Download Practice Exam for Pharmacology Exam 1 – Lectures 1

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Practice Exam for Pharmacology Exam 1 – Lectures 1-10
This the what the body does to the drug:
a. Pharmacology
b. Pharmacokinetics
c. Pharmacodynamics
d. Pharmacotherapeutics
This is the study of the actions, mechanisms of action, uses, adverse effects,
and fate of drugs in animals and humans:
a. Pharmacology
b. Pharmacokinetics
c. Pharmacodynamics
d. Pharmacotherapeutics
This is what the drug does to the body:
a. Pharmacology
b. Pharmacokinetics
c. Pharmacodynamics
d. Pharmacotherapeutics
Your neighbor goes to the local pharmacy to pick up some pain reliever for
her daughter. She is not sure what to get and remembers a commercial on TV
advertising a fast acting pain reliever for young children. What would be the
kind of name that she would remember the drug under?
a. Chemical name
b. Proprietary name
c. Non-proprietary name
d. Generic name
You are on an amazing cruise during the summer between your first and
second years in medical school and suddenly begin having severe motion
sickness. You don’t think you’ll be able to take anything orally and most
certainly don’t want to take anything rectally. The doctor on board
prescribes you a transdermal medication. What does she tell you is the most
likely side effect?
a. Stomach upset
b. Blurred vision
c. Dizziness
d. Skin irritation
e. Acid reflux
In order to bypass first-pass metabolism, you prescribe your patient an
enteral. What type of administration would it be?
a. Oral
b. Sublingual
c. Rectal
d. A and B
e. B and C (buccal as well)
During your lunch hour you pick up an article about a new drug. A human
study was done with 10,000 participants. The results of this amazing new
drug are described in the article. What type of evidence is this?
a. Drug-oriented evidence (DOE)
b. Patient-oriented evidence (POE)
8. What does ADME stand for?
a. Absorption, distribution, metabolism, excretion
b. Administration, distribution, metabolism, efficacy
c. Administration, drug, metabolism, excretion
d. Absorption, drug, metabolism, efficacy
9. You have a patient in your clinic who you prescribe 100 mg of Drug A. Once
absorbed, Drug A will result in 10% of “free drug.” Your patient is not getting
better and goes to the ED where he fails to tell the doctor that he was already
prescribed a medication. The doctor prescribes this patient Drug B, which
happens to be a drug that competes for same protein binding sites as Drug A.
What happens to the amount of “free drug” in the patient’s system?
a. The amount of free drug will decrease and the medication won’t be as
efficacious.
b. The amount of free drug will decrease because Drug B doesn’t effect
the amount of Drug A in the system
c. The amount of free drug will increase and the patient could be at risk
for toxicity
d. The amount of free drug will increase because Drug B
noncompetitively bound to the same protein that Drug A was bound
to.
10. The stomach flu is circulating throughout the area and you happen to have 2
30 year old patients come into your office complaining of stomach flu
symptoms. You prescribe each patient the same drug, but in different doses.
Why would you prescribe them different doses?
a. Lipid-solubility
b. Water solubility
c. Body weight
d. Gender
e. A and B
f. C and D
11. You prescribe a patient a drug at what you believe is the MEC (minimal
effective concentration) but after the appropriate period of time you draw a
plasma concentration and determine that the drug was metabolized too
quickly and was not effective. You prescribe a higher dose than before and
the next plasma concentration shows that you are above the MEC. Will the
drug still be effective?
a. Yes, just so the plasma concentration is above the MEC, the drug will
be efficacious.
b. Yes, the MEC is just the base concentration
c. No, the patient will need more because they metabolize too quickly
d. No, once above the MEC the patient is at risk for toxicity
12. If a drug goes through first-pass metabolism it will have a higher
bioavailability because it has more than one chance to be absorbed.
a. True
b. False – if a drug goes through first-pass metabolism then it will have
less ability to be absorbed in the location it is needed and thus less
efficacious
13. All prodrugs are cleaved to their inactive form.
a. True
b. False
14. What are some positives for prodrugs being prescribed?
a. They reduce toxicity because they are metabolized to their inactive
form quickly
b. They improve bioavailability
c. They have site specific delivery
d. A, B and C
e. B and C
15. A patient presents to the emergency department with an overdose of Asprin.
You want to increase the rate of excretion, what would you want to induce?
