AD 2-----------—-----------------------------------------------EXAM2

Question 1

Inc GI tract motility

Answer 1

Dec absorption

Metoclopramide-inc motility

Question 2

Some metabolites can be toxic

Answer 2

Acetaminophen- hepatic injury

Meperidine- seizure

Question 3

Some metabolites retain same activity

Answer 3

Fexofenadine

Question 4

Some drugs must be converted to metabolites to be active

Produg

Answer 4

Enalapril-> must be hydrolyzed to enalaprilat (active)

Question 5

Poor metabolizer

If not prodrug,

Answer 5

Inc efficacy, inc risk of ADR

Question 6

Extensive metabolizer

Answer 6

Normal metabolizer

Question 7

Poor metabolizer

If prodrug,

Answer 7

Dec efficacy, dec ADR

Question 8

Rapid or ultra rapid metabolizer

If prodrug

Answer 8

Inc efficacy, inc AD

Question 9

Phase I

Answer 9

Oxidation and reduction

Question 10

ADR % (drug-drug interaction)

Answer 10

3-5%

Question 11

Drug metabolism

Phase I

CYP1A2

Answer 11

Induced by tobacco

Inhibitor- quinolones, fluvoxamine, cimetidine

Question 12

3A4. *****

Located in GUt, Liver

Not polymorphic

Answer 12

3A4 metabolizes majority of meds

Is inhibited by ketoconazole (antifungal), Cimetidine, grapefruit juice

Is induced by Rifampin(antimicrobiol)- induce metabolites, dec plasma concentra, dec efficacy

Question 13

2C9

Answer 13

Warfarin- metabolized by 2C9

Question 14

2C19

Anticonvulsants

Answer 14

Omeprazole can be metabolized by enzyme and inhibit this enzyme as well.

Question 15

2D6

2nd most drug metabolizer

Cardiovascular, neurologic drugs

Answer 15

Codein (prodrug)-> morphine

Ultra-rapid metabolizers of CYP2D6 have inadequate responses to standard doses of B blockers, narcotic analgesics, or antidepressants. Require higher doses for clinical effectiveness

Question 16

Phase I

2D6

Inhibitor

Answer 16

Fluoxetine, paroxetine, Haloperidol, Quinidine

Question 17

Phase II

Answer 17

Conjugation of water soluble entity onto the drug for facilitated excretion in urine or bile

Question 18

Grapefruit juice contains *****

Answer 18

a bioflavinoid that inhibit CYP3A4 and blocks metabolism of many drugs

Question 19

Antagonistic

Answer 19

Warfarin and Vt K

Question 20

Synergism

Answer 20

Propranolol and verapamil

Alcohol and benzodiazepines

Question 21

Avoid Foods high in tyramine

Avocado, bananas, chedder cheese, beer, wine

Answer 21

When taking MAOI(depression tr)

Question 22

Avoid Food rich in Vt K

Green leafy, liver

Answer 22

When taking Warfarin

Question 23

Food rich in pyridoxine

Answer 23

Invreases metabolism of Levodopa (parkinson’s)

Question 24

Nutritional deficiency

Answer 24

Dec albumin-> inc free drug

Diuretics=’dec in amt of potassium

Question 25

Ethanol

Answer 25

Long term= inc clearance | Short term = dec clearance

Question 26

Tobacco

Answer 26

Enhanced drug metabolism