Ther 201 Exam 2 Flashcards
Specific/nonspecific properties of CNS neurotransmitters
A.
B. Increased concentration, becomes non-specific
C. Does not affect different areas equally
D. AOTA
Ans: D
Developmental Pharmacology – NM Dando 1) If a child is malnourished A. Penicillin excretion increases B. Vd of tetracycline increases C. Salicylate plasma binding decreases D. Chloramphenicol excretion decreases
Ans: C/D
Trans: Malnutrition affects highly protein bound drugs excretion of penicillin and chloramphenicol decreases, Vd of tetracycline is decreases, plasma binding of salicylates decreased
2) Drug that causes patent ductus arteriosus to remain open, as life-saving measure in neonates with transposition of great vessel A. Indomethacin B. Ibuprofen C. Prostaglandin E1 D. Aspirin
Ans: C
Alprostadil (PGE1 analogue) is used to keep the PDA open. NSAIDS such as indomethacin inhibit PG sysnthesis, closing the ductus arteriosus
3) Lipophilic drugs have low Vd in prematures because of
A. Immaturity of the kidney
B. Low amount of enzymes in liver
C. Low water content of the body
D. Small amount of fat tissues in the body
Ans: D
4) The following phase II metabolizing enzymes have low activity at birth EXCEPT A. Glucuronidation B. Sulfatation C. Acetylation D. Methylation
Ans: B
At birth, sulfation is increased, glucoronidation and acetylation is decreased
5) Skin testing in neonates to detect allergy to penicillin will not be informative because
A. Erractic absorption of parenteral penicillin
B. Thinner stratum corneum especially in preterm
C. Absence of histamine in the skin until 3rd week of life
D. Small volume of drug compared to weight and surface area ratio
Ans: C
6) At 4th to 10th week AOG, fetus is more prone to concern about drug-induced fetal A. Cardiac arrest B. Hemorrhage C. Malformations D. Jaundice
Ans: C
7) Tetracycline is NOT recommended for children below 8 years old because it can cause A. Enamel dysplasia B. Fetal hydantoin syndrome C. Bone marrow suppression D. Cerebral palsy
Ans: A
Fetal hydantoin syndrome- phenytoin
8) Pharmacogenetics is the study of genetically controlled variations in drug response. Which condition listed below is considered to be pharmacogenetic? A. Malignant hyperthermia B. Oligondontia C. Waardenburg syndrome D. Treacher Collins syndrome
Ans: A
Malignant hyperthermia after use of succinylcholine
9) The following conditions have X-linked type of inheritance EXCEPT A. G6PD deficiency B. Pyridoxine sensitive anemia C. Vasopressin resistance D. Aminoglycoside-induced deafness
Ans: D
A,B,C are X-linked
10) The probe drug used in pharmacogenetic study of CYP2D6 A. Isoniazid B. Debrisoquine C. Azathioprine D. Succinylcholine
Ans: B
11) Increased risk of cancer is associated with the following polymorphism A. NAT2 B. TPMT C. G6PD D. CYP2D6
Ans: A
Increased risk of cancer is associated with the ff polymorphism: CYP 2A1, 1A2, 2E1, Glutatione transferases, epoxide hydrolase, NAT2
12) Severe hemolytic anemia after administration of antimalarial agent primaquine is seen in individuals deficient with this enzyme A. Homogentisate 1,2-dioxygenase B. Glucose-6-phosphate dehydrogenase C. Dihydropyrimidine dehydrogenase D. Glutathione transferase
Ans: B
G6PD deficient patients may develop hemolytic anemia after intake of antimalarial drugs like primaquine
13) Which of the following is the most common type of polymorphism in the human genome? A. Various tandem repeats B. Insertion polymorphism C. Deletion polymorphism D. Single nucleotide polymorphism
Ans: D
14) To maintain concentrations similar to CYP 2D6 extensive metabolizers, the dose of nortriptylline given to poor metabolizers should be A. Increased B. Decreased C. The same D. Any of the above
Ans: A
Extensive metabolizers will have lower drug concentration compared to poor metabolizers.
