ADT Final

Question 1

define Pharmacobezoar

Answer 1

A mass of undissolved drug(s) in the gastrointestinal tract.

Question 2

effects of Pharmacobezoar

Answer 2

Causes erratic absorption.
Prolongs absorption phase.

Question 3

examples of Pharmacobezoars

Answer 3

theophylline, diltiazem, carbamazepine.

Question 4

Sodium Bicarbonate and Cardiotoxicity mechanism

Answer 4

Inhibition of calcium sodium channels.

Question 5

Sodium bicarbonate reduces free _____ concentrations

Answer 5

TCA

Question 6

t/F Binding to plasma proteins or tissues makes drug inactive.

Answer 6

true

Question 7

T/F Increasing plasma concentration of drug can saturate protein binding.

Answer 7

true

Question 8

how does low blood pressure effect clearance?

Answer 8

impairs clearance

Question 9

Antidote for Methanol Poisoning
MoA?

Answer 9

fomepizole
Alcohol dehydrogenase inhibitor.

Question 10

Indications for Hemodialysis (HD)? (AEIOU)

Answer 10

A = Metabolic Acidosis.
E = Electrolyte disturbances.
I = Intoxications.
O = Fluid Overload.
U = Uremia.

Question 11

As free drug concentration increases, glomerular filtration ________, leading to __________ renal drug clearance.

Answer 11

increases, increased

Question 12

Activated charcoal can be used to reduce the _______ of a drug that remains in the stomach.

Answer 12

toxicity

Question 13

Whole bowel irrigation can help clear ______.

Answer 13

toxins

Question 14

Intrinsic Clearance: The maximum ability of the liver to irreversibly ________ a drug by all pathways.

Answer 14

remove

Question 15

As the rate of metabolism ________, the plasma drug concentration increases.

Answer 15

increases

Question 16

As the rate of metabolism increases, the plasma drug concentration _________.

Answer 16

increases

Question 17

higher Vmax = ______ drug metabolized

Answer 17

more

Question 18

_______ Vmax = more drug metabolized

Answer 18

higher

Question 19

Km is the affinity where a lower value requires _____ drug concentration for half-maximal metabolism, where Higher Km requires ______ drug concentration for equivalent half-maximal metabolism.

Answer 19

less,more

Question 20

High affinity = _______ intrinsic clearance, Low affinity = ______ intrinsic clearance.

Answer 20

faster, slower

Question 21

_____ affinity = Faster intrinsic clearance, ____ affinity = Slower intrinsic clearance.

Answer 21

high, low

Question 22

Clearance is affected by changes in ______ binding.

Answer 22

protein

Question 23

Causes of Altered Hepatic Blood Flow:

Answer 23

CHF, cirrhosis, sepsis, shock, mechanical vent, positive end-expiratory pressure (decrease Q). Vasopressors (increase Q).

Question 24

what does Q mean?
Q is equivalent to?

Answer 24

liver blood flow/drug delivery to liver.
clearance

Question 25

ffp = 1 - E, where E= 0 means ____ drug escapes first-pass metabolism (_____ bioavailability). and E=1 means ___ drug escapes first-pass metabolism (_______ bioavailability).

Answer 25

all, good no, poor

Question 26

define Vd

Answer 26

Amount of drug binding in plasma vs. in tissue.

Question 27

Increased Vd indicates the drug is _____ bound to proteins in tissue than plasma.

Answer 27

more

Question 28

_______ Vd indicates the drug is more bound to proteins in tissue than plasma.

Answer 28

increased

Question 29

If intrinsic clearance decreases, the amount of drug that escapes first-pass metabolism (ffp) ________.

Answer 29

increases

Question 30

If intrinsic clearance _______, the amount of drug that escapes first-pass metabolism (ffp) increases.

Answer 30

decreases

Question 31

Synonymous mutation type means it's a ______ mutation

Answer 31

silent

Question 32

Non-synonymous mutation type means ________ or _______ mutation

Answer 32

missense, nonsense

Question 33

define Pharmacogenetics: Drug response related to a single or a few ______.

Answer 33

genes

Question 34

define Pharmacogenomics: Study of variations of all ___________ related to drug response.

Answer 34

DNA and RNA

Question 35

list the "Three Rights"

Answer 35

Right Person: Who benefits from the med. Right Test: Don't do the wrong one! Right Interpretation: Give genetic info and inform physicians to make appropriate management decisions.

