Chapter 33 – Peptic Ulcer (QE) Sample Questions
1. JH, is a 45 year old patient comes with a prescription of omeprazole 40 mg daily po for his ulcer. His current medical condition includes liver disorders with allergies of lactose intolerance. If you have to make recommendations to his therapy, which of the following best represents your opinion?
- A. Recommend cimetidine
- B. Continue using omeprazole
- C. Recommend ranitidine
- D. Recommend combination of antacid and H2-antagonist.
Ans:
C
Tips: Omeprazole excipients include lactose and PPIs are precaution in liver diseases. So alternate H2RAs. (Cimetidine). Minor increases in liver enzymes are usually mild and may resolve without a change in drug therapy. Severe H2RA-related liver injury is rare, with an onset within days to 14 months of starting therapy, and will usually resolve within 4–12 weeks of discontinuing the drug. In patients with liver injury, switching to a PPI avoids potential cross-reactivity with another H2RA. Consider monitoring liver enzymes in patients receiving high intravenous doses of ranitidine or in patients with existing liver impairment. Patients with liver impairment may be at increased risk of CNS toxicity with cimetidine and dosage adjustment is indicated.
2. JH, is a 45 year old patient comes with a prescription of omeprazole 40 mg daily po for his ulcer. His current medical condition includes liver disorders with allergies of lactose intolerance. If you have to make recommendations to his therapy, which of the following best represents your opinion?
- A. PPI BID + Bismuth subsalicylate 2 tabs QID + Metronidazole 500 mg TID-QID + Tetracycline 500 mg QID for 14 days
- B. PPI BID + Amoxicillin 1g BID + Clarithromycin 500 mg BID
- C. PPI BID + Amoxicillin 1 g BID+ Levofloxacin 500 mg once daily
- D. PPI BID + Metronidazole 500 mg BID + Clarithromycin 500 mg BID
Ans:
C
Tips: The resources list the regimen for "Prior failure" as PPI (BID) + Amoxicillin (1 g BID) + Levofloxacin (500 mg once daily).
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