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more mc q's Flashcards

1
Q

Genotyping can significantly reduce the incidence of severe toxicity for which of the following cancer chemotherapeutic agent?

a. doxorubicin
b. paclitaxel
c. azathioprine
d. irinotecan
e. A & B
f. C & D

A

f. C & D

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2
Q

Tolbutamide is a drug often used as a phenotypic probe for CYP 2C9. Which of the following drugs will require close monitoring, or even dose reductions, in individuals exhibiting a poor metabolizer phenotype following tolbutamide administration?

a. quinidine
b. cyclosporine
c. omeprazole
d. warfarin
e. metoprolol

A

d. warfarin

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3
Q

Drug X has a total clearance value of 20 L/hr, an apparent volume of distribution of 250 L and an F=0.7, is metabolized primarily by CYP 3A4 and has a therapeutic window between 1-5 micrograms/mL. Which dosing regimen below will yield average steady state concentrations within the desired therapeutic range?

a. 250 mg Q24hr
b. 500 mg Q12hr
c. 250 mg Q12hr
d. 1000 mg Q6hr
e. 500 mg Q24hr

A

b. 500 mg Q12hr

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4
Q

Which one of the following CYP enzymes plays the most prominent role in first-pass drug metabolism with regard to the number of orally administered prescription drugs affected?

a. CYP 1A2
b. CYP 2D6
c. CYP 3A4
d. CYP 2E1
e. CYP 2C19

A

c. CYP 3A4

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5
Q

A patient has been receiving oxycodone for pain relief after gall bladder surgery but is not experiencing any therapeutic benefit (i.e. pain relief). If this patient’s lack of response is because of an inability to metabolize oxycodone to the active moiety morphine, which of the following allelic variations is most likely responsible?

a. CYP 1A21/1
b. CYP 2D64/4
c. CYP 2C92/3
d. CYP 2C191/2
e. CYP 3A42/2

A

b. CYP 2D64/4

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6
Q

Fruit juices can often affect the bioavailability of drugs when ingested concomitantly. Which combination of juice and drug with result in a decrease in oral bioavailability?

a. grapefruit juice and felodipine
b. grapefruit juice and chlorzoxazone
c. orange juice and fexofenadine
d. orange juice and caffeine
e. cranberry juice and midazolam

A

c. orange juice and fexofenadine - DECREASES oral bioavailability

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7
Q

Which of the following statements is true regarding the interaction between penicillin and probenecid?

a. probenecid induces the renal uptake transporter OAT
b. probenecid inhibits the renal uptake transporter OAT
c. probenecid decreases the half life of penicillin
d. probenecid increases the renal clearance of penicillin
e. probenecid inhibits CYP 2D6

A

b. probenecid inhibits the renal uptake transporter OAT

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8
Q

he efficacy of which of the following HMG-CoA reductase inhibitors is least likely to be affected by St. John’s wort supplementation?

a. atorvastatin
b. simvastatin
c. pravastatin
d. lovastatin
e. cerivastatin

A

c. pravastatin

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9
Q
  1. Which genotype can render oxycodone ineffective in some people?
    a. heterozygous for the CYP 3A41 allele
    b. homozygous for the CYP 2D6    1 allele
    c. heterozygous for the CYP 2D62(x3) allele
    d. homozygous for the CYP 2D6    4 allele
    e. homozygous for the CYP 2C9*2 allele
A

d. homozygous for the CYP 2D6*4 allele

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10
Q

Transplant patients immunosuppressed with tacrolimus are at a high risk for graft rejection when ingesting which herbal supplement?

a. ginseng
b. goldenseal
c. echinacea
d. St. John’s wort
e. ginkgo biloba

A

d. St. John’s wort

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11
Q

Which of the following nuclear receptors is responsible for up regulating transcription of the CYP 1A2 gene?

a. steroid xenobiotic receptor
b. farnesoid X receptor
c. constitutive androstane receptor
d. aryl hydrocarbon receptor
e. vitamin D3 receptor

A

d. aryl hydrocarbon receptor

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12
Q

Phenobarbital induces the metabolism of which of the following CYP 2D6 substrates?

a. nortriptyline
b. desimpramine
c. fluoxetine
d. all of the above
e. none of the above

