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Exam 1: Risk of Upper Gastrointestinal Bleeding From Different Drug Combinations
Gastroenterology 2014;147:e13–e16
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES Philip S. Schoenfeld, Section Editor
CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)Ô. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www. gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for specific objectives.
Exam 1: Risk of Upper Gastrointestinal Bleeding From Different Drug Combinations Test ID No.: gastro00210
Contact hours: 1.0
Expiration Date: October 31, 2015
Question 1: What is the most common cause of acute upper gastrointestinal bleeding in Western countries?
a. b. c. d. e.
Helicobacter pylori infection. Low-dose aspirin use. NSAID use. Variceal bleeding. Malignancy.
Question 2: When 2 drugs are used concomitantly, they may act synergistically. This means that both drugs strengthen each other’s pharmacologic action. If the combination of the drugs increases the risk of upper gastrointestinal bleeding (UGIB) to a greater extent than what you would expect based on the risks of the drugs separately, excess risk (‘synergism’) of UGIB is present. Based on the article by Masclee et al, for which drug combination would you expect the highest excess risk of UGIB?
a. Steroids and nonselective NSAIDs. b. Steroids and cyclo-oxygenase (COX)-2 selective inhibitors. c. Selective serotonin reuptake inhibitors and nonselective NSAIDs. d. Selective serotonin reuptake inhibitors and COX-2 selective inhibitors. e. Low-dose aspirin and COX-2 selective inhibitors.
e14
CME Activities
Gastroenterology Vol. 147, No. 4
Question 3: On a population basis, the proportion of UGIB owing to concomitant drug use is reflected in the populationattributable risk (PAR). This number also provides information on the magnitude of potential preventable UGIBs in the general population when appropriate and correct use of gastroprotective drugs is applied. When is the PAR highest?
a. If the drug is rarely used in the population and for drug-related UGIB is high. b. If the drug is frequently used in the population risk for drug-related UGIB is low. c. If the drug is rarely used in the population and for drug-related UGIB is low. d. If the drug is frequently used in the population risk for drug-related UGIB is high.
the risk and the the risk and the
Question 4: A 66-year-old woman with hypertension, for which she uses a b-blocker and aldosterone antagonist, underwent a screening colonoscopy. During consultation, she asks your advice for another problem. She suffers from mild annoying pain in her knee. What do you recommend her to take as appropriate pain relief therapy?
a. Any NSAID. b. COX-2 inhibitor. c. Any NSAID plus a gastroprotective agent (being a proton pump inhibitor, misoprostol, or double-dosed histamine-2 receptor antagonist). d. COX-2 inhibitor plus a gastroprotective agent (being a proton pump inhibitor, misoprostol, or double-dosed histamine-2 receptor antagonist).
Exam 2: Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease Test ID No.: gastro00211
Contact hours: 1.0
Expiration Date: October 31, 2015
Question 1: In which age group was the incidence of IBD increasing most rapidly?
a. b. c. d. e.
<6 years. 6e9.9 years. 10 years. <18 years. a and b have equally increasing incidence.
Question 2: In the 2 years before the diagnosis of IBD, which of the following statements is true?
a. Children <6 years were less likely to be diagnosed with rectal bleeding, diarrhea, or arthralgias compared with patients 10 years. b. Children <6 years were more likely to be diagnosed with rectal bleeding, diarrhea, or arthralgias compared with patients 10 years. c. Children <6 years were more likely to be diagnosed with rectal bleeding and diarrhea, but less likely to be diagnosed with arthralgias compared with patients diagnosed at 10 years. d. Irritable bowel syndrome and constipation were more common diagnoses in children 10 years compared with those <6 years. e. None of the above.
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES Philip S. Schoenfeld, Section Editor
CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)Ô. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www. gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for specific objectives.
Exam 1: Risk of Upper Gastrointestinal Bleeding From Different Drug Combinations Test ID No.: gastro00210
Contact hours: 1.0
Expiration Date: October 31, 2015
Question 1: What is the most common cause of acute upper gastrointestinal bleeding in Western countries?
a. b. c. d. e.
Helicobacter pylori infection. Low-dose aspirin use. NSAID use. Variceal bleeding. Malignancy.
Question 2: When 2 drugs are used concomitantly, they may act synergistically. This means that both drugs strengthen each other’s pharmacologic action. If the combination of the drugs increases the risk of upper gastrointestinal bleeding (UGIB) to a greater extent than what you would expect based on the risks of the drugs separately, excess risk (‘synergism’) of UGIB is present. Based on the article by Masclee et al, for which drug combination would you expect the highest excess risk of UGIB?
a. Steroids and nonselective NSAIDs. b. Steroids and cyclo-oxygenase (COX)-2 selective inhibitors. c. Selective serotonin reuptake inhibitors and nonselective NSAIDs. d. Selective serotonin reuptake inhibitors and COX-2 selective inhibitors. e. Low-dose aspirin and COX-2 selective inhibitors.
e14
CME Activities
Gastroenterology Vol. 147, No. 4
Question 3: On a population basis, the proportion of UGIB owing to concomitant drug use is reflected in the populationattributable risk (PAR). This number also provides information on the magnitude of potential preventable UGIBs in the general population when appropriate and correct use of gastroprotective drugs is applied. When is the PAR highest?
a. If the drug is rarely used in the population and for drug-related UGIB is high. b. If the drug is frequently used in the population risk for drug-related UGIB is low. c. If the drug is rarely used in the population and for drug-related UGIB is low. d. If the drug is frequently used in the population risk for drug-related UGIB is high.
the risk and the the risk and the
Question 4: A 66-year-old woman with hypertension, for which she uses a b-blocker and aldosterone antagonist, underwent a screening colonoscopy. During consultation, she asks your advice for another problem. She suffers from mild annoying pain in her knee. What do you recommend her to take as appropriate pain relief therapy?
a. Any NSAID. b. COX-2 inhibitor. c. Any NSAID plus a gastroprotective agent (being a proton pump inhibitor, misoprostol, or double-dosed histamine-2 receptor antagonist). d. COX-2 inhibitor plus a gastroprotective agent (being a proton pump inhibitor, misoprostol, or double-dosed histamine-2 receptor antagonist).
Exam 2: Incidence, Outcomes, and Health Services Burden of Very Early Onset Inflammatory Bowel Disease Test ID No.: gastro00211
Contact hours: 1.0
Expiration Date: October 31, 2015
Question 1: In which age group was the incidence of IBD increasing most rapidly?
a. b. c. d. e.
<6 years. 6e9.9 years. 10 years. <18 years. a and b have equally increasing incidence.
Question 2: In the 2 years before the diagnosis of IBD, which of the following statements is true?
a. Children <6 years were less likely to be diagnosed with rectal bleeding, diarrhea, or arthralgias compared with patients 10 years. b. Children <6 years were more likely to be diagnosed with rectal bleeding, diarrhea, or arthralgias compared with patients 10 years. c. Children <6 years were more likely to be diagnosed with rectal bleeding and diarrhea, but less likely to be diagnosed with arthralgias compared with patients diagnosed at 10 years. d. Irritable bowel syndrome and constipation were more common diagnoses in children 10 years compared with those <6 years. e. None of the above.