15) Which of the following would you expect in NAT2 fast/rapid acetylators compared to slow acetylators?
A. Lower concentration of isoniazid at any dose
B. Higher incidence of hydralazine-induced lupus erythematosus
C. Faster appearance of antinuclear antibodies with procainamide
D. Decreased risk of colon cancer with heterocyclic amines from cooked amines
Ans: A
Fast acetylators: lower concentration of isoniazid, lower incidence of hydralazine induced lupus, increased risk of colon cancer from acetylation of heterocyclic amines in cooked meats
16) Administration of 6-mercaptopurine (6MP) in children with low intracellular activity of thiopurinemethyltransferase (TPMT) for acute lymphoblastic leukemia will result in A. Profound myelosuppression B. Cancer cell lysis C. Therapeutic failure D. Methemoglobinemia
Ans: A
TPMT metabolizes 6MP, hence low TPMT increased the toxicity of 6MP
17) The “atypical alcohol dehydrogenase” variant beta-2 subunit is responsible for a
A. Lower ethanol Vmax of the atypical enzyme
B. Lower plasma level of acetaldehyde metabolite
C. Higher Km for the homozygous B2B2
D. Higher intracellular activity of the alcohol dehydrogenase enzyme
Ans: C
Mutation to an atypical B2 subunit is responsible for a higher ethanol Vmax of the atypical enzyme, higher Km for the homozygous B2B2
18) Dibucaine number is indicative of possible abnormality in A. Tyrosine hydroxylase B. Catechol-O-methyltransferase C. Pseudocholinesterase D. Monoamine oxidase
Ans: C
19) The accumulation of trimethylamine that can cause “Fish odor Syndrome” is due to what genetically determined
A. Hydrolysis
B. N-oxidation
Ans: B
Fish odor syndrome is due the excessive excretion of trimethylaminuria, due to defect in N-oxidation of trimethylamine
What is true of the nature of the toxic actions of chemicals?
A. Toxic action is always an exaggeration of the therapeutic action
B. The MOA in acute reactions is the same as those in chronic reactions
C. A chemical may exert its effects thru several mechanisms
D. AOTA
Ans: C
A- type b reactions are not due to exaggeration
The following is true about adverse drug reactions EXCEPT
A. ADRs are the fourth leading cause of death in US statistics
B. ADRs are the single largest source of malpractice suits in the US
C. Most ADRs are related to the wrong dosage
D. 3% to 11% of hospital admission can be attributed to adverse drug effects
Ans: C
21) A noxious or unwanted response at any dosage of a drug and where causality has been established A. Toxidrome B. Therapeutic index C. Adverse drug reaction D. Adverse drug event
Ans: C
Adverse drug event: no causality established
22) What is not an adverse drug reaction?
