Quiz 6: Therapeutic Drug Monitoring

Question 1

The study of pharmacogenomics refers to?

(a) Comparison of dose-response curves between family members
(b) Familial studies to determine the inheritance of drug resistance
(c) Testing drugs with cell cultures to determine the minimum toxic dosage
(d) Studying variations and developing drug therapies to compensate for genetic differences impacting therapy regimes

Answer 1

(d) Studying variations and developing drug therapies to compensate for genetic differences impacting therapy regimes

Question 2

The term pharmacokinetics refers to the:

(a) Concentration of drug at its sites of action
(b) Relationship between blood and tissue drug levels
(c) Relationship between blood concentration and the therapeutic response
(d) Mathematical model of drug concentrations in circulation

Answer 2

(d) Mathematical model of drug concentrations in circulation

Question 3

When should blood samples for peak drug levels be collected?

(a) Is independent of drug formulation
(b) Is independent of the route of administration
(c) Is 30 minutes after a bolus IV injection is completed
(d) Varies with the drug, depending on its rate of absorption

Answer 3

(d) Varies with the drug, depending on its rate of absorption

Question 4

When should blood samples for trough drug levels be collected?

(a) Immediately before the next dose is given
(b) 30 minutes after peak levels
(c) 45 minutes before the next dose
(d) One to two hours after the last dose

Answer 4

(a) Immediately before the next dose is given

Question 5

Conditions in which therapeutic drug monitoring (TDM) is indicated.

(a) Patient noncompliance
(b) Poor relationship between drug dosage and serum drug concentrations due to large variability in drug metabolism between individuals
(c) Therapeutic effects are not easily measured by observation alone
(d) All of the above

Answer 5

(d) All of the above

Question 6

Which could account for drug toxicity following a normally prescribed dose?

(a) Altered serum protein binding caused by disease
(b) Decreased renal clearance caused by kidney disease
(c) Discontinuance or administration of another drug
(d) All of these options

Answer 6

(d) All of these options

Question 7

The main purpose(s) of therapeutic drug monitoring (TDM) is/are:

(a) Identify when the drug is outside the therapeutic intervals which may lead to drug inefficacy or toxicity
(b) Consider drug route of administration, absorption, distribution, biotransformation, rate of elimination
(c) Ensure drug dosage is within intervals that produce maximal therapeutic benefit
(d) All of the above

Answer 7

(d) All of the above

Question 8

Which are true about the therapeutic index?

(a) It is the same from drug to drug and patient to patient
(b) The lowest concentration of drug in the blood that will produce the desired response
(c) Ratio of the minimum toxic concentration/ and the minimum effective concentration
(d) All of the above

Answer 8

(c) Ratio of the minimum toxic concentration/ and the minimum effective concentration

Question 9

A gentamicin level on a patient is found to be incompatible with life, but the patient is alive and well. What are the possible reasons?

(a) Patient overdosed
(b) Patient has a high tolerance for the drug
(c) Sample taken from a venous/port line where the medication had just been injected
(d) Any of the above

Answer 9

(c) Sample taken from a venous/port line where the medication had just been injected

Question 10

Which of the following are routes of administration of therapeutic drugs.

(a) Intramuscular and intravenous
(b) Oral and rectal
(c) Subcutaneous and transcutaneous
(d) All of the above

Answer 10

(d) All of the above

Question 11

The drug procainamide is prescribed to treat cardiac arrhythmia. What biologically active liver metabolite of procainamide is often measured simultaneously?

(a) Phenobarbital
(b) Quinidine
(c) N-acetyl procainamide (NAPA)
(d) Lidocaine

Answer 11

(c) N-acetyl procainamide (NAPA)

Question 12

A carbonate salt used to control bipolar/manic-depressive disorders is:

(a) Digoxin
(b) Acetaminophen
(c) Lithium
(d) Phenytoin

Answer 12

(c) Lithium

Question 13

A drug that relaxed the smooth muscle of the bronchial passage is:

(a) Acetaminophen
(b) Lithium
(c) Phenytoin
(d) Theophylline

Answer 13

(d) Theophylline

Question 14

A cardiac glycoside that is used in the treatment of congenital heart failure and arrhythmias by increasing the force and velocity of myocardial contraction is:

(a) Digoxin
(b) Acetaminophen
(c) Lithium
(d) Phenytoin

Answer 14

(a) Digoxin

Question 15

The phrase “first-pass hepatic metabolism” means that:

(a) All drug is inactivated by hepatic enzymes after one pass through the liver
(b) One hundred percent of a drug is excreted by the liver
(c) In the liver the drug is substantially metabolized and may be more or less active depending on the metabolite products
(d) The drug must be metabolized in the liver to an active form

Answer 15

(c) In the liver the drug is substantially metabolized and may be more or less active depending on the metabolite products

Question 16

If drug X has a half-life (T 1/2) of 2 days (48 hours) and the concentration at 12:00 today was 10 mcg/mL what would the expected concentration of drug X be at 12:00 tomorrow?

(a) 7 mcg/mL
(b) 7.5 mcg/mL
(c) 5 mcg/mL
(d) 3.5 mcg/mL

Answer 16

(b) 7.5 mcg/mL

Question 17

If a drug is administered orally, which of the following would affect the efficiency of its absorption in the gastrointestinal tract?

(a) Dissociation of the drug from its administered form
(b) The drug’s solubility in gastrointestinal fluid
(c) Diffusion of the drug across gastrointestinal membranes
(d) All of the above

Answer 17

(d) All of the above

Question 18

Which of the following is the primary purpose for measuring serum concentrations of methotrexate?

(a) To determine the optimum dosage for oral administration of methotrexate
(b) To ensure that serum concentrations are within the therapeutic range
(c) To confirm serum concentrations when toxicity is suspected
(d) To determine the amount of leucovorin needed to halt methotrexate action

Answer 18

(d) To determine the amount of leucovorin needed to halt methotrexate action

Question 19

Primidone is an inactive proform of which of the following antiepileptic drugs?

(a) Gabapentin
(b) Clozapine
(c) Phenobarbital
(d) Ethosuximide

Answer 19

(c) Phenobarbital

Question 20

Twenty miligrams (mg) of drug Y is injected intravenously. One hour after the injection blood is collected and assayed for the concentration of drug Y. If the concentration of drug Y in this specimen was 0.4 mg/mL, what is the volume of distribution for this drug?

(a) 0.8 L
(b) 8 L
(c) 20 L
(d) 50 L

Answer 20

(d) 50 L