Deck 30: Therapeutic Drugs and Their Management

Question 1

When a drug concentration exceeds the available metabolic capacity of the body,what does the drug's metabolism become dependent on?

A) The health of the renal system
B) The number of doses given per hour
C) The drug concentration itself
D) The amount of metabolizing enzyme

Answer 1

The amount of metabolizing enzyme

Question 2

A class III antiarrhythmic drug that acts by blocking potassium channels and that is used to manage atrial fibrillation is:

A) procainamide.
B) digoxin.
C) amiodarone.
D) quinidine.

Answer 2

amiodarone.

Question 3

If a drug is acidic in nature,which of the following proteins will it associate with primarily for transport and distribution?

A) Lipoprotein
B) . $\alpha$ ₁-Glycoprotein
C) Albumin
D) All of the above

Answer 3

Albumin

Question 4

Which of the following is a major active metabolite of procainamide that must be monitored along with the parent drug?

A) Disopyramide
B) Glycinexylidide
C) N-acetylprocainamide
D) Procainamide does not have an active metabolite.

Question 5

The steady state of a drug is defined as the:

A) point at which the body concentration of the drug is in equilibrium with the rate of dose administered and the rate of elimination.
B) time required for one-half of an administered drug to be lost through metabolism and elimination.
C) metabolism of a drug with a high hepatic extraction rate by the liver before it reaches the systemic circulation.
D) action of one drug on another.

Question 6

What do both cyclosporine and tacrolimus inhibit?

A) Erythrocyte precursor proliferation
B) Plasma cell proliferation
C) Gram-negative bacterial growth
D) Calcineurin

Question 7

Which one of the following is not a good rationale for monitoring the blood concentration of a therapeutic drug?

A) To check patient compliance
B) To determine drug concentrations in a pathophysiological state
C) To monitor drugs with a broad therapeutic range
D) To monitor significant drug-drug interactions

Question 8

A woman is treated for a seizure disorder with levetiracetam.She began experiencing dizziness and fatigue.Blood cell values indicated decreased RBC count and low hematocrit.Trough blood concentration of levetiracetam was assessed to be 15 µg/mL,although her dosing should have resulted in a trough therapeutic concentration of 3 µg/mL.She claimed that she was not taking antacids or any other medication.What is the likely cause of the elevated levetiracetam?

A) Levetiracetam is metabolized to gabapentin in systemic circulation,leading to an increase in antiepileptic activity.
B) The patient might have an issue with her renal function,leading to decreased elimination of the drug.
C) The patient was probably also taking phenytoin,which reacts with levetiracetam resulting in increased concentration.
D) The physician made an error in calculating the correct dosage of gabapentin.

Question 9

Which of the following could account for drug toxicity following a prescribed dose?

A) Decreased renal elimination leading to increased free drug concentration
B) Using a single drug as opposed to multiple drugs for treatment
C) Using a different route of administration than is typically used for that drug
D) Increased drug metabolism caused by central nervous system disease

Question 10

Which of the following therapeutic drugs is considered to be a selective serotonin reuptake inhibitor?

A) Fluoxetine
B) Imipramine
C) Lithium
D) Both a and b

Question 11

A hospitalized patient is being given gentamicin to treat a gram-negative bacterial infection.The patient's physician contacts you regarding monitoring of this antibiotic because this patient is beginning to exhibit signs of hearing loss and renal failure.When you assess the patient's 10-hour postinfusion trough antibiotic concentration,it is increased.You learn from the physician that he has been dosing the patient to keep the antibiotic concentration high,"at a steady state" he tells you.You state that:

A) it would be better to change antibiotics because the patient is obviously allergic to gentamicin.
B) you have made an error in the method of assessment of this antibiotic and need to repeat the analysis.
C) with aminoglycoside antibiotics,trough concentrations must be allowed to decrease because of the postantibiotic effect.
D) aminoglycosides display peak level concentration-dependent killing of microorganisms and the dosage should be increased even more.

Question 12

What is occurring in phase I metabolism of a therapeutic drug?

A) Conjugation to a different moiety
B) Elimination
C) Chemical modification such as hydrolysis
D) First-pass metabolism

Question 13

Mycophenolate mofetil (MMF)is rapidly hydrolyzed by widely distributed esterases in blood and tissue to produce MPA.In regard to drug metabolism,this chemical reaction is referred to as:

A) enzyme induction.
B) a phase I reaction.
C) a first pass effect.
D) a phase II reaction.

