The management of Peptic Ulcer Disease (PUD) is a cornerstone of gastrointestinal pharmacotherapy and a prime example of etiology-driven treatment, a key concept emphasized throughout the PharmD curriculum. Whether an ulcer is caused by an insidious Helicobacter pylori infection or the use of NSAIDs, the pharmacist’s role is critical in selecting, implementing, and monitoring the appropriate therapeutic plan. The Patient Care 4: Gastrointestinal and Renal Disorders course provides a dedicated module on the “Management of Peptic Ulcer Disease,” underscoring its importance. This quiz will test your knowledge on creating effective eradication regimens, mitigating NSAID-induced GI risk, and counseling patients to achieve optimal outcomes.
1. What are the two most common causes of Peptic Ulcer Disease (PUD)?
- a. Spicy foods and stress
- b. Helicobacter pylori infection and NSAID use
- c. Caffeine and alcohol consumption
- d. Smoking and GERD
Answer: b. Helicobacter pylori infection and NSAID use
2. What is the drug class of choice for healing both H. pylori-associated and NSAID-induced ulcers?
- a. Antacids
- b. H2-Receptor Antagonists (H2RAs)
- c. Proton Pump Inhibitors (PPIs)
- d. Prostaglandin analogs
Answer: c. Proton Pump Inhibitors (PPIs)
3. The standard duration of therapy for H. pylori eradication is typically:
- a. 3-5 days
- b. 7 days
- c. 10-14 days
- d. 28 days
Answer: c. 10-14 days
4. Which of the following is a component of bismuth-based quadruple therapy for H. pylori?
- a. Clarithromycin
- b. Amoxicillin
- c. Metronidazole
- d. Levofloxacin
Answer: c. Metronidazole
5. What is the first and most critical step in managing an NSAID-induced ulcer?
- a. Start a high-dose PPI.
- b. Add sucralfate to the regimen.
- c. Discontinue the offending NSAID, if clinically possible.
- d. Test the patient for H. pylori.
Answer: c. Discontinue the offending NSAID, if clinically possible.
6. A patient taking an NSAID long-term is at high risk for a GI bleed. Which of the following concomitant medications would most increase that risk?
- a. Acetaminophen
- b. An oral anticoagulant like warfarin
- c. A calcium channel blocker
- d. Metformin
Answer: b. An oral anticoagulant like warfarin
7. Clarithromycin-based triple therapy for H. pylori should be avoided in regions where local resistance rates to clarithromycin are greater than:
- a. 5%
- b. 10%
- c. 15%
- d. 25%
Answer: c. 15%
8. Which medication is a synthetic prostaglandin E1 analog approved for the prevention of NSAID-induced ulcers?
- a. Omeprazole
- b. Famotidine
- c. Sucralfate
- d. Misoprostol
Answer: d. Misoprostol
9. A patient being treated for an H. pylori infection should be counseled that bismuth subsalicylate may cause what harmless side effect?
- a. Drowsiness
- b. Blackening of the tongue and stool
- c. Increased blood pressure
- d. A metallic taste
Answer: b. Blackening of the tongue and stool
10. Which diagnostic test is considered a gold standard for confirming H. pylori infection and can also be used to confirm eradication after treatment?
- a. Serum antibody testing
- b. Urea Breath Test (UBT)
- c. A trial of PPI therapy
- d. Abdominal X-ray
Answer: b. Urea Breath Test (UBT)
11. The management of PUD is a specific module within the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
12. A patient with a history of a bleeding ulcer must take an NSAID for severe arthritis. Which strategy offers the best gastroprotection?
- a. Taking the NSAID with food.
- b. Using a COX-2 selective NSAID alone.
- c. Using a non-selective NSAID plus an H2RA.
- d. Using a COX-2 selective NSAID plus a daily PPI.
Answer: d. Using a COX-2 selective NSAID plus a daily PPI.
13. The mechanism of action of sucralfate in PUD management is:
- a. Potent acid suppression.
- b. Forming a viscous, protective barrier that binds to the ulcer crater.
- c. Eradication of H. pylori.
- d. Antagonism of histamine receptors.
Answer: b. Forming a viscous, protective barrier that binds to the ulcer crater.
14. What is the role of amoxicillin in H. pylori eradication therapy?
- a. It provides a protective coating for the stomach.
- b. It inhibits the proton pump.
- c. It is a bactericidal antibiotic that disrupts the bacterial cell wall.
- d. It reduces stomach acid.
Answer: c. It is a bactericidal antibiotic that disrupts the bacterial cell wall.
15. A key counseling point for a patient starting a complex, multi-drug regimen for H. pylori is:
- a. The importance of adherence to all medications for the full duration.
- b. They can stop taking the antibiotics once symptoms improve.
- c. They can share the medication with family members.
- d. The medications should be taken on an empty stomach.
