PEBC MCQ GI, Renal & Hepatic Disorders question: naproxen for an inflammatory arthritis flare for several weeks

PEBC MCQGI, Renal & Hepatic Disorders

HU, 72, with a past bleeding ulcer, needs naproxen for an inflammatory arthritis flare for several weeks. Which strategy best reduces his risk of another GI bleed?

a. Add a PPI, or use a COX-2 inhibitor with a PPI
b. Take naproxen with food and a glass of milk at each dose
c. Add famotidine 20 mg at bedtime
d. Take enteric-coated naproxen alone

Show the answer and explanation

Answer: a. Add a PPI, or use a COX-2 inhibitor with a PPI

In patients at high GI risk (older age, prior ulcer bleeding), guidelines recommend avoiding NSAIDs if possible, and if needed, combining a COX-2 selective inhibitor with a PPI, or at minimum adding a PPI to a non-selective NSAID. Food and enteric coating reduce dyspepsia but not ulcer complications, and standard-dose H2 blockers do not adequately prevent NSAID ulcers. H. pylori should also be tested and treated. Source: Lanza FL et al. ACG guidelines for prevention of NSAID-related ulcer complications (Am J Gastroenterol 2009;104:728), endorsed in Canadian practice; naproxen product monograph (DPD, checked 2026).

Common mistake

Relying on enteric coating or food to prevent NSAID ulcers.

Practice more PEBC MCQ GI, Renal & Hepatic Disorders questions

Exam-style questions with worked answers, then full timed mocks. Free to start.

Start practicing →

Study note: GI, Renal & Hepatic Disorders PEBC MCQpractice questions & mock exams

Related PEBC MCQ practice questions

PS, 64, asks for an over-the-counter acid reducer. He has had heartburn for 3 months, now with food sticking in his throat and a 5 kg weight loss he did not intend. Which of the following is the most appropriate recommendation?ER, 70, has taken pantoprazole 40 mg daily for 5 years, started for heartburn during a stressful period. She has no Barrett esophagus, bleeding history or ongoing NSAID use and has been symptom-free. What does the Canadian deprescribing guideline suggest?PK is a 52 year old male newly diagnosed with hypertension after home monitoring averaged 148/94 mm Hg. He has no other medical conditions and takes no medications. According to Hypertension Canada's 2025 primary care guideline, which initial treatment is most appropriate?

Build a daily practice habit — a few exam-style questions a day, with worked answers. Free to start.

Start practicing →

Original practice material written to the public PEBC blueprint; not a past or real exam question. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC). 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.