A. Bradycardia from methyldopa
B. Hypotension from generic nifedipine
C. No increase on the protime from generic warfarin
D. Agranulocytosis from propylthiuracil
Ans: C
C may be due to inappropriate dosing or counterfeit, not an ADR
23) ADRs are hard to identify especially among sick patients with co-morbidites because of A. Confounding by indication B. Drug-drug interaction C. Drug-disease interaction D. AOTA
Ans: D
24) Dose-related type A pharmacokinetic variation causing adverse drug reaction can be due to one of the following
A. Change in formulation
B. Prolonged apnea on succinylcholine
C. Expired drugs
D. Presence of pyrogens in parenteral meds
Ans: B
pseudocholinesterase deficiency can lead to prolonged apnea in patients on succinylcholine. A,C, D are due to Pharmaceutical variation
25) The reaction of GI hemorrhage from use of aspirin is considered as A. Rebound phenomenon B. Side effect C. Extension effect D. Tachyphylaxis
Ans: C
due to the inhibition of synthesis of prostaglandins, which is protective to mucosa
26) This drug should be avoided in patients with hepatic disease, because it may cause bleeding A. Barbiturates B. Indomethacin C. Diuretics D. Short-acting benzodiazepines
Ans: B
hepatic diseases causes decrease in drug metabolism, accumulation of anticoagulants and NSAIDS (Indomethacin) may leads to bleeding
27) Hypokalemia potentiates the effect of the following drug A. Quinidine B. Digitalis C. Amlodipine D. Lignocaine
Ans: B
28) Peripheral neuropathy with the use of isoniazid is more commonly seen among A. Slow acetylators B. Rapid acetylators C. Intermediate acetylators D. Rapid hydroxylators
Ans: A
in slow acetylators, isoniazid accumulates, increasing its ADR
29) Type B or immunologic drug reactions are usually seen in A. Vaccines B. Patients with atopy C. Polypeptides such as insulin D. AOTA
Ans: D
Type B drug reactions are elicited by high MW proteins (vaccine), polypeptides(insulin), and dextrans, it occurs in inherently atopic patients wand those with deficiency in the major histocompatibility cells
30) Steven-Johnson syndrome and toxic epidermal necrolysis is associated with
A. IgE mediated reaction
B. Type 3 or immune complex type of reaction
C. Transmembrane protein associated with TNF
D. NOTA
Ans: C
SJS and TEN are associated with Fas/Fas-Ligand induced reaction. Fas ligand is a type 2 transmembrane protein that belongs to the TNF family. binding causes apoptosis
31) In Gell-Coombs classification, hemolytic anemia due to penicillin is classified under A. Type 2 or cytotoxic type of reaction B. Type 1 or IgE mediated C. Specific T-cell activation D. Type 4 or cell-mediated reaction
Ans: A
Type 1: anaphylaxis from beta-lactam
type 3/ immune complex: serum sickness from anti-thymocyte globulin
type 4: contact dermatitis from topical antihistamine
specific T-cell activation: morbilliform rask from sulfonamices
Fas/Fas-ligand induced: SJS, TEN
32) The type of immunologically mediated adverse drug reaction are not mutually exclusive. Some drugs can exhibit ADRs from different mediators such as IgE or drug antibody complexes. An example of this is A. Carbamezepine B. Itraconazole C. Indomethacin D. Terbutaline
Ans: C
example in trans is penicillin
NSAIDS may cause both type 1 and 3 reactions
33) A dermatologic manifestation of a reaction to oral contraceptive use A. Urticaria B. Liver peliosis C. Melasma D. Morbilliform rash
Ans: C
34) True of toxic action of hazardous substances
A. Toxic action of acute exposure is same with that of chronic exposure
B. Toxic action is not always the exaggeration of its therapeutic effects
C. Toxicity is mainly brought about by parent compound
D. Intensity of toxic action depends on the amount of chemical/drug
Ans: B
Toxic action of acute exposure is NOT the same with that of chronic exposure
Toxicity may be brought about by parent compound, or a metabolite
Intensity of toxic action depends on the amount of chemical/drug- if an extension effect, but not true for type b reactions
35) Potential stages in the development of toxicity include the following EXCEPT A. Delivery B. Interaction with target molecule C. Cellular dysfunction/injury D. Dysrepair
Ans: B
Potential stages in the development of toxicity after clinical exposure: Delivery, interaction with target molecule, cellular dysfunction/injury, disrepair (toxicology trans)
36) The following statement/s is/are true of metabolism factors that affect toxicity of hazardous substances
A. Hazardous substances can pass through specialized barriers such as the blood brain barrier
B. The organ in which a chemical is most highly concentrated is not always the organ where most tissue damage occurs
C. A chemical may be converted to a toxic metabolite which is more toxic than the parent compound
D. Some chemicals/drugs undergo enterohepatic cicrulation
Ans: C
Factors affecting kinetic processes
A is ability of metabolites to pass through cell membranes
B is distribution of toxicant within the body
D is rate and site of excretion