Answer: a. The importance of adherence to all medications for the full duration.
16. How do NSAIDs contribute to the formation of peptic ulcers?
- a. They increase the production of protective prostaglandins.
- b. They inhibit the production of protective prostaglandins in the gastric mucosa.
- c. They directly kill H. pylori.
- d. They neutralize stomach acid.
Answer: b. They inhibit the production of protective prostaglandins in the gastric mucosa.
17. After successful eradication of H. pylori for an uncomplicated duodenal ulcer, how long should acid-suppressive therapy (e.g., a PPI) typically be continued?
- a. It can be stopped immediately with the antibiotics.
- b. For an additional 2 to 4 weeks to ensure ulcer healing.
- c. For one year.
- d. For life.
Answer: b. For an additional 2 to 4 weeks to ensure ulcer healing.
18. A patient complains of a metallic taste in their mouth while on H. pylori therapy. Which medication is the most likely cause?
- a. Omeprazole
- b. Amoxicillin
- c. Metronidazole or Clarithromycin
- d. Bismuth subsalicylate
Answer: c. Metronidazole or Clarithromycin
19. Which of the following patients would be a candidate for stress-related mucosal damage (SRMD) prophylaxis in the ICU?
- a. A patient admitted for an elective knee replacement.
- b. A patient on mechanical ventilation for more than 48 hours.
- c. A patient with well-controlled hypertension.
- d. A patient with a common cold.
Answer: b. A patient on mechanical ventilation for more than 48 hours.
20. A patient with PUD presents with black, tarry stools (melena). This is a sign of what complication?
- a. Gastric outlet obstruction
- b. Perforation
- c. Upper GI bleeding
- d. Pancreatitis
Answer: c. Upper GI bleeding
21. In the management of PUD, PPIs are generally preferred over H2RAs because they provide:
- a. Faster pain relief.
- b. More potent and prolonged acid suppression, leading to faster ulcer healing.
- c. Fewer drug interactions.
- d. A lower cost.
Answer: b. More potent and prolonged acid suppression, leading to faster ulcer healing.
22. Which antibiotic used in H. pylori therapy can cause photosensitivity?
- a. Amoxicillin
- b. Metronidazole
- c. Clarithromycin
- d. Tetracycline
Answer: d. Tetracycline
23. The role of bismuth in quadruple therapy is to:
- a. Provide potent acid suppression.
- b. Have topical bactericidal effects against H. pylori and prevent adherence to the gastric mucosa.
- c. Improve the taste of the other medications.
- d. Prevent diarrhea caused by the antibiotics.
Answer: b. Have topical bactericidal effects against H. pylori and prevent adherence to the gastric mucosa.
24. A patient taking an NSAID who is also on high-dose corticosteroids is at an increased risk for PUD.
- a. True
- b. False
Answer: a. True
25. A major reason for treatment failure in H. pylori eradication is:
- a. The patient drinking too much water.
- b. The PPI dose being too high.
- c. Patient non-adherence and antimicrobial resistance.
- d. The use of generic medications.
Answer: c. Patient non-adherence and antimicrobial resistance.
26. Which of the following is an “alarm symptom” for PUD that requires immediate medical evaluation?
- a. Mild epigastric burning
- b. Bloating after meals
- c. Sudden, severe stomach pain and a rigid abdomen
- d. Occasional nausea
Answer: c. Sudden, severe stomach pain and a rigid abdomen
27. The pharmacology of gastric acid-reducing drugs is a specific topic in the Patient Care 4 syllabus.
- a. True
- b. False
Answer: a. True
28. How long after completing H. pylori eradication therapy should a patient wait before undergoing a urea breath test to confirm eradication?
- a. 24 hours
- b. 1 week
- c. At least 4 weeks
- d. 6 months
Answer: c. At least 4 weeks
29. A patient should be counseled to avoid alcohol while taking which antibiotic to prevent a disulfiram-like reaction?
- a. Amoxicillin
- b. Clarithromycin
- c. Tetracycline
- d. Metronidazole
Answer: d. Metronidazole
30. Which of the following NSAIDs is COX-2 selective, carrying a lower risk for GI toxicity compared to non-selective agents?
- a. Ibuprofen
- b. Naproxen
- c. Ketorolac
- d. Celecoxib
Answer: d. Celecoxib
31. The primary goal of maintenance therapy with a PPI after healing a complicated ulcer is to:
- a. Eradicate H. pylori.
- b. Prevent ulcer recurrence.
- c. Treat constipation.
- d. Improve medication adherence.
Answer: b. Prevent ulcer recurrence.
32. The management of Helicobacter pylori is mentioned as a key GI pathogen in the Patient Care 2 syllabus.
- a. True
- b. False
Answer: a. True
33. What is the role of the pharmacist in managing PUD in the community?
- a. Identifying patients at risk due to NSAID use.
