A patient has a bleeding gastric ulcer with a visible vessel, and endoscopic haemostasis has succeeded. Which PPI regimen is recommended for the next 72 hours?

80 mg intravenous bolus followed by 8 mg/hour infusion

Oral omeprazole 20 mg once daily for 72 hours

Intravenous ranitidine bolus 50 mg only

Which drug is first-line for inducing and maintaining remission in mild to moderate ulcerative colitis?

Methotrexate given weekly with folic acid

Which test should be done before a patient starts azathioprine for Crohn's disease?

Thiopurine methyltransferase (TPMT) activity

Urine catecholamines and plasma metanephrines

A patient with Crohn's disease is about to receive a first infliximab infusion. Which pre-treatment checks does the pharmacist confirm?

Latent tuberculosis and hepatitis B screening

Vitamin D level and a baseline bone density scan

GI disorders and dosing in renal and liver disease

30 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on GI disorders and dosing in renal and liver disease, part of Clinical Pharmacy and Therapeutics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A patient has a bleeding gastric ulcer with a visible vessel, and endoscopic haemostasis has succeeded. Which PPI regimen is recommended for the next 72 hours?
1. AOral sucralfate
2. BOral omeprazole 20 mg once daily for 72 hours
3. C80 mg intravenous bolus followed by 8 mg/hour infusion
4. DIntravenous ranitidine bolus 50 mg only
Show answerHide answer
Answer: C · 80 mg intravenous bolus followed by 8 mg/hour infusion
After endoscopic therapy of a high-risk ulcer, high-dose intravenous PPI (80 mg bolus then 8 mg/hour for 72 hours) maintains an intragastric pH above 6, which stabilises clots and lowers rebleeding. Standard oral doses give insufficient acid suppression early on.
- A: Sucralfate does not maintain a high pH.
- B: Low-dose oral therapy is inadequate for high-risk ulcers.
- D: H2 blockers show tolerance and are not equivalent.
Remember this
High-risk ulcers after endoscopic therapy receive high-dose IV PPI for 72 hours.
Question 2 · Easy
Which drug is first-line for inducing and maintaining remission in mild to moderate ulcerative colitis?
1. AInfliximab
2. BMesalazine (5-ASA)
3. CAzathioprine
4. DMethotrexate given weekly with folic acid
Show answerHide answer
Answer: B · Mesalazine (5-ASA)
Aminosalicylates act topically on the colonic mucosa, and oral combined with rectal mesalazine is first-line for mild to moderate ulcerative colitis. Biologics and immunomodulators are for steroid-dependent or more severe disease.
- A: Infliximab is for moderate to severe or refractory disease.
- C: Azathioprine maintains remission in steroid-dependent disease.
- D: Methotrexate is used mainly in Crohn's disease.
Remember this
Mesalazine is first-line for mild to moderate ulcerative colitis.
Question 3 · Hard
A 68 kg patient is prescribed infliximab 5 mg/kg at weeks 0, 2 and 6. Each dose is rounded up to the nearest whole 100 mg vial. How many vials are needed for the three induction infusions?
1. A15 vials
2. B12 vials
3. C9 vials
4. D10 vials
Show answerHide answer
Answer: B · 12 vials
Each dose is 5 x 68 = 340 mg, which rounds up to 400 mg, or 4 vials. Three infusions need 3 x 4 = 12 vials, a total of 1,200 mg, although 1,020 mg is actually given. Pharmacists often dose-round within 10% to limit waste.
- A: 15 vials would be 5 vials per dose.
- C: 9 vials would give only 3 vials per dose, which is under the dose needed.
- D: 10 vials would be 3.33 vials per dose.
Remember this
Multiply the weight-based dose first, round to whole vials, then multiply by the infusions.
Question 4 · Medium
Which test should be done before a patient starts azathioprine for Crohn's disease?
1. ASerum lipase
2. BHLA-B*5701
3. CUrine catecholamines and plasma metanephrines
4. DThiopurine methyltransferase (TPMT) activity
Show answerHide answer
Answer: D · Thiopurine methyltransferase (TPMT) activity
TPMT inactivates thiopurines, so patients with low or absent activity accumulate toxic thioguanine nucleotides and are at risk of severe myelosuppression. Testing allows a reduced dose or an alternative. A blood count is also monitored regularly.
