NAPLEX GERD & PUD Questions with Correct Answers (Grade
A+)
Question 1: What 3 hormones regulate HCl production?
Answer: histamine, acetylcholine, gastrin
Question 2: What physical abnormality leads to GERD?
Answer: reduces lower esophageal sphincter pressure
Question 3: symptoms of GERD
Answer: heartburn, hypersalivation, regurgitation, epigastric pain, nausea, cough
Question 4: diagnosis of GERD
Answer: symptoms e2 weeks (no imaging required)
Question 5: drugs that worsen GERD
Answer: aspirin, NSAIDs, bisphosphonates, dabigatran, estrogen, fish oil, iron, nicotine replacement
therapy, steroids, tetracyclines
Question 6: When should a patient be referred to a provider for GERD?
Answer: symptoms continue after 2 weeks of OTCs; alarm symptoms: odynophagia, dysphagia, n/v,
hematemesis, black/bloody stool, unintentional weight loss
Question 7: How should GERD be treated?
Answer: sx <2x/wk: prn antacids or H2RAs; sx e2x/wk: PPI QD x8wks, then stop and see if sx return
Question 8: GERD lifestyle modifications
Answer: weight loss, elevate head of bed, avoid high fat meals before bed, avoid caffeine, chocolate,
acidic/spicy foods, carbonation
Question 9: antacid onset and duration
Answer: within minutes; 30-60 minutes
Question 10: When are H2RAs used for GERD?
Answer: prn or maintenance after PPI trial and no esophageal erosions
Page 1
, Question 11: PPI MOA
Answer: irreversibly bind H/K-ATPase pump in parietal cells to decrease HCl production
Question 12: long-term ADE with PPIs
Answer: increased risk for GI infections (C. diff), pneumonia, osteoporosis, on Beer's list
Question 13: metoclopramide MOA in GERD
Answer: dopamine antagonist - increased gastric emptying and LES tone
Question 14: H2RA + CNS depressant
Answer: increased delirium, cognitive impairment in elderly and those with renal impairment
Question 15: Which PPIs inhibit 2C19?
Answer: all - esomeprazole and omeprazole strongest
Question 16: When should metoclopramide not be used?
Answer: Parkinson's, with antipsychotics, droperidol, promethazine; risk for serotonin syndrome with
SSRIs, SNRIs, TCAs
Question 17: PPI + methotrexate
Answer: PPIs inhibit renal elimination of methotrexate
Question 18: Mylanta Supreme
Answer: calcium carbonate/magnesium
Question 19: Maalox Advanced Maximum Strength
Answer: calcium carbonate/simethicone
Question 20: sodium bicarbonate/aspirin/citric acid
Answer: Alka-Seltzer
Question 21: Which antacid increases bleeding risk?
Answer: Alka-Seltzer (sodium bicarb/aspirin/citric acid)
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A+)
Question 1: What 3 hormones regulate HCl production?
Answer: histamine, acetylcholine, gastrin
Question 2: What physical abnormality leads to GERD?
Answer: reduces lower esophageal sphincter pressure
Question 3: symptoms of GERD
Answer: heartburn, hypersalivation, regurgitation, epigastric pain, nausea, cough
Question 4: diagnosis of GERD
Answer: symptoms e2 weeks (no imaging required)
Question 5: drugs that worsen GERD
Answer: aspirin, NSAIDs, bisphosphonates, dabigatran, estrogen, fish oil, iron, nicotine replacement
therapy, steroids, tetracyclines
Question 6: When should a patient be referred to a provider for GERD?
Answer: symptoms continue after 2 weeks of OTCs; alarm symptoms: odynophagia, dysphagia, n/v,
hematemesis, black/bloody stool, unintentional weight loss
Question 7: How should GERD be treated?
Answer: sx <2x/wk: prn antacids or H2RAs; sx e2x/wk: PPI QD x8wks, then stop and see if sx return
Question 8: GERD lifestyle modifications
Answer: weight loss, elevate head of bed, avoid high fat meals before bed, avoid caffeine, chocolate,
acidic/spicy foods, carbonation
Question 9: antacid onset and duration
Answer: within minutes; 30-60 minutes
Question 10: When are H2RAs used for GERD?
Answer: prn or maintenance after PPI trial and no esophageal erosions
Page 1
, Question 11: PPI MOA
Answer: irreversibly bind H/K-ATPase pump in parietal cells to decrease HCl production
Question 12: long-term ADE with PPIs
Answer: increased risk for GI infections (C. diff), pneumonia, osteoporosis, on Beer's list
Question 13: metoclopramide MOA in GERD
Answer: dopamine antagonist - increased gastric emptying and LES tone
Question 14: H2RA + CNS depressant
Answer: increased delirium, cognitive impairment in elderly and those with renal impairment
Question 15: Which PPIs inhibit 2C19?
Answer: all - esomeprazole and omeprazole strongest
Question 16: When should metoclopramide not be used?
Answer: Parkinson's, with antipsychotics, droperidol, promethazine; risk for serotonin syndrome with
SSRIs, SNRIs, TCAs
Question 17: PPI + methotrexate
Answer: PPIs inhibit renal elimination of methotrexate
Question 18: Mylanta Supreme
Answer: calcium carbonate/magnesium
Question 19: Maalox Advanced Maximum Strength
Answer: calcium carbonate/simethicone
Question 20: sodium bicarbonate/aspirin/citric acid
Answer: Alka-Seltzer
Question 21: Which antacid increases bleeding risk?
Answer: Alka-Seltzer (sodium bicarb/aspirin/citric acid)
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