Individualized Medicine

Question 1

____ is in the top 5 drugs that cause adverse drug reactions

Answer 1

Warfarin

Question 2

Warfarin was discovered in 1920. Coumarin from spoiled sweet clover becomes ____. And cows were dying from simple procedures by bleeding out

Answer 2

Dicoumarol

Question 3

Warfarin was originally sold as a ____ by Wisconsin alumni research foundation

Answer 3

Rodenticide

Question 4

Warfarin is an oral _____ that decreases concentrations of vitamin K-dependent clotting factors. It has a narrow ___ ___. It is a ____ acid. The active enantiomer is labeled ___ and called ___. The less active enantiomers is ___

Answer 4

Anticoagulant
Therapeutic index
Weak
S
CYP2C9
R

Question 5

_____ is the enzyme that helps reduce vitamin K after it has been oxidized to form active clotting factors. Warfarin inhibits ____ in order to reduce clotting factors

Answer 5

VKORC1
VKORC1

Question 6

___ is what the body does to the drug
___ is what the drug does to the body

Answer 6

PK
PD

Question 7

VKORC1 is an active clotting factor. Mutated VKORC1 polymorphism _____ effects warfarin. It reduces the amount of vitamin K, which ____ warfarins effect

Answer 7

Pharmacodynamically
Increases

Question 8

CYP2C9 is the gene that codes the major enzyme that metabolizes warfarin. CYP2C9 polymorphism decreases the metabolism of warfarin, which ____ the effects of warfarin. It _____ effects warfarin

Answer 8

Increases
Pharmacokinetically

Question 9

____ neutralize the acids in the stomach, which decreases the absorption of warfarin (weak acid), there is less available warfarin, _____ it’s affects. This acts on the ____

Answer 9

Decreasing
Pharmacokinetics

Question 10

____ contain a lot of vitamin K, which increases your bodies ability to clot. It is essential that you keep your vitamin K intake the ___ from when you started taking it. This effects warfarin ____ and it can increase or decrease its effects

Answer 10

Salads
Same
Pharmacodynamically

Question 11

____ decreases the amount of plasma protein that binds to warfarin, which increases the amount of free warfarin, which ____ warfarins effects. It effects the _____

Answer 11

Aspirin
Increases
Pharmacokinetically

Question 12

____ is a drug that has the same substrate as warfarin, results in less warfarin being metabolized, which ____ warfarin effects _____

Answer 12

Glipizide
Increases
Pharmacokinetically

Question 13

____ inhibits CYP29, so metabolism is decreased, the level of free warfarin is increased, the effects do warfarin are ____ , ____

Answer 13

Cimetidine
Increased
Pharmacokinetically

Question 14

_____ induces CYP2C9, which increases metabolism of warfarin, ____ the effects of warfarin ___

Answer 14

Rifampin
Decrease
Pharmacokinetically

Question 15

Diagram of the 8 different warfarin drug interactions:

Answer 15

Question 16

INR is the amount of time it takes your body to ___. In a healthy person, INR should be ____ to ___. In a person who is prone to clotting, therapeutic range is ___ to ___

Answer 16

Clot
0.8 to 1.2
2 to 3.5