Question 36

How many chromosomes are in the human body?

Answer 36

46

Question 37

How many base-pairs are in the entire genome?

Answer 37

3.2 billion

Question 38

What percentage of the genome makes proteins?

Answer 38

~1%

Question 39

Avoid prescribing abacavir in patients with __________ mutation.

Answer 39

HLA-B*5701

Question 40

Avoid prescribing phenytoin or carbamazepine in patients with _________ mutation.

Answer 40

HLA-B*1502

Question 41

Mutations in CYP2D6 are common in ________ and can cause _________ metabolism.

Answer 41

Africans, ultrarapid

Question 42

Mutations in CYP2C19 are most common in ________, causing _____ metabolism of drugs via the 2C19 pathway, such as _________(drug).

Answer 42

Oceanians, poor, clopidogrel

Question 43

CYP2C19 polymorphism requires a _______ in the initial warfarin dose. VKORC1 polymorphism also requires a _______ in the initial warfarin dose.

Answer 43

reduction, reduction

Question 44

Main Resource for Pharmacogenetic Information?

Answer 44

The Clinical Pharmacogenetics Implementation Consortium (CPIC).

Question 45

what is a major SE of Azathioprine, mercaptopurine, thioguanine.?

Answer 45

Myelosuppression

Question 46

if low TPMT: Reduce daily dose by _____, frequency to _____ times weekly. if intermediate TPMT: Reduce dose by ______ if high TPMT: ______ dosing

Answer 46

10X, three 30-80%. normal

Question 47

Thioguanine with low NUDT15 activity: ______ dose by 25%.

Answer 47

reduce

Question 48

Thioguanine with low NUDT15 activity: Reduce dose by _____

Answer 48

25%

Question 49

Irinotecan Dose Reduction: Patients Homozygous for UGT1A1*28 allele: Start with ____ of normal dose.

Answer 49

70%

Question 50

Irinotecan Dose Reduction: Patients Homozygous for _______ allele: Start with 70% of normal dose.

Answer 50

UGT1A1*28

Question 51

CYP2D6 and Tamoxifen: Poor metabolizer (0): ______ concentration. Intermediate metabolizer (0.5): _____ concentration. Normal/Intermediate (1): _____ concentration. Normal (1.5-2): ______ concentration. Ultrarapid (>2): ______ concentration.

Answer 51

lower lower lower normal normal

Question 52

Avoid CYP2D6 inhibitors with tamoxifen (bupropion, fluoxetine, paroxetine, quinidine, terbinafine).

Answer 52

.

Question 53

Tissue-Agnostic Agent: A drug that targets specific ________ across multiple cancer types.

Answer 53

biomarkers

Question 54

The two tissue-agnostic agents are Larotrectinib and Entrectinib, which treat _____ solid tumors

Answer 54

NTRK-fusion

Question 55

what does SMMART do?

Answer 55

allows tracking of cancer progression over time to adjust drug combinations before resistance develops.

Question 56

phenytoin is used to treat Tonic-clonic seizures, Partial seizures, Generalized status epilepticus and seizure prevention. what is the MoA?

Answer 56

Increases efflux or decreases influx of sodium ions and Prolongs inactivation of voltage-gated sodium ion channels.

Question 57

what causes purple glove syndrome?

Answer 57

large- multiple doses of IV phentoin

Question 58

long-term use of phenytoin may lead to?

Answer 58

lupus erythematosus

Question 59

what Alters phenytoin plasma binding due to displacement?

Answer 59

hyperbilirubinemia, jaundice, liver disease, renal dysfunction

Question 60

what Alter phenytoin plasma binding due to hypoalbuminemia?

Answer 60

liver disease, nephrotic syndrome, burns, trauma, malnourishment, elderly.

Question 61

what drugs influence plasma protein binding of phenytoin?

Answer 61

Warfarin, valproic acid, aspirin (>2g/d), NSAIDs.

Question 62

Hypoalbuminemia ______ phenytoin Vd.

Answer 62

increases

Question 63

Coadministration of Valproic Acid ______ Vd and fu plasma of phenytoin.

Answer 63

increases

Question 64

Renal failure ________ the Vd of phenytoin.