A

e. none of the above– no known CYP 2D6 inducers

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13
Q

Rifampin reduces the effectiveness of digoxin by which of the following mechanisms?

a. induction of CYP 1A2
b. induction of CYP 3A4
c. induction of CYP 2C9
d. induction of OATP
e. induction of ABCB1

A

e. induction of ABCB1

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14
Q

An individual who is overly sensitive to the effects of codeine may be:

a. heterozygous for the CYP 2D64 allele
b. homozygous for the CYP 2D61 allele
c. heterozygous for the CYP2D61 (x3) allele
d. homozygous for the CYP 2D64 allele
e. homozygous for the CYP 2C9*2 allele

A

c. heterozygous for the CYP2D6*1 (x3) allele

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15
Q

Concomitant administration of quinidine and digoxin may lead to digoxin toxicity via which of the following mechanism?

a. inhibition of CYP 2D6
b. inhibition of ABCB1
c. inhibition of OATP
d. inhibition of OCT
e. inhibition of CYP 3A4

A

b. inhibition of ABCB1

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16
Q

What effect does rifampin have on the pharmacokinetics of drugs whose metabolism is predominantly mediated by CYP 2D6?

a. insignificant effect on steady state concentrations
b. significant decrease in steady state concentrations
c. insignificant effect on half life
d. significant decrease in half life
e. A & C
f. B & D

A

e. A & C

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17
Q

A renal transplant patent receiving tacrolimus for immunosuppression develops a systemic Mycoplasma infection. Which of the following macrolide antibiotics is least likely to produce elevated levels of tacrolimus and subsequent nephrotoxicity?

a. trolenadromycin
b. erythromycin
c. clarithromycin
d. telithromycin
e. azithromycin

A

e. azithromycin

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18
Q

Dietary supplements containing goldenseal are likely to prolong the half life of which of the following drugs?

a. midazolam
b. isoflurane
c. caffiene
d. digoxin
e. pravastatin

A

a. midazolam

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19
Q

In order to maintain efficacy, cigarette smokers often require higher doses of which of the following drugs?

a. warfarin
b. theophylline
c. omeprazole
d. proguenil
e. diazepam

A

b. theophylline

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20
Q

The effectiveness of warfarin can be reduced by which of the following botanicals?

a. ginkgo biloba
b. echinacea
c. goldenseal
d. ephedra
e. ginseng

A

e. ginseng

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21
Q

Genotyping can significantly reduce the incidence of severe toxicity for which fo the following cancer chemotherapeutic agents?

a. azathioprine
b. paclitaxel
c. methotrexate
d. doxorubicin
e. adriamycin

A

a. azathioprine

22
Q

Grapefruit juice will significantly increase the oral bioavailability of which of the following drugs?

a. indinavir
b. quinidine
c. fexofenadine
d. nisoldipine
e. amlodipine

A

d. nisoldipine

23
Q
  1. Which SSRI is associated with the fewest number of significant drug interactions?
    a. fluvoxamine
    b. citalopram
    c. fluoxetine
    d. paroxetine
    e. venlafaxine
A

b. citalopram

24
Q

Acute hepatic dysfunction is least likely to increase the average steady state concentrations of which drug?

a. pheynton (CYP 2C9 substrate, fr=0.0f5)
b. tobramycin (OAT substrate, fr=0.92)
c. lidocaine (CYP 3A4 substrate, fr=0.02)
d. lansoprazole (CYP 2C19 substrate, fr=0.01)
e. chlorpromazine (CYP 2D6 substrate, fr=0.20)

A

b. tobramycin (OAT substrate, fr=0.92)

25
Q

If concomitant administration of Drug A produces a significant but proportional increase in the apparent volume of distribution and clearance of Drug B, which of the following effects would you expect to see? (assume no change in Drug B dosing interval)

a. an increase in the time for Drug B to reach steady state
b. a decrease in the half-life of Drug B
c. an increase in the bioavailability of Drug B
d. an increase in the peak concentrations of Drug B at steady state
e. a decrease in the average steady state concentrations of Drug B

