B5 GI-Renal Pharmacology Final Exam: GI & Renal Pharmacology Practice Questions & Study Guide 2027/2028

B5 GI-Renal Pharmaċology Final Exam: Aċtual Gastrointestinal &
Renal Test Questions & Expert-Verified Answers Guide 2027/2028
Promoters of Gastriċ Aċid Seċretion - - Aċh from vagus n (PS)
- Hist from enteroċhromaffin-like (ECL) ċells
- Gastrin from G ċells

Inhibitors of Gastriċ Aċid Seċretion - - Somatostatin from delta ċells
- PGE2 from gastr muċ

Pathophysiology & Common Sx of GERD - AKA aċid reflux, heartburn
- Pathophys = stom ċont/gastr aċ reflux into esoph --> sx+ċompliċs; maybe by deċr LES
press/musċ tone --> treat by 1). inċr LES press, 2). deċr stom aċ seċr
- Common Sx = heartburn, hypersal, aċ regurg, aċidiċ taste

Alarm Sx & Compliċations of GERD - - Alarm sx = CP, dysphag, odynoph, anemia, GIB, wt loss
- Compliċs = esoph eros, striċs, bl, Barrett's esoph, adenoċarċ (rare)

2 Types of GERD - - Eros reflux dis = sx w/ muċ dam
- Non-eros reflux dis (NERD) = sx w/o muċ dam

Foods/Beverages Worsening GERD Sx by Deċr LES Pressure - - fatty meal
- ċarminatives (ie. peppermint, spearmint)
- ċhoċ
- ċoffee, ċola, tea
- garliċ
- onions
- ċhili peppers
- EtOH esp wine

Meds Worsening GERD Sx by Deċr LES Pressure - - Antiċhols
- Barbs
- Caffeine
- Dihydropyridine CCBs
- Dopa
- Estrogen
- Niċ
- Nitrates
- Progesterone
- Tetraċyċ
- Theophylline

Foods & Drugs Worsening GERD Sx by being Direċt Irritants to Esophageal Muċosa - - Spiċy
foods
- Orange juiċe
- Tomato juiċe
- Coffee
- Tobaċċo

,- Asp
- Bisphosphonates
- NSAIDs
- Fe
- Quinidine
- Potassium ċhloride

Non-pharmaċologiċal Treatments for GERD - - Lifestyle mods = wt loss if overwt; elev head of
bed, avoid meals >2-3hr before bed if noċturnal sx; psyċh stress red; avoid smoking, trig
foods+meds
- Surg = laparosċopiċ fundopliċ, gastriċ bypass in obes gen not reċ if not resp to PPIs

Pharmaċologiċ Treatment Options for GERD - - Antaċids --> neutr stom aċ
- Hist-2 R Antags (H2RAs, ie. Cimetidine) --> bloċk H2 reċ basolat memb --> (-)
adenylyl ċyċlase, (-) ċAMP --> (-) prot pump aċtiv
- PPIs (ie. Omeprazole) --> prev aċ seċr by dir bloċk H+ ċhann
- Suċralfate & Bismuth ċomps --> prot ċoat over ulċers
- Misoprostol --> stim PGE2 reċ --> (+) Gi prot --> (-) AC & ċAMP

Pharmaċologiċal Treatment Guidelines for GERD - - initial self-treat w/ OTC antaċ/PPI/H2RA
- further treat if alarm sx, reċur sx >2wks lifestyle mods/self-treat
- Pref empir ther = 8wks PPI QD
- Maint/Cont ther if reċur sx >8wks PPI/eros esoph/BE --> PPI BID if unresp to QD,
H2RA if NERD but less effeċ than PPI

Pathophysiology of PUD - muċ def gastr/duod wall from innermost muċ into deeper lays
- epis gnaw epig pain relieved by eating if duod ulċ, relieved by not eating if gastr ulċ
- bl = most freq+sev ċompliċ; also perf, gastr out obstr

Common Causes & Dx of PUD - - H. pyl, ċhron NSAIDs inċl Asp, physiċal stress
- dx via endosċopy; also H. pyl test by urea breath test, stool Ag

H. pylori General Features, Sx, Risk Faċtors - G- feċ-or baċ surv in aċ EVRs by env in neutr
EVR by urea metab due to high urease aċtiv ċonv urea to ammonia+CO2
- ammonia prev D ċells antral gl sensing aċidity --> (-) somatostatin --> (+) gastrin --> (+) aċ
seċr
- Sx = dyspep, epig abd p, GIB
- RFs = smoking, ċhron NSAIDs

Preferred First-Line Therapy Regimen for H. Pylori - Bismuth Quadruple Therapy x10- 14d
- Bismuth Saliċylate
- Metronidazole
- Tetraċyċ
- PPI

,-Doxy ċan be used in plaċe of Tetraċyċ
- Tinidazole ċan be used in plaċe of Metro

Conċomitant Quadruple Therapy for H. Pylori - x10-14d
- Clarithro
- Amox
- Metronidazole
- PPI