- A: Lipase relates to pancreatitis, not dose selection.
- B: HLA-B*5701 is checked before abacavir.
- C: Catecholamines are not relevant.
Remember this
Check TPMT before starting azathioprine or mercaptopurine.
Question 5 · Medium
A patient with Crohn's disease is about to receive a first infliximab infusion. Which pre-treatment checks does the pharmacist confirm?
1. ALatent tuberculosis and hepatitis B screening
2. BVitamin D level and a baseline bone density scan
3. CThyroid function only
4. DLipid profile
Show answerHide answer
Answer: A · Latent tuberculosis and hepatitis B screening
Anti-TNF drugs can reactivate latent tuberculosis and hepatitis B, so patients are screened with an interferon-gamma release assay or tuberculin test, chest imaging and hepatitis B serology before the first infusion.
- B: Vitamin D is not a precondition.
- C: Thyroid tests are not the critical screen.
- D: Lipids are not the key concern.
Remember this
Screen for latent TB and hepatitis B before anti-TNF therapy.
Question 6 · Medium
A 50-year-old man has had no reflux symptoms for 8 weeks on pantoprazole 40 mg daily for uncomplicated GORD. What is the best next step?
1. AContinue 40 mg daily indefinitely
2. BStep down to the lowest effective dose or on-demand use
3. CIncrease to 80 mg daily to prevent any relapse
4. DStop abruptly without any review or taper
Answer and explanation in LearnFree account
Question 7 · Easy
Which supplement should accompany sulfasalazine therapy?
1. AVitamin K
2. BIron only
3. CVitamin C
4. DFolic acid
Answer and explanation in LearnFree account
Question 8 · Medium
A patient is 170 cm tall, weighs 120 kg (ideal body weight 66 kg) and has a BMI of 41.5. Which body weight is generally preferred in the Cockcroft-Gault equation?
1. AIdeal body weight only for all patients
2. BLean tissue mass measured by DEXA
3. CActual body weight
4. DAdjusted body weight
Answer and explanation in LearnFree account
Question 9 · Hard
A woman on stable levothyroxine has a rising TSH 3 months after starting pantoprazole 40 mg daily for GORD, with good adherence and no other changes. What is the most appropriate response?
1. ASuspect reduced absorption from lower gastric acidity, recheck TSH and adjust the dose
2. BStop levothyroxine
3. CAdd a calcium supplement to the morning levothyroxine dose to improve its absorption rate
4. DSwitch pantoprazole to omeprazole
Answer and explanation in LearnFree account
Question 10 · Medium
A patient on azathioprine is started on allopurinol for gout. What dose adjustment of azathioprine is needed?
1. AReduce by 10%
2. BReduce to about 25% of the usual dose, with close blood count monitoring
3. CNo adjustment is needed because the two drugs act on different metabolic pathways
4. DDouble the dose
Answer and explanation in LearnFree account
Question 11 · Hard
An 80-year-old woman weighs 50 kg and has a serum creatinine of 1.4 mg/dL. She takes metformin 500 mg twice daily. Using CrCl = (140 - age) x weight / (72 x creatinine) x 0.85 for women, what should the pharmacist conclude?
1. ACrCl is about 60 mL/min, so metformin can continue
2. BCrCl is about 90 mL/min, so no action is needed
3. CCrCl is about 25 mL/min, so metformin should be stopped
4. DCrCl is about 45 mL/min, so double the dose
Answer and explanation in LearnFree account
Question 12 · Medium
Why is oral budesonide often chosen for mild to moderate ileocaecal Crohn's disease?
1. AIt avoids the need for any monitoring
2. BHigh first-pass hepatic metabolism gives fewer systemic steroid effects
3. CIt has far higher systemic potency than prednisolone, so smaller doses are used
4. DIt acts only by an antibiotic effect
Answer and explanation in LearnFree account
Question 13 · Medium
Which patient is most likely to benefit from stress ulcer prophylaxis with a PPI in intensive care?
1. AA patient with a cold
2. BA patient on mechanical ventilation for more than 48 hours
3. CA patient admitted for observation after a mild fall with no organ dysfunction
4. DA patient on enteral feeding with no risk factors