a. Urine acidification
b. Urine alkalinization – you would want to prescribe an alkalizer
because Asprin is an acid and would be ionized in a base and thus
excreted. If it was induced acidification it would be non-ionized and
better absorbed and we want to excrete it, not absorb it.
c. Neither, Asprin isn’t excreted largely enough by the kidney’s for this
to work
d. None of the above
16. The rate of drug elimination is proportional to the plasma drug concentration
at any given time. This describes
a. First-order kinetics
b. Zero-order kinetics
c. Both
d. None of the above
17. You observe a patient’s excretion of a drug and determine that the rate of
drug elimination is constant. What would expect to be the type of kinetics
involved and what could have caused this?
a. First-order kinetics, drug elimination mechanisms are saturated
b. First-order kinetics, the drug is dependent on the concentration of the
drug
c. Zero-order kinetics, drug elimination mechanisms are saturated
d. Zero-order kinetics, the drug is dependent on the concentration of the
drug
18. Only these types of drugs can penetrate the blood brain barrier:
a. Highly lipid-soluble drugs
b. Low lipid-soluble drugs
c. High protein albumin binding drugs
d. Low protein albumin binding drugs
19. The rate of drug elimination is equal to the rate of drug elimination and it
takes 4-5 half lives for this to occur:
a. Loading dose
b. Maintenance dose
c. Steady State
d. All of the Above
20. This part of the kidney is responsible for filtration:
a. Proximal tubule
b. Glomerulus
c. Tubular lumen
21. This part of the kidney is responsible for the reabsorption of the drug
a. Proximal tubule
b. Glomerulus
c. Tubular lumen
22. This part of the kidney is responsible for tubular secretion of the drug:
a. Proximal tubule
b. Glomerulus
c. Tubular lumen
23. You just finished a bilateral hip replacement and prescribe morphine for
pain. What would be the characteristics of this drug while it is in its active
form?
a. Polar and lipid-soluble
b. Polar and water-soluble
c. Non-polar and lipid soluble
d. Non-polar and water-soluble
24. What would be the characteristics of this drug while it is in its inactive form?
a. Polar and lipid-soluble
b. Polar and water-soluble
c. Non-polar and lipid soluble
d. Non-polar and water-soluble
25. Six weeks later you see this patient for a follow up appointment. She is doing
fantastic and is getting around without any assistance. However, she still has
a moderate amount of pain. You suggest she take an over the counter pain
reliever like Motrin. Where would this drug be most readily absorbed?
a. The stomach because Motrin is acidic and would be non-ionized in an
acidic environment like the stomach where the pH is low. Non-ionized
drugs are more readily absorbed. An acidic drug will be non-ionized at
pH’s below its pKa
b. The intestines
c. The kidneys
d. The bones
26. While in clinic today, you saw a new patient who was on more than 9
medications. You are concerned one of the drugs that she is on is actually
binding to a receptor and changing the conformation of the receptor so that
another drug cannot bind. What would you classify this drug as?
a. Agonist with both affinity and efficacy
b. Agonist with affinity, but no efficacy
c. Antagonist with both affinity and efficacy
d. Antagonist with affinity, but no efficacy
27. According to this graph:
a. both lines exhibit nearly the same efficacy
b. both lines exhibit nearly the same potency
c. the green line exhibits more efficacy than the blue line
d. A and C
e. B and C
28. Two days ago you gave a patient in the ED a drug to reduce his blood
pressure because it was extremely high You have been watching his plasma
concentrations of the drug to make sure you keep his blood pressure in a
normal range and have been observing a progressively higher blood pressure
even with increased doses of the medication. You are getting concerned that
the drug is not doing its job. What could be the cause of this?
a. Idiosyncratic effect
b. Tachyphylaxis – this is a result of rapid development of
pharmocodynamic tolerance which causes a diminished response
with repeated administration.
c. Decreased potency
d. First-pass metabolism effect
29. You have a patient in your clinic who has is having a severe asthma attack.
Why would you want to prescribe an inhaled bronchodilator?
a. It is increases systemic effects
b. It gets the drug to the location it needs to be quickly
c. It increases the duration of the drug’s efficacy by skipping first-pass
metabolism
d. It is has a higher efficacy than an oral drug
30. Conjugation to form glucuronides, acetates, or sulfates is an example of phase
____ metabolism.
a. I
b. II
c. III
31. Oxidation, hydrolysis, and reduction of a drug is an example of ____
metabolism.
