nocturnal acid breakthrough (NAB) in reflux patients on once-daily PPI therapy?

• NAB is eliminated by H2 antagonists given at bedtime without drawbacks.
• NAB can occur due to incomplete 24‑hour acid suppression by once-daily PPIs.
• NAB indicates PPI treatment failure and mandates surgical referral.
• NAB is prevented by taking PPIs immediately after dinner.

Correct Answer: NAB can occur due to incomplete 24‑hour acid suppression by once-daily PPIs.

Q19. Which laboratory monitoring is most appropriate for a patient on long-term high-dose PPI therapy?

• Serum calcium every week
• Serum magnesium and bone mineral density as clinically indicated
• Frequent liver enzyme monitoring due to PPI hepatotoxicity
• Platelet function tests monthly

Correct Answer: Serum magnesium and bone mineral density as clinically indicated

Q20. Which option best reflects the role of treating Helicobacter pylori in the context of reflux esophagitis pharmacotherapy?

• Eradication of H. pylori consistently worsens reflux symptoms and should be avoided.
• H. pylori eradication is central to healing reflux esophagitis in all patients.
• H. pylori status does not directly guide acid-suppressive therapy for reflux; eradication is recommended when infection is present for other GI benefits.
• H. pylori infection is the primary cause of reflux esophagitis, so antibiotics alone suffice.

Correct Answer: H. pylori status does not directly guide acid-suppressive therapy for reflux; eradication is recommended when infection is present for other GI benefits.

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