Clinical Pharmacy Past Paper 8th Semester University of Lahore

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS

SCHOOL OF PHARMACY

Subject: Clinical Pharmacy	Session:                 Pharm-D VIII-Semester
Total Marks:  15	Date: 24/10/2012
Time Allowed:  30min	Paper:                    Quiz 1
Name:	Roll No.

A 54-year-old man complains of burning epigastric pain that usually improves after a meal, and is occasionally relieved with antacids. On examination, he appears well and besides some epigastric tenderness on palpation, the rest of the examination is normal. Upper endoscopy confirms a duodenal ulcer. Which of the following statements concerning PUD is most likely correct?

(A) duodenal ulcer is seen more often in older people than is gastric ulcer

(B) clinically, gastric ulcers are more common than duodenal ulcers

(C) duodenal ulcers can frequently be malignant

(D) infection can cause both types of peptic ulcers

(E) peptic gastric ulcers are usually quite proximal in the stomach

A 35-year-old patient comes into your office with persistent iron deficiency anemia. His past medical history is significant for end-stage renal disease on hemodialysis,

hypertension, and rheumatoid arthritis. His medications include calcium acetate, a multivitamin, nifedipine, aspirin, iron sulfate, and omeprazole. His hemoglobin 6 months ago was 8 mg/dL. One week ago, it was 7.9 mg/dL. His ferritin is 8 mg/dL. He reports no bright red blood per rectum, and his stool guaiac examinations have been repeatedly negative over the past 6 months. What is the most likely cause of this patient’s iron deficiency anemia?

A. Celiac sprue

B. Colon cancer

C. Hemorrhoids

D. Medication effect

E. Peptic ulcer disease

Helicobacter pylori colonization is implicated in all of the following conditions except

A. duodenal ulcer disease

B. gastric adenocarcinoma

C. gastric mucosa-associated lymphoid tissue (MALT) lymphoma

D. gastroesophageal reflux disease

E. peptic ulcer disease

One month after receiving a 14-day course of omeprazole,clarithromycin, and amoxicillin for Helicobacter

pylori–associated gastric ulcer disease, a 44-year-old woman still has mild dyspepsia and pain after meals.What is the appropriate next step in management?

A. Empirical long-term proton pump inhibitor therapy

B. Endoscopy with biopsy to rule out gastric adenocarcinoma

C. H. pylori serology testing

D. Second-line therapy for H. pylori with omeprazole, bismuth subsalicylate, tetracycline, and metronidazole

E. Urea breath test

Which of the following is the most important in the pathogenesis of gastro-oesophageal reflux?

A. Hiatus hernia

B. Persistent reduced lower oesophageal spincter tone

C. Increased transient relaxation of the lower oesophageal sphincter

D. Increased gastric acid secretion

E. Poor lower oesophageal sphincter relaxation

A 37-year-old executive returns to your office for follow-up of recurrent upper abdominal pain. He initially presented 6 weeks ago, complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the

pain occurs three or four times per week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids but then recurs within 2 to 3 hours. He admitted that stress at work had recently

increased and that because of long working hours, he was drinking more caffeine and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal,

including stool guaiac that was negative for occult blood. You advised a change in diet and started him on an H2 blocker. His symptoms resolved completely with the diet changes and daily use of the medication. Results of laboratory tests performed at his first visit show

no anemia, but his serum Helicobacter pylori antibody test was positive.

1) What is your diagnosis?

2) What is your next step?

Mr B is a 57-year-old man who was admitted yesterday after starting to pass black stools. He has a two-day history of severe stomach pains and has suffered on and off with indigestion for some months. He is a life-long smoker, with mild chronic cardiac failure (CCF) for which he has been taking enalapril 5 mg twice daily for 2 years. He also recently started taking naproxen 500 mg twice daily for arthritis. Yesterday his haemoglobin was reported as 10.3 g/dL (range

12–18 g/dL), platelets 162 109/L (range 150–450 109/L), INR 1.1 (range 0.8–1.2 with U+Es and LFTs normal. He was mildly tachycardic (97 bpm) and had a slightly low blood pressure of 115/77 mmHg and was given 1.5 L of saline.

He has just returned from endoscopy this morning and has been newly diagnosed as having a bleeding duodenal ulcer. He has been written up for his usual medication for tomorrow if he is eating and drinking again.

1) What risk factors does Mr B have for a bleeding peptic ulcer?

2 Should Mr B be given a proton pump inhibitor (PPI)? State your reasons. If yes, what would you recommend?

3what other drug instead of naproxen we can give to him?

4 What drugs should Mr B be discharged on?

5 What counseling would you give him?

OR

Question) How enzyme induction and inhibition can lead to drug interaction?example?

How drug interaction can be prevented?

Prepared by:

Dr Haseeb Sattar