Question 1

Decreased serum albumin levels, which is seen in many conditions, including malnutrition and liver disease, affect medications by

Accepted Answer

Albumin is a primary carrier protein of drugs in the blood, and when albumin levels decrease, fewer binding sites for protein-bound drugs leave a larger free fraction of the protein available to leave the blood and affect target tissues.This results in an increased pharmacologic effect of the drug.Biotransformation systems in the liver and other tissues are not dependent upon albumin.

Question 2

Which of the following medications should not be taken with foods that contain bran?

Accepted Answer

The phytates in bran bind with the drug digoxin leading to a loss of therapeutic effect.Various food components impair the absorption of alendronate, iron supplements, and ciprofloxacin.

Question 3

Supplementation of coenzyme Q10 should be considered in patient taking which drug?

Accepted Answer

Statin drugs, such as Lipitor, are also known as HMG-CoA reductase inhibitors.They affect the formation of CoQ10 and the result it decreased circulating levels.Methotrexate is a folic acid antagonist.Cholestyramine absorbs fat-soluble vitamins, and carbamazine affects the metabolism of biotin, vitamin D, and folic acid.

Question 4

The cancer chemotherapeutic agent methotrexate acts as an antagonist to

Accepted Answer

Methotrexate binds with the enzyme dihydrofolate reductase, inhibiting its activity of converting folate to its active form.This could lead to the development of megaloblastic anemia.To prevent this from happening, leucovorin, or folinic acid, is administered with methotrexate and other folate antagonists.

Question 5

A patient is being treated for depression with a monoamine oxidase inhibitor.Which of the following should the patient be instructed to avoid while taking this medication?

Accepted Answer

Aged cheese and meats and fermented foods and beverages contain tyramine, a pressor agent that can promote a hypertensive crisis when eaten while a patient is receiving MAO inhibitors.In general, fresh fruits and vegetables, meats and poultry, and milk and unfermented cheeses are acceptable.

Question 6

An excipient is a(n)

Accepted Answer

An excipient is an inactive, filler ingredient mixed in with the active ingredient in drugs such as a flavorings, dyes, and preservatives.Acetylation is a process of inactivating amines, hydrazines, and sulfonamides so as to detoxify a drug.A pressor agent is an organic compound that causes vasoconstriction and an increase in blood pressure.

Question 7

A patient is receiving warfarin (Coumadin).What MNT education should this patient receive?

Accepted Answer

For warfarin to be effective as an anticoagulant, the dose of the drug must be balanced with the amount of vitamin K consumed.Therefore, the patient needs to maintain a consistent intake of vitamin K.Decreasing the intake of vitamin K runs the risk of the patient being unable to stop bleeding.Vitamin D is not affected by warfarin therapy.

Question 8

Which of the following is NOT a possible side effect of use of corticosteroids?

Accepted Answer

Because corticosteroids such as prednisone promote sodium and water retention, they can contribute to an increase in blood pressure.Calcium is excreted in the place of sodium, and this coupled with corticosteroid impairment of intestinal calcium absorption and osteoblast activity can lead to bone loss.Corticosteroids promote gluconeogenesis and insulin resistance, both of which can cause hyperglycemia.Weight gain is a common side effect of corticosteroids because of both fluid retention and a stimulation of appetite.

Question 9

Antacids, H₂-receptor antagonists, and proton pump inhibitors affect the absorption of calcium, iron, and magnesium through

Accepted Answer

Changes in gastrointestinal pH may occur because of the use of antacids, H₂-receptor antagonists, and proton pump inhibitors because these drugs inhibit gastric acid secretion or alter the pH of the stomach.An acidic pH is necessary for the absorption of vitamin B₁₂.However, acidic pH is also necessary for the oxidation of various minerals to improve their bioavailability and absorption.Increasing the gastrointestinal pH may decrease the absorption of these minerals.

Question 10

Which of the following medications could be given to a patient with cancer or AIDS to stimulate food intake?

Accepted Answer

Commonly used appetite stimulation medications include oxandrolone, megestrol acetate, somatropin, and dronabinol.Dextroamphetamine, sibutramine, and phentermine are appetite suppressant medications.

Question 11

Patients receiving anticonvulsant medications, such as phenytoin and phenobarbital, may need to be supplemented with which nutrients?

