Study Questions
Choose the ONE best answer.
40.1 A 68-year-old patient with cardiac failure is diagnosed with ovarian cancer. She begins using cisplatin but
becomes nauseous and suffers from severe vomiting. Which drug would be most effective to counteract the
emesis in this patient without exacerbating her cardiac problem?
A. Droperidol
B. Dolasetron
C. Prochlorperazine
D. Palonosetron
Correct answer = D. Palonosetron is a 5-HT3 antagonist that is effective against drugs with high emetogenic
activity, such as cisplatin. Although dolasetron is also in this category, its propensity to affect the heart makes it a
poor choice for this patient. Droperidol is only a moderately effective antiemetic and has the potential to prolong
the QTc interval, so it is not preferred in this patient. The antiemetic effect of prochlorperazine, a phenothiazine,
is most beneficial against anticancer drugs with moderate to low emetogenic properties.
40.2 A 45-year-old woman complains of severe persistent heartburn and an unpleasant, acid-like taste in her
mouth. The clinician suspects that she has gastroesophageal reflux disease. Which drug is most appropriate?
A. An antacid such as aluminum hydroxide
B. Dicyclomine
C. Granisetron
D. Esomeprazole
Correct answer = D. It is appropriate to treat this patient with a proton-pump inhibitor (PPI) to reduce acid
production and promote healing. An H2 receptor antagonist might also be effective, but the PPIs are preferred. An
antacid would decrease gastric acid, but its effects are short lived compared to those of the PPIs and H2 receptor
antagonists. Dicyclomine is an antimuscarinic drug that is mainly used as an antispasmodic for IBS. The 5-HT3
receptor antagonist granisetron is an antiemetic, and not appropriate for the treatment of GERD.
40.3 A couple celebrating their 30th wedding anniversary are given a trip to Peru to visit Machu Picchu. Because
of past experiences while traveling, they ask their doctor to prescribe an agent in case they experience
diarrhea. Which drug would be effective?
A. Omeprazole
B. Loperamide
C. Famotidine
D. Lubiprostone
Correct answer = B. Loperamide is the only drug that has antidiarrheal activity. Omeprazole is a proton-pump
inhibitor, famotidine antagonizes the H2 receptor to reduce acid production, and lubiprostone is indicated for
chronic constipation or IBS-C.
40.4 A 27-year-old woman who is 34 weeks’ pregnant is on bed rest and is experiencing mild constipation. Which
drug is most appropriate for her?
A. Castor oil
B. Docusate
C. Mineral oil
D. Loperamide
Correct answer = B. Although its effects are not immediate, docusate may be used for mild constipation and is
generally considered safe in pregnancy. Castor oil should not be used in pregnancy because of its ability to cause
uterine contractions. Mineral oil should not be used in bedridden patients due to the possibility of aspiration.
Loperamide is used for diarrhea, not constipation.
40.5 Which drug has been known to cause discoloration of the tongue?
A. Amoxicillin
B. Omeprazole
C. Bismuth subsalicylate
D. Lubiprostone
Correct answer = C. Bismuth subsalicylate compounds may cause a harmless black discoloration of the tongue.
The other agents have not been associated with this effect.
40.6 An elderly woman with a recent history of myocardial infarction is seeking a medication to help treat her
occasional heartburn. She is currently taking several medications, including aspirin, clopidogrel, simvastatin,
metoprolol, and lisinopril. Which drug should be avoided in this patient?
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A. Calcium citrate
B. Famotidine
C. Omeprazole
D. Ranitidine
Correct answer = C. Omeprazole may possibly decrease the efficacy of clopidogrel because it inhibits the
conversion of clopidogrel to its active form.
40.7 Extrapyramidal symptoms (EPS) have been associated with which drug?
A. Metoclopramide
B. Sucralfate
C. Aprepitant
D. Bisacodyl
Correct answer = A. Only metoclopramide has been associated with EPS. This is due to its ability to inhibit
dopamine activity.
40.8 Which agent for gastrointestinal problems is contraindicated in pregnancy?
A. Calcium carbonate
B. Famotidine
C. Lansoprazole
D. Misoprostol
Correct answer = D. Misoprostol, a synthetic prostaglandin analog, is contraindicated in pregnancy because it
may stimulate uterine contractions. The other medications may be used during pregnancy for the treatment of
heartburn (common in pregnancy) or peptic ulcer disease.
40.9 A patient presents with a 2-month history of crampy right lower quadrant abdominal pain. Results of
endoscopy are consistent with moderate Crohn’s disease involving the terminal ileum and proximal large
intestine. Which drug is best to initiate in this patient at this time?
A. Extended-release budesonide
B. Delayed-release budesonide
C. Mesalamine enema
D. Ustekinumab
Correct answer = B. Delayed-release budesonide is indicated in Crohn’s disease because it releases in the
terminal ileum and proximal large bowel and is effective in inducing remission. Extended-release budesonide,
although effective at inducing remission, is only indicated in ulcerative colitis because it does not release in the
small bowel and would not be expected to be effective in this patient’s ileal disease. Mesalamine enema is only
effective on the distal large intestine. Ustekinumab is only indicated in patients who are refractory or intolerant to
TNF-α inhibitors.
40.10 A patient with a history of ulcerative colitis well controlled on mesalamine (Apriso) presents with epigastric
pain and dark tarry stools. He is found to have a duodenal ulcer and is prescribed esomeprazole for 8 weeks.
At follow-up 2 weeks later, his epigastric pain and dark tarry stools are resolved. However, he reports having
increased lower abdominal pain and increased stool frequency. Which change in drug therapy is appropriate
at this time?
A. Change esomeprazole to omeprazole due to interaction with mesalamine (Apriso).
B. Discontinue esomeprazole.
C. Change mesalamine (Apriso) to mesalamine (Asacol).
D. Change mesalamine (Apriso) to olsalazine (Dipentum).
Correct Answer = D. The patient seems to be having increased symptoms of ulcerative colitis after starting the
PPI, esomeprazole. The pH-dependent release formulations of mesalamine have a significant interaction with the
PPIs, which may lead to early release and loss of efficacy. A is incorrect because omeprazole is expected to have
the same interaction. B is incorrect because this patient still requires therapy with a PPI. C is incorrect because
Asacol is also pH-dependent release and is likely to be affected. D is correct because olsalazine is not pH
dependent and release relies on cleavage by colonic bacteria.
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