A

a. an increase in the time for Drug B to reach steady state

26
Q

R.V., a 45 y/o wf presents to the neurology clinic for her biannual checkup. She is currently on daily oral doses of phenytoin and valproic acid to control her seizure episodes. She has not missed a dose of either medication since her last visit 6 mo ago. Also, she has not suffered an epileptic episode in 5 mo. The 4th year medical student on call this week orders a total phenytoin level to be run. The result indicated that R.V.’s total phenytoin concentrations are 5 micrograms/mL. Seeing that the phenytoin levels are below the therapeutic range he asks you, the clinical pharmacist, to recommend a dosage adjustment. Phenytoin has a low hepatic extraction ratio and is cleared almost entirely via hepatic metabolism. Phenytoin is also highly bound to plasma albumin (fup=0.12). The therapeutic index for total phenytoin is 10-20 micrograms/mL. Which of the following would you recommend?

a. increase the phenytoin dose because valproic acid inhibits the metabolism of phenytoin
b. increase the phenytoin dose because valproic acid displaces phenytoin from plasma protein binding sites.
c. lower the phenytoin dose because valproic acid reduces hepatic blood flow
d. do not adjust the phenytoin dose because valproic acid displaces phenytoin from plasma protein binding sites.

A

d. do not adjust the phenytoin dose because valproic acid displaces phenytoin from plasma protein binding sites.

27
Q

Warfarin is a highly bound drug (fup=0.005) with a low extraction ratio and a long half life (approx 2 days). Phenylbutazone is also poorly extracted, is highly bound (fup=0.007), and has a half life even longer than that of warfarin (approx 3 days). Both drugs are administered orally and are eliminated predominantly via hepatic mechanisms. When phenylbutazone is coadministered with warfarin, total warfarin concentrations are reduced yet unbound warfarin concentrations are elevated. Since the anticoagulant effect of warfarin is related to its unbound concentration, serious bleeding episodes are more frequent when phenylbutazone is also given. Which explanation below best describes the above observations?

a. phenylbutazone displaces warfarin from plasma protein binding sites
b. phenylbutazone induces the metabolism of warfarin
c. phenylbutazone inhibits the hepatic metabolism of warfarin
d. A and C are correct
e. B and D are correct

A

d. A and C are correct

28
Q

The following botanical supplements can result in herb/drug interactions except:

a. St. John’s wort
b. ginkgo biloba
c. goldenseal
d. panax ginseng
e. saw palmetto

A

e. saw palmetto

29
Q

. A poor metabolizer phenotype is not likely to affect which of the following drugs?

a. codeine
b. tolbutamide
c. warfarin
d. erythromycin
e. omeprazole

A

d. erythromycin

30
Q

Which of the following CYPs is the least important with regard to drug interactions?

a. CYP 1A2
b. CYP 2E1
c. CYP 2D6
d. CYP 3A4
e. CYP 2C9

A

b. CYP 2E1

31
Q

. Each of the following is a P-gp substrate except:

a. midazolam
b. digoxin
c. cyclosporine
d. talinolol
e. paclitaxel

A

a. midazolam

32
Q

Each of the following is true regarding generic polymorphisms except:

a. genetic polymorphism means that within a normal population, some people have a functional enzyme whereas others do not
b. there are no ethnic differences with regard to population distribution of genetic polymorphisms
c. people with genetically determined low levels of activity are referred to as poor metabolizers
d. people who have a functional enzyme are known as extensive metabolizers
e. poor metabolizers may be at a greater risk of toxicity than extensive metabolizers for drugs that are highly dependent on clearance to an inactive metabolite

A

b. there are no ethnic differences with regard to population distribution of genetic polymorphisms

33
Q

. If the metabolism of a drug is impeded because of enzyme inhibition, each of the following may result except:

a. a high plasma level may result
b. the desired effect of the drug may be minimized
c. undesirable side effects may be minimized
d. alternative metabolic pathways may become important
e. if a prodrug is inhibited, reduced therapeutic efficacy may result

A

c. undesirable side effects may be minimized

34
Q

. Each of the following is true except:

a. azithromycin has less potential than clarithromycin to cause drug interactions
b. citalopram has less potential than fluvoxamine to cause drug interactions
c. cimetidine has less potential than ranitidine to cause drug interactions
d. pravastatin has less potential than simvastatin to cause drug interactions
e. orange juice has less potential than grapefruit juice to cause drug interactions.