Question 14

A hospital patient is receiving amikacin for her Enterobacter infection,which seems to be resistant to all other antibiotics.Her physician is somewhat unfamiliar with the antibiotic and wants to know what laboratory analyses can be performed to assess this antibiotic's efficacy and risk of toxicity.You suggest:

A) immunoassay for amikacin at the peak blood concentration.
B) assessment of hearing by a speech pathologist.
C) both peak and trough amikacin concentration assessment.
D) that amikacin should not be used in this case because it is not suitable for Enterobacter infections.

Question 15

Which one of the following therapeutic drugs is used in the management of acute lymphoblastic leukemia and inhibits DNA synthesis by decreasing methylation of pyrimidine nucleotides and their synthesis?

A) Mycophenolic acid
B) Cyclosporine
C) Tacrolimus
D) Methotrexate

Question 16

Which one of the following immunosuppressant prodrugs inhibits inosine monophosphate dehydrogenase (IMPDH)to reduce the pool of intracellular guanine nucleotides and arrest T-cell proliferation?

A) Tacrolimus
B) Mycophenolate mofetil
C) Disopyramide
D) Imipramine

Question 17

The fraction of drug absorbed into a physiological system that is based on the amount of drug given is referred to as:

A) bioavailability.
B) dosing.
C) volume of distribution.
D) steady state.

Question 18

The therapeutic drug used to treat all but absence seizures by prolonging inactivation of the synaptic sodium channel and reducing synaptic transmission is:

A) phenytoin.
B) ethosuximide.
C) carbamazepine.
D) gabapentin.

Question 19

The therapeutic range of a drug is:

A) dependent on renal function.
B) the range of concentrations within which the drug is effective yet not toxic.
C) the range of concentrations at which there are no drug interactions.
D) dependent on the route of drug administration.

Question 20

The period of time during which the concentration of a therapeutic drug decays by 50% is referred to as the drug's:

A) subtherapeutic range.
B) dosing curve.
C) volume of distribution.
D) half-life.

Question 21

Match each drug with its major mode of action.
Procainamide

A)Antiarrhythmic
B)Tricyclic antidepressant
C)Immunosuppressant
D)Antiepileptic

Question 22

The name given to the group of enzymes that are particularly involved in phase I metabolism of drugs and that involve reduction/oxidation or hydrolysis is:

A) methyltransferases.
B) glucuronyltransferases.
C) urokinases.
D) cytochromes P-450.

Question 23

MATCHING
Match each therapeutic drug with its major therapeutic use.
Lamotrigine

A)Antiepileptic
B)Antiarrhythmic
C)Antidepressant
D)Antimetabolic

Question 24

Match each drug with its major mode of action.
Sirolimus

A)Antiarrhythmic
B)Tricyclic antidepressant
C)Immunosuppressant
D)Antiepileptic

Question 25

MATCHING
Match each therapeutic drug with its major therapeutic use.
Imipramine

A)Antiepileptic
B)Antiarrhythmic
C)Antidepressant
D)Antimetabolic

Question 26

Match each drug with its major mode of action.
Phenobarbital

A)Antiarrhythmic
B)Tricyclic antidepressant
C)Immunosuppressant
D)Antiepileptic

Question 27

MATCHING
Match each therapeutic drug with its major therapeutic use.
Methotrexate

A)Antiepileptic
B)Antiarrhythmic
C)Antidepressant
D)Antimetabolic

Question 28

MATCHING
Match each therapeutic drug with its major therapeutic use.
Quinidine

A)Antiepileptic
B)Antiarrhythmic
C)Antidepressant
D)Antimetabolic

Question 29

Match each drug with its major mode of action.
Amitriptyline

A)Antiarrhythmic
B)Tricyclic antidepressant
C)Immunosuppressant
D)Antiepileptic

Question 30

The method of monitoring therapeutic drug concentrations that is replacing HPLC-based methods and is now considered to be the best technology for analysis of biological specimens with high specificity and fewer interferences is:

A) gas-liquid chromatography.
B) spectrophotometry.
C) high performance liquid chromatography.
D) liquid chromatography-mass spectrometry/mass spectrometry.

Question 31

For a therapeutic drug that has a short half-life,for example levetiracetam,when is the appropriate time to collect a blood sample for therapeutic drug assessment?

A) Immediately after a dose of the drug is given
B) Immediately before a dose of the drug is given
C) At 8 AM,when liver metabolism is highest
D) There is no specific time that is the best for blood collection.