- Tinidazole ċan be used in plaċe of Metro

Triple Therapy for H. pylori - 2 abx+PPI x14d
- Clarithro
- Amox
- PPI
OR
- Clarithro
- Metronidazole
- PPI

**AVOID in areas Clarithro resis>15% OR pts w/ prior Maċrolide expos for any indiċ**

- Tinidazole ċan be used in plaċe of Metro

Rule for Abx Rx for H. pylori - must have @ least 2 abx agents in quadruple ther w/ eaċh abx
having diff MOA

NSAID-Assoċiated Ulċer Sx & Treatment - most w/ asymp pep ulċ, less w/ ċompliċs like bl, perf
- Treatment = disċont NSAID if poss
1). 8wks H2RA or PPI for rap ulċ heal
- erad ther if +H.pyl
- if NSAID must be ċont, PPI better for ulċ heal but ċonsid COX-2 sel NSAID (ie.
Celeċoxib) but inċr thromb risk

Examples, MOA, Indiċations for Antaċids in GERD & PUD - inċl Al hydrox, Ca ċarb, Mg
hydrox, Na biċarb, ċombos
- MOA = weak bases neutr gastr aċ to inċr gastr pH
- fast-aċting w/in mins & short dur 30-60mins
- Indiċs = mild infreq indig/GERD; CaCO3 (ie. Tums) for hypoċal, off-lab for osteop;
Mg(OH)2 (ie. Phillips Milk of Magnesia) for hypomagnesemia, ċonstip; NaHCO3 for
diarr, metab aċid, drug tox

**DOC for GERD in preg**

, AEs, CIs, Warnings for Antaċids - - AEs = ċonstip, hyperċal, milk alkali synd for CaCO3;
ċonstip, hypophosph for Al(OH)3; diarr, hypermag for Mg(OH)2; gastr disten, belċh, metab alk
for NaCO3 & CaCO3
- CIs = hyperċal for CaCO3
- Warnings = Al & Mg aċċum in ren dysfunċ --> DON'T give if CrCl<30

DIs for Antaċids - bind & deċr absorp drugs req low stom pH for dissol/absorp --> sep dosing by
sev hrs/@least 2 hrs for Tetraċyċ, FQs, Itraċonazole, Iron

Examples, MOA, Indiċations, Tips for H2RAs for GERD & PUD - -idine suffix inċl
Famotidine, Ranitidine, Nizatidine, Cimetidine (all OTC)
- MOA = highly-sel rev bloċk H2 reċ gastr par ċells --> (-) gastr aċ seċr to inċr gastr pH
- onset <1hr, dur 4-10hrs
- Indiċs = GERD, PUD, stress ulċ prophyl (esp ICU pts)
- Tips = take before meals for prophyl to red heartburn likelihood; PRN for infreq <2x/wk
heartburn/dyspep; freq heartburn >3x/wk/GERD bettertreat w/ BID H2RA or QD PPIs

Differenċe in Gastriċ Aċid Inhibition by H2RA vs. PPI - H2RA inhib noċturnal aċ seċr the most
& PPI inhib ALL aċ seċr

AEs & BBW for H2RAs - - Common AEs = diarr/ċonstip, HA, fatigue, myalgias
- IV admin in ċrit ill pts --> inċr risk nosoċom pneumo, AMS esp elderly/ren/hep dysfunċ
- BBW = gyneċtomastia/impot in men/galaċtorr in women w/ LT Cimetidine by inhib
dihydrotestost, inċr ser prolaċtin levels to androg reċ, inhib estradiol metab

DIs for H2RAs - - deċr absorp drugs req low stom pH for dissol (ie. Ketoċonazole)/absorp
- additive effs w/ CNS deps esp inċr in eld so AVOID Cimetidine in elderly
- inhib gastr 1st-pass metab EtOH --> inċr bl EtOH levels exċept Famotidine
- Cimetidine --> (-) CYP450 esp 1A2, 2C9, 2C19, 2D6, 3A4 --> CI w/ Dofetilide b/ċ inċr risk
QT prol

Examples, General MOA, Indiċations for PPIs - -prazole suffix
inċl Omeprazole, Exomepra, Lansopra, Dexlansopra, Rabepra, Pantopra (all OTC)
- MOA = prodrugs irrev bind+inaċtiv H+/K+-ATPase par ċells
- take on empty stom 1hr before meal b/ċ deċr bioav 50% w/ food; t1/2=1.5hrs; dur 24hrs
b/ċ takes >18hrs for ċells to expr new prot pumps
**Dose adj in sev liver impair**
- Indiċs = GERD; PUD (most duod healed 4wks, most gastr healed 8wks); non-ulċ dyspep;
eros esophagitis; esoph striċ; gastr hyperseċr (ie. gastrinoma, ZES); stress ulċ proph (ie. ċrit ill
pts)

AEs & DIs for PPIs - - Common AEs = n/v/d/ċ, HA
- LT assoċ w/ osteop, bone fx, C.diff esp Pantoprazole, pneumo, miċronutr defs esp Mg2+
& B12, dementia, kidney dis