Accepted Answer

Phenytoin and phenobarbital increase the metabolism of vitamin D, folic acid, and vitamin K.As a result, these nutrients are commonly supplemented to patients receiving these drugs.

Question 12

Pseudomembranous colitis is a serious side effect of antibiotic therapy

Accepted Answer

The desired effects of medications often are accompanied by effects that are considered undesirable.Side effects are often an extension of the desired effects, such as bacterial overgrowth, as a result of use of an antibiotic.Overgrowth of Clostridium difficile causes pseudomembranous colitis.Suppression of natural oral bacteria may lead to oral yeast overgrowth, or candidiasis.

Question 13

Which term describes the metabolism of drugs by reactions such as oxidation, reduction, hydrolysis, or conjugation?

Accepted Answer

Biotransformation refers to the metabolism of drugs, most of which occurs in the liver.Bioavailability pertains to the degree of absorption of a substance by the intestine.An excipient is an inactive ingredient mixed in with a drug.Pharmacodynamics is the study of the physiologic or biologic effects of a drug.

Question 14

Which term is used to describe the movement of a drug through the body by absorption, distribution, metabolism, and excretion?

Accepted Answer

Pharmacokinetics focuses on the time course of a drug through the body.Pharmacodynamics focuses directly on the drug's effect on the body.Pharmacogenomics involves the study of genetic variations that are affected by drugs.Polypharmacy refers to the use of multiple drugs, which could lead to interactions and have additional consequences in regard to health.

Question 15

Patients receiving the antibiotic tetracycline should be taught to avoid taking it with what?

Accepted Answer

Tetracycline will chelate with calcium from dairy foods and supplements, making both the drug and the calcium unavailable for absorption.Calcium supplements should not be taken during the duration of this antibiotic's prescription.Dairy products should be taken 2 to 6 hours separate from tetracycline administration.

Question 16

The gastrointestinal side effect commonly seen when narcotic drugs such as codeine and morphine are administered is

Accepted Answer

Narcotic medications affect peristalsis in the gastrointestinal tract, causing constipation to occur.Antineoplastic drugs commonly promote changes in taste.Nonsteroidal anti-inflammatory drugs promote gastrointestinal irritation that results in bleeding.A wide variety of medications, including antiinfective agents and antineoplastic drugs, cause anorexia as a side effect.

Question 17

Hypertensive patients who are taking loop diuretics for reduction of blood pressure may experience hypokalemia.Which other electrolyte does NOT need to be monitored for a potential secondary nutrient deficiency?

Accepted Answer

Loop diuretics also promote the urinary excretion of sodium, magnesium, chloride, and calcium.With long-term use, magnesium and calcium supplementation may need to be prescribed to maintain serum blood levels.Phosphorus is not affected by loop diuretics, but care should be taken in maintaining normal levels of phosphorus because altered levels will affect calcium metabolism from bone.

Question 18

When the sedative propofol (Diprivan) is administered to a patient, what nutritional consequence must be considered?

Accepted Answer

Propofol provides fat calories to a patient, and this must be considered when determining total calories and other sources of fat to administer to a patient under sedation.Laxatives such as Fibercon and Fiber-lax contain extra calcium, which may be nutritionally significant.Various drugs use lactose or wheat starch as excipients, and these must be considered when dealing with patients with lactose intolerance and celiac disease.

Question 19

Which of the following is an appropriate procedure for administering oral medications through a feeding tube?

Accepted Answer

Because of the potential for physical incompatibilities that result in the clogging of a feeding tube, medications should not be mixed directly with feeding formula.Protocols should be established in regard to which medications may be administered through a feeding tube.In these protocols, specification should be included in regard to stopping the feeding administration, irrigating the feeding tube to ensure patency, administering the medication, and irrigating the tube again with water.Sudafed and Robitussin are two medications that could lead to clogging of the feeding tube.

Question 20

Which of the following drugs will produced an Antabuse (disulfiram)-like reaction when taken with ethanol?

Accepted Answer

Metronidazole (Flagyl), cefoperazone, and chlorpropamide cause a reaction similar to that of Antabuse when taken with alcohol.The reaction is characterized by flushing, a rapid heartbeat, palpitations, and elevated blood pressure

Quiz 9: Clinical: Food-Drug Interactions