Answer and explanation in LearnFree account
Question 14 · Easy
A pharmacist wants to estimate creatinine clearance by the Cockcroft-Gault method. Which four data points must be collected from the chart?
1. AAge, height, cystatin C and urine albumin ratio
2. BWeight and urine output
3. CAge, weight, sex and serum creatinine
4. DRace and albumin
Answer and explanation in LearnFree account
Question 15 · Hard
A patient with Crohn's disease has not responded to azathioprine 2 mg/kg. Metabolite testing shows high 6-methylmercaptopurine (6-MMP) and low 6-thioguanine nucleotides (6-TGN). What is the best strategy?
1. AAdd another thiopurine
2. BStop the drug and give no further therapy until the next flare of Crohn's disease
3. CDouble the azathioprine dose
4. DAdd allopurinol and reduce azathioprine to about 25% of the dose
Answer and explanation in LearnFree account
Question 16 · Medium
A patient who has taken esomeprazole 40 mg for 6 months stops it abruptly and develops worse heartburn within days. What is the likely explanation?
1. ATreatment failure of H. pylori
2. BRebound acid hypersecretion from hypergastrinaemia
3. CA drug interaction with antacids
4. DA new allergy to esomeprazole
Answer and explanation in LearnFree account
Question 17 · Medium
A 64-year-old woman who has taken omeprazole for 5 years presents with muscle cramps, tetany and palpitations. Which laboratory test is most useful?
1. ASerum amylase
2. BSerum urate
3. CSerum ferritin
4. DSerum magnesium
Answer and explanation in LearnFree account
Question 18 · Medium
A patient taking clopidogrel after a stent needs a PPI for gastroprotection. Which choice is the most appropriate?
1. AFluconazole to boost clopidogrel
2. BEsomeprazole
3. COmeprazole
4. DPantoprazole
Answer and explanation in LearnFree account
Question 19 · Medium
A patient is started on a PPI and also takes ketoconazole tablets for a fungal infection. What is the most likely effect?
1. AKetoconazole absorption increases
2. BPPI levels fall because of ketoconazole
3. CNo clinically significant interaction exists between these two drugs
4. DKetoconazole absorption falls because it needs gastric acid
Answer and explanation in LearnFree account
Question 20 · Easy
When should an oral PPI be taken for the best effect?
1. AImmediately after a large meal
2. BOnly when pain occurs
3. CAt bedtime on an empty stomach, several hours after the last meal
4. D30 to 60 minutes before the first meal of the day
Answer and explanation in LearnFree account
Question 21 · Medium
A hospitalised patient with severe acute ulcerative colitis (more than 6 bloody stools a day, tachycardia, raised CRP) should first receive which treatment?
1. AOral mesalazine alone at the maximum dose, with rectal mesalazine added as well
2. BOral loperamide
3. CIntravenous corticosteroid, such as methylprednisolone or hydrocortisone
4. DOral azathioprine
Answer and explanation in LearnFree account
Question 22 · Medium
Which medicine should be avoided in a patient with an acute severe flare of ulcerative colitis?
1. ALoperamide
2. BIntravenous hydrocortisone
3. CThromboprophylaxis
4. DIntravenous fluids
Answer and explanation in LearnFree account
Question 23 · Easy
Metformin is contraindicated in which range of renal function?
1. AAny degree of renal function
2. BeGFR 60 to 89 mL/min/1.73 m2
3. CeGFR above 90 mL/min/1.73 m2
4. DeGFR below 30 mL/min/1.73 m2
Answer and explanation in LearnFree account
Question 24 · Medium
A 79-year-old man with CKD on an oral anticoagulant has life-threatening bleeding. Which agent can be reversed specifically with idarucizumab?
1. ARivaroxaban
2. BDabigatran
3. CApixaban
4. DFondaparinux
Answer and explanation in LearnFree account
Question 25 · Medium
A care-home resident (female, 83 years, 52 kg) has a creatinine of 118 micromol/L on her latest blood test. Applying the SI-unit Cockcroft-Gault equation with the female constant 1.04, what clearance should the pharmacist record?
1. AAbout 31 mL/min
2. BAbout 26 mL/min
3. CAbout 18 mL/min
4. DAbout 45 mL/min
Answer and explanation in LearnFree account