a. I
b. II
c. III
32. A small volume of distribution is indicative of:
a. Extensive distribution into body tissues
b. Limited drug distribution
33. You have a 25 yo, 49 kg patient in the hospital on Drug A and have
determined her loading dose to be 350 mg/day. For this particular drug you
determine that the bioavailability is 70%. What would be her maintenance
dose every 8 hours?
a. 500 mg
b. 12,000 mg
c. 1050 mg
d. 1500 mg
350mg/d /.70 = 500 mg/d X 24 h/d = 12000 mg/h /8h = 1500 mg/8
hr
34. Half life is the time required for the plasma concentration to decrease by onehalf after absorption is complete, but before distribution.
a. True
b. False – after both absorption and distribution
35. What happens when enzymes become saturated?
a. They metabolize the drug faster
b. They metabolize the drug slower
c. They metabolize the drug at a constant rate, enzymes cannot become
saturated
36. What happens when protein binding sites becomes saturated in a non-linear
drug?
a. Clearance decreases because there is not as much “free drug”
b. Clearance decreases because the drug is metabolized faster
c. Clearance increases because there is more “free drug”
d. Clearance increases because there is less “free drug”
37. You have a patient who is obese and you prescribe him a lipid-soluble drug.
Why would you prescribe a larger dose of the medication to this person than
to someone who is under weight?
a. This patient has a higher volume of distribution
b. This patient has a lower volume of distribution because the drug gets
“stuck” in the fat
c. This patient has more availability in the body to contain the drug
d. B and c
e. A and C
38. You are working late in the ED and have been constantly slammed all night. It
is now 3:30 am and a patient comes in complaining of a migraine. You
prescribe this patient a pain medication. You failed to read an important
piece of information regarding this patient’s health and a few hours later this
patient returns with possible toxicity. What piece of information would have
made you reconsider the dosage and prescribe a lower dose?
a. The patient was overweight
b. The patient smoked ½ a pack a day for the last 5 years
c. The patient had cirrhosis of the liver – liver disease is important to
know about because it decreases the rate at which a drug is
metabolized and would therefore increase the likely hood of drug
toxicity
d. The patient was breast feeding
39. You see a patient in clinic with GERD and advise this patient to take
Omeprazole (prilosec). While you are writing out the dosage you remember
that the patient has a genetic abnormality that will affect what dose you
prescribe. What is the genetic abnormality?
a. CYP2D6
b. CYP2D19
c. CYP2C6
d. CYP2C19
40. You have a 52 yo male patient who is 72 kg with a Scr = 1.8 mg/dL. Using the
Hartford nomogram, what is the initial dose and dosing interval of
gentamicin?
Clcr = (140-age)BW/Scr X 72
7 mg/kg dose every:
q24h: > 60 mL/min
q36h: 59-40 mL/min
q24h: 39-20 mL/min
a. 504 mg IV q 36 h
b. 504 mg IV q 24 h
c. 504 mg IV q 48 h
41. A patient has failed to tell you that she is taking Gingko biloba and you
suggest she take an NSAID for her sprained wrist. She goes to ED vomiting
blood. What type of interaction would this be classified as?
a. Pharmacodynamics interaction
b. Pharmacokinetic interaction
c. OATP
d. Protein albumin competitive binding
42. You prescribe a patient a fluoroquinolone and tell her to stop taking TUMs
because it might interfere with the effectiveness of the prescription. What
type of interaction would this be classified as?
a. Pharmacodynamics interaction – this is a toxic interaction because
both of these drugs thin the blood, they act on the same pathways
leading to exaggerated biological effects. Pharmacodynamic
interactions are effects on tissues, organ systems, microbes, or tumor
cells. Pharmacokinetic interactions are altered drug absorption
b. Pharmacokinetic interaction
c. OATP
d. Protein albumin competitive binding
43. Every morning you drink orange juice with breakfast. It is April and the
flowers are blooming, your nose feels a bit stuffy and you decide you should
probably take your Allegra with your orange juice. What type of interaction
would this be classified as?
a. Pharmacodynamics interaction
b. Pharmacokinetic interaction
c. OATP – which is a pharmacokinetic interaction which occurs when
fruit juices like OJ inhibit OATP (organic anion transporting peptide)
which leads to decreased absorption of drugs like allegra,
ciprofloxacin, acebutolol, levofloxacin, etc.
d. Protein albumin competitive binding
44. This type of disease decreases protein (albumin) synthesis and thus
decreases available binding sites, increasing unbound concentration and thus
increasing risk of toxicity. What is this type of disease?
