PEBC Part I (MCQ) · Competency 1A Clinical Care (about 50% of Part I)
GI, Renal & Hepatic Disorders
GI, renal and hepatic items test reflux and ulcer care, IBD and IBS, constipation and nausea, CKD drug stewardship, electrolyte problems and dosing in liver disease, often as medication reviews in older adults.
1A Clinical Care·2 min read·7 sections
✓Checked against the CAG guidelines (GERD/dyspepsia 2017, UC 2015, IBS 2019); Deprescribing PPIs guideline (Can Fam Physician 2017); KDIGO 2024 CKD guideline; AASLD/CASL ascites and HE guidance; Health Canada product monographs; checked 13 Oct 2026. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC).
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Must-know for the exam
✓Dysphagia, weight loss, bleeding, anemia or vomiting with reflux need prompt referral, not self-care.
✓Deprescribe long-term PPIs without a clear indication by stepping down or switching to on-demand use.
✓High GI-risk NSAID users need a PPI (or COX-2 inhibitor plus PPI); enteric coating does not prevent ulcers.
✓Opioid constipation: start senna (with PEG if needed) with the opioid; docusate alone is ineffective.
✓Metoclopramide: limit to 12 weeks because of tardive dyskinesia.
✓Check TPMT before azathioprine; screen for TB and hepatitis B before TNF inhibitors; avoid live vaccines.
✓KDIGO 2024: SGLT2 inhibitor for CKD with eGFR 20 or more and diabetes or albuminuria.
✓In CKD avoid NSAIDs, glyburide, metformin below eGFR 30 and nitrofurantoin; linagliptin needs no renal adjustment.
✓Cirrhotic ascites: spironolactone and furosemide in a 100:40 ratio; avoid NSAIDs.
✓Lactulose for hepatic encephalopathy: titrate to 2-3 soft stools a day.
▸On this page · 7 sections
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Traps that cost marks
→Self-treating reflux in a patient with alarm symptoms.
→Continuing long-term PPIs without reassessing the indication.
→Relying on enteric coating or food to prevent NSAID ulcers.
→Using docusate alone for opioid-induced constipation.
→Prescribing metoclopramide long term without considering tardive dyskinesia.
→Escalating to steroids or biologics for mild distal UC.
→Confusing pharmacogenetic tests for different drugs.
→Starting a TNF inhibitor without TB and hepatitis B screening.
How this is tested on Part I
Typical items are medication reviews (CKD stage 4, cirrhosis, polypharmacy with bleeding risk) where you must pick the drug to stop or the safest alternative.
Upper GI
PPI before breakfast; review need after 4-8 weeks.
With clopidogrel, choose pantoprazole.
Black stools in an anticoagulated patient: same-day assessment.
Bismuth darkens stools and contains salicylate.
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Educational practice material for exam preparation only. Not medical advice and not a substitute for current product monographs, clinical guidelines or professional judgement. Questions have not yet been reviewed by a licensed pharmacist.