5 more GI disorders and dosing in renal and liver disease questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Clinical Pharmacy and Therapeutics

GI disorders and dosing in renal and liver disease

A patient has a bleeding gastric ulcer with a visible vessel, and endoscopic haemostasis has succeeded. Which PPI regimen is recommended for the next 72 hours?

Which drug is first-line for inducing and maintaining remission in mild to moderate ulcerative colitis?

A 68 kg patient is prescribed infliximab 5 mg/kg at weeks 0, 2 and 6. Each dose is rounded up to the nearest whole 100 mg vial. How many vials are needed for the three induction infusions?

Which test should be done before a patient starts azathioprine for Crohn's disease?

A patient with Crohn's disease is about to receive a first infliximab infusion. Which pre-treatment checks does the pharmacist confirm?

A 50-year-old man has had no reflux symptoms for 8 weeks on pantoprazole 40 mg daily for uncomplicated GORD. What is the best next step?

Which supplement should accompany sulfasalazine therapy?

A patient is 170 cm tall, weighs 120 kg (ideal body weight 66 kg) and has a BMI of 41.5. Which body weight is generally preferred in the Cockcroft-Gault equation?

A woman on stable levothyroxine has a rising TSH 3 months after starting pantoprazole 40 mg daily for GORD, with good adherence and no other changes. What is the most appropriate response?

A patient on azathioprine is started on allopurinol for gout. What dose adjustment of azathioprine is needed?

An 80-year-old woman weighs 50 kg and has a serum creatinine of 1.4 mg/dL. She takes metformin 500 mg twice daily. Using CrCl = (140 - age) x weight / (72 x creatinine) x 0.85 for women, what should the pharmacist conclude?

Why is oral budesonide often chosen for mild to moderate ileocaecal Crohn's disease?

Which patient is most likely to benefit from stress ulcer prophylaxis with a PPI in intensive care?

A pharmacist wants to estimate creatinine clearance by the Cockcroft-Gault method. Which four data points must be collected from the chart?

A patient with Crohn's disease has not responded to azathioprine 2 mg/kg. Metabolite testing shows high 6-methylmercaptopurine (6-MMP) and low 6-thioguanine nucleotides (6-TGN). What is the best strategy?

A patient who has taken esomeprazole 40 mg for 6 months stops it abruptly and develops worse heartburn within days. What is the likely explanation?

A 64-year-old woman who has taken omeprazole for 5 years presents with muscle cramps, tetany and palpitations. Which laboratory test is most useful?

A patient taking clopidogrel after a stent needs a PPI for gastroprotection. Which choice is the most appropriate?

A patient is started on a PPI and also takes ketoconazole tablets for a fungal infection. What is the most likely effect?

When should an oral PPI be taken for the best effect?

A hospitalised patient with severe acute ulcerative colitis (more than 6 bloody stools a day, tachycardia, raised CRP) should first receive which treatment?

Which medicine should be avoided in a patient with an acute severe flare of ulcerative colitis?

Metformin is contraindicated in which range of renal function?

A 79-year-old man with CKD on an oral anticoagulant has life-threatening bleeding. Which agent can be reversed specifically with idarucizumab?

A care-home resident (female, 83 years, 52 kg) has a creatinine of 118 micromol/L on her latest blood test. Applying the SI-unit Cockcroft-Gault equation with the female constant 1.04, what clearance should the pharmacist record?