a. Kidney disease
b. Lung disease
c. Liver disease
d. Heart disease
45. You have a patient come to your office who suspects she is pregnant. The
pregnancy test comes back positive, but when you tell the young lady the
news she is distraught. She has been on birth control for the last 3 years and
is not ready to have a child. She wants to know why the birth control pill did
not work? You ask her if she is on any other medication. She tells you she has
recently started taking St. John’s Wort. What would you tell her the reason is
for the decrease in the efficacy of the birth control pill?
a. The metabolism of the birth control pill is induced by St. John’s Wort
b. The metabolism of the birth control pill was inhibited by St. John’s
Wort
c. CYP3A4 metabolism is inhibited by the St. John’s Wort
d. None of the above
46. This results in accelerated metabolism, increases clearance, reduces half life,
decreases pharmacologic action:
a. Enzyme inhibition
b. Enzyme induction
c. Barbiturates
d. Erthryomycin
e. A and d
f. B and c
47. Grapefruit juice is a CYP3A4 inhibitor and would result in what?
a. Higher drug excretion
b. Increased possibility of toxicity
c. Increasing concentrations – if CYP3A4 is inhibited then the
concentration of certain HMG-CoA reductase inhibitors (simvastatin)
will increase in concentration because the enzyme won’t be working
as well and therefore the likelihood of toxicity will also increase
because more of the drug will be available when it should not have
been
d. Decreasing concentrations
48. This is a protein that secretes drug from the blood back into the intestinal
track. If it is inhibited then absorption would be ______
a. Increased because it would prevent the transport of the drug away
from its location of use – the protein is P-gp or P-glycoprotein and if
inhibited will result in increased absorption and if induced will result
in decreased absorption because P-gp may remove drugs from body
tissues, liver, or kidney
b. Decreased because it would increase the transport of the drug away
from its location of use
c. It would neither be increased or decreased
49. A patient has recently been placed on clopidogrel. When the patient comes to
the clinic for a follow up appointment he asks about taking an over the
counter antacid for heart burn. Why would you be reluctant to suggest any
PPI’s?
a. PPI’s are CYP2C19 inhibitors that interact with the metabolism of
clopidogrel to its active form
b. PPI’s are CYP2C19 inducers that interact with the metabolism of
clopidogrel to its active form
c. You are worried about the patient abusing the PPI’s and taking too
much
d. You are concerned about the Ca2+ in PPI’s like TUMs that could bind
the clopidogrel
50. You have a patient that has GERD and you prescribe a regular dose of
antacids. This patient goes to an urgent care clinic for a sinus infection and is
prescribed a fluoroquinolone. When this patient comes to you after she has
finished the antibiotic and is not any better what do you tell her is the
reason?
a. Her antacids have been increasing the metabolism of her antibiotic
and preventing the antibiotic from getting to a MEC
b. Her antacids have been blocking the elimination of the antibiotic
c. Her antacids have been binding the antibiotic and preventing it from
being absorbed
d. Her antacids aren’t to be blamed, but that the antibiotics aren’t the
right antibiotic for her infection
51. How does the drug diltiazem affect the concentration of a drug like
Simvastatin (HMG-CoA Reductase inhibitor)?
a. Concentrations of Simvastatin increase because diltiazem inhibits
metabolism of simvastatin
b. Concentrations of simvastatin decrease because diltizaem inhibits
metabolism of simvastatin
c. Concentrations of simvastatin increase because diltizaem induces
metabolism of simvastatin
d. Concentratins of simvastatin decrease because diltizaem induces
metabolism of simvastatin
52. Flavonoids in grapefruit juice = ______
a. Increased concentration of a drug like simvastatin
b. Decreased concentration of a drug like Simvastatin
c. Increased likely hood of toxicity
d. Decreased likely hood of toxicity
e. A and c – grapefruit juice is a CYP3A4 inhibitor and thus it will
increase the concentrations and possibly adverse effects of drugs like
simvastatin – this is a pharmacokinetic interaction because it deals
with altered drug exretion
f. B and d
53. What is the pharmacokinetic interaction between PPI and azoles and calcium
carbonates?
a. PPIs increase acid secretion necessary for absorption of these drugs
b. PPIs decrease acid secretion necessary for absorption of these drugs
c. PPIs have no affect on these drugs
d. PPIs bind drugs competitively and prevent their absorption