A

c. cimetidine has less potential than ranitidine to cause drug interactions

35
Q

Which of the following CYPs/transporters does not exhibit a polymorphism?

a. CYP 2D6
b. CYP 2C9
c. CYP 2C19
d. P-gp
e. CYP 1A2

A

e. CYP 1A2

36
Q

Which of the following macrocodes does not inhibit CYP 3A4?

a. azithromycin
b. clarithromycin
c. erythromycin
d. streptomycin
e. troleandromycin

A

a. azithromycin

37
Q

Each of the following inhibits CYP 3A4 except:

a. intraconazole
b. phenyotin
c. cimetidine
d. ritonavir
e. clarithromycin

A

b. phenyotin

38
Q

Important substrates of CYP 2D6 include each of the following except:

a. propranolol
b. fluoxetine
c. codeine
d. cyclosporine
e. amitriptyline

A

d. cyclosporine

39
Q

The least important mechanism of drug interactions is:

a. displacement from plasma proteins
b. competitive inhibition of CYP 3A4
c. reduced metabolic clearance
d. reduced renal elimination
e. induction of P-gp

A

a. displacement from plasma proteins

40
Q

Each of the following drugs may interfere with cyclosporine except:

a. erythromycin
b. verapamil
c. St. John’s wort
d. caffeine
e. intraconazole

A

d. caffeine

41
Q
  1. Each of the following is an inducer of CYP 1A2 except:
    a. brussels sprouts
    b. cabbage
    c. char boiled foods
    d. St. John’s wort
    e. cigarette smoke
A

d. St. John’s wort

42
Q

Genotyping can significantly reduce the incidence of severe toxicity for which of the following cancer chemotherapeutic agents?

a. Doxorubicin
b. Paclitaxel
c. Azathioprine
d. Irinotecan
e. A & B
f. C & D

A

f. C & D

43
Q

Antihypertensive medications should not be used with dietary supplements containing which of the following botanicals?

a. Guarana
b. Echinacea
c. Saw palmetto
d. Ginkgo biloba
e. Ginseng

A

a. Guarana

44
Q

Which of the following issues can contribute to the incidence of herb-drug interactions?

a. Variability in product content and potency.
b. Lack of notification of supplementation usage to health care providers.
c. Lack of safety and efficacy studies prior to marketing.
d. Adulteration with conventional medications.
e. All of the above.
f. None of the above.

A

e. All of the above.

45
Q

Clarithromycin can produce elevated digoxin concentration by which of the following mechanisms?

a. Inhibition of CYP1A2
b. Inhibition of CYP3A4
c. Inhibition of CYP2C9
d. Inhibition of OATP
e. Inhibition of ABCB1

A

e. Inhibition of ABCB1

46
Q

High quality St. John’s Wort induces the metabolism of which of the following CYP2D6 substrates?

a. Nortryptiline
b. Desimipramine
c. Fluoxetine
d. All of the above
e. None of the above

A

e. None of the above

47
Q

Which of the following nuclear receptors is responsible for upregulating transcription of the CYP2D6 gene?

a. Steroid xenobiotic receptor
b. Constitutive androstane receptor
c. Vitamin D3 receptor
d. Aryl hydrocarbon receptor
e. All of the above
f. None of the above

A

f. None of the above

48
Q

Transplant recipients immunosuppressed with cyclosporine are at possible risk for nephrotoxicity when ingesting which herbal supplement?

a. Ginseng
b. Goldenseal
c. Echinacea
d. St. John’s wort
e. Ginkgo biloba

A

b. Goldenseal

49
Q

Which of the following statements is true regarding the interaction between penicillin and probenecid?

a. Probenecid induces the renal uptake transporter OAT
b. Probenecid inhibits the renal uptake transporter OAT
c. Probenecid decreases the half-life of penicillin
d. Probenecid increases the renal clearance of penicillin
e. Probenecid inhibits CYP3A4

A

b. Probenecid inhibits the renal uptake transporter OAT

50
Q

Fruit juices can often affect the bioavailability of drugs when ingested concomitantly. Which combination of juice and drug will result in a decrease in oral bioavailability?

a. Grapefruit juice and felodipine
b. Grapefruit juice and fluoxetin
c. Orange juice and pravastatin
d. Orange juice and theophylline
e. Cranberry juice and diazepam

A

c. Orange juice and pravastatin

Kinetics (4 decks)

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