Answer 64

increases

Question 65

Phenytoin is a ______(extraction) drug. Protein binding changes that increase fu would cause an _______ in Vd and clearance, with ______ in t1/2.

Answer 65

low E increase, no change

Question 66

phenytoin Hypoalbuminemia increases fu plasma, therefore Css,total _________.

Answer 66

decreases

Question 67

phenytoin Hypoalbuminemia ________ fu plasma, therefore Css,total decreases.

Answer 67

increases

Question 68

Phenytoin At steady-state, the rate of drug in ______ the rate of drug out. aka Rate of drug ________ = Rate of drug elimination.

Answer 68

equals administration

Question 69

for phenytoin: Rate of drug administration = Rate of drug ________.

Answer 69

elimination

Question 70

For oral LD of phenytoin, only ______ can be absorbed at a time.

Answer 70

400mg

Question 71

what are Initial Immunosuppressants for Organ Rejection Prevention

Answer 71

Thymoglobulin, alemtuzumab, rituximab, basiliximab.

Question 72

what are Maintenance Immunosuppressants

Answer 72

Cyclosporine, tacrolimus, sirolimus, everolimus, mycophenolate, azathioprine, methylprednisolone, prednisone.

Question 73

what is the Treatment for Acute Rejection?

Answer 73

Thymoglobulin

Question 74

Adverse Effects of Cyclosporine

Answer 74

Hirsutism, nephrotoxicity, hypertension, gingival hyperplasia.

Question 75

Adverse Effect of Mycophenolate?

Answer 75

Gastrointestinal hemorrhage.

Question 76

Mycophenolic acid is _______.

Answer 76

teratogenic

Question 77

what drug is an IL-2 inhibitor?

Answer 77

Basiliximab

Question 78

what drugs Decrease transcription of IL-2?

Answer 78

Cyclosporine, tacrolimus.

Question 79

Azathioprine Combination with allopurinol causes?

Answer 79

severe myelosuppression

Question 80

avoid combining azathioprine with ACE-Is due to?

Answer 80

increased risk of myelosuppression.

Question 81

side effects of azathiioprine?

Answer 81

Pancytopenia (leukopenia, anemia, thrombocytopenia), alopecia, hepatotoxicity, pancreatitis.

Question 82

SE;s of sirolimus?

Answer 82

Hyperlipidemia, pancytopenia, mouth ulcers.

Question 83

SEs of tacrolimus?

Answer 83

Nephrotoxicity, hyperglycemia.

Question 84

Definitions: Prematurity: Neonates: Infants: Children: Adolescents:

Answer 84

Prematurity: Born before 37 weeks. Neonates: Younger than 28 days of life when born full term. Infants: 28 days to 1 year old. Children: 1-11 y/o. Adolescents: 12-16 y/o.

Question 85

Children have ______ clearance.

Answer 85

increased

Question 86

Absorption: ______ in neonates and young infants, ________ Tmax.

Answer 86

slower, prolonged

Question 87

Neonates have _______ gastric pH, ________ bioavailability of drugs like penicillin and ampicillin.

Answer 87

elevated, increasing

Question 88

Children have ________ percutaneous absorption.

Answer 88

enhanced

Question 89

Neonates and young infants have _______ bioavailability of rectal metabolism.

Answer 89

enhanced

Question 90

intramuscular Absorption: ______ in infants due to ______ blood flow.

Answer 90

reduced, reduced

Question 91

Infants have less body fat, so highly lipid-soluble drugs are distributed _____.

Answer 91

less

Question 92

Drugs renally eliminated have _______ clearance in neonates and ______ clearance in young children (older than 1 year).

Answer 92

decreased, increased

Question 93

Promethazine is contraindicated under?

Answer 93

2 y/o

Question 94

what drug is contraindicated in children under 2?

Answer 94

promethazine

Question 95

Ceftriaxone contraindicated in _______ (under 28 days of age).

Answer 95

neonates

Question 96

what cephalosporin is contraindicated in neonates?

Answer 96

ceftriaxone

Question 97

FDA Warning: Not to use ______ in children under 12.

Answer 97

codeine

Question 98

Avoid drugs containing benzyl alcohol for kids. Main ones to watch for are ________ saline and water.

Answer 98

bacteriostatic

Question 99

Avoid drugs containing __________ for kids. Main ones to watch for are bacteriostatic saline and water.

Answer 99

benzyl alcohol