- b. Counseling patients on complex eradication regimens.
- c. Screening for drug interactions.
- d. All of the above.
Answer: d. All of the above.
34. For a patient with a duodenal ulcer caused by H. pylori, successful eradication of the bacteria:
- a. Will have no effect on ulcer recurrence.
- b. Significantly reduces the risk of ulcer recurrence.
- c. Increases the risk of ulcer recurrence.
- d. Guarantees the ulcer will never return.
Answer: b. Significantly reduces the risk of ulcer recurrence.
35. If a patient must take an NSAID and has multiple risk factors for a GI bleed, co-therapy with which agent is most effective for prevention?
- a. An H2RA
- b. A PPI
- c. An antacid
- d. Sucralfate
Answer: b. A PPI
36. A patient presents with a prescription for “Prevpac.” The pharmacist knows this is a combination package for treating what condition?
- a. GERD
- b. Crohn’s Disease
- c. H. pylori infection
- d. Gastroparesis
Answer: c. H. pylori infection
37. PPIs can reduce the absorption of which nutrient that requires an acidic environment for absorption?
- a. Vitamin C
- b. Iron and Vitamin B12
- c. Vitamin D
- d. Folate
Answer: b. Iron and Vitamin B12
38. The use of PPIs has been linked in some studies to an increased risk of community- and hospital-acquired pneumonia.
- a. True
- b. False
Answer: a. True
39. Why is it important to confirm H. pylori eradication?
- a. To ensure the infection is gone and reduce the risk of complications like recurrence and gastric cancer.
- b. It is a requirement for insurance reimbursement.
- c. To allow the patient to start taking NSAIDs again.
- d. It is not necessary to confirm eradication.
Answer: a. To ensure the infection is gone and reduce the risk of complications like recurrence and gastric cancer.
40. A patient taking tetracycline for H. pylori should be counseled to avoid taking it at the same time as:
- a. Water
- b. Dairy products, antacids, or iron supplements
- c. Other antibiotics
- d. Acetaminophen
Answer: b. Dairy products, antacids, or iron supplements
41. For a patient with a complicated, bleeding gastric ulcer, PPI therapy should be initiated with:
- a. A low-dose oral tablet.
- b. A high-dose IV infusion.
- c. An H2RA first.
- d. An antacid.
Answer: b. A high-dose IV infusion.
42. Which of the following is NOT a component of any standard H. pylori eradication therapy?
- a. A proton pump inhibitor
- b. An antifungal agent
- c. An antibiotic
- d. Bismuth subcitrate
Answer: b. An antifungal agent
43. The primary difference between a gastric ulcer and a duodenal ulcer is:
- a. The cause.
- b. The treatment.
- c. The location.
- d. The diagnostic method.
Answer: c. The location.
44. A patient with a history of PUD should be advised to use which agent for mild pain relief?
- a. Ibuprofen
- b. Naproxen
- c. Aspirin
- d. Acetaminophen
Answer: d. Acetaminophen
45. The “Management of Peptic Ulcer Disease” is an active learning session in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
46. Long-term, high-dose PPI therapy should be:
- a. Encouraged for all patients with heartburn.
- b. Used at the lowest effective dose for the shortest duration necessary for the indication.
- c. Combined with an H2RA for best effect.
- d. Switched to an OTC product after one week.
Answer: b. Used at the lowest effective dose for the shortest duration necessary for the indication.
47. Misoprostol is effective for NSAID-ulcer prevention but its use is limited by:
- a. High cost.
- b. GI side effects like diarrhea and abdominal cramping.
- c. Its need for IV administration.
- d. Its lack of efficacy.
Answer: b. GI side effects like diarrhea and abdominal cramping.
48. Can a patient develop an ulcer without being infected with H. pylori or using NSAIDs?
- a. No, these are the only two causes.
- b. Yes, in cases of Zollinger-Ellison syndrome or idiopathic PUD.
- c. No, all ulcers are caused by stress.
- d. Yes, but only if they smoke.
Answer: b. Yes, in cases of Zollinger-Ellison syndrome or idiopathic PUD.
49. The overall goal of PUD management is to:
- a. Relieve pain, heal the ulcer, and prevent recurrence and complications.
- b. Ensure the patient is on a PPI for life.
- c. Eliminate all NSAIDs from the market.
- d. Perform an endoscopy on every patient with stomach pain.
Answer: a. Relieve pain, heal the ulcer, and prevent recurrence and complications.
50. For a patient who fails initial H. pylori therapy, what is the most important factor in choosing the next regimen?
- a. The cost of the medications.
- b. The patient’s preference.
- c. Avoiding antibiotics used in the initial regimen.
- d. Using the same regimen but for a longer duration.
Answer: c. Avoiding antibiotics used in the initial regimen.