Systemic Pharmacology - Midterm 1

You prescribe moxifloxacin to your patient for the treatment of bacterial conjunctivitis. However your patient comes back a week later and states that although the bacterial conjunctivitis cleared up it also caused some of her eyelashes to fall out. What is another term for an unusual or unexpected response to a drug?

• Tolerance

• Idiosyncracy

• Withdrawal

• First Pass effect

An optometrist places one drop of 0.5% proparacaine in a patient's OD eye prior to instilling a mydriatic/cycloplegic agent. In this case, the use of proparacaine would be considered to be wich of the following?

• Diagnostic

• Prophylactic

• Treatment

• Idiosyncractic

Which of the following drugs primary use is not for treatment?

• Metoprolol

• Proparacaine

• Moxifloxacin

• Lopressor

• Vancomycin

A patient comes in for an annual exam. While taking the case history they tell you they have been placed on a new heart medication by their cardiologist. The patients reveals to you that they have had episodes of delirium and hallucinations in the past few weeks. What does it sound like the patient is experiencing?

• Therapeutic effect

• Adverse drug effect (ADE)

• Antagonism

• Drug dependence

• Potentiation

A 63 yr, asian male comes in for an eye exam. While taking his case history you discover they are taking Clonidin for the treatment of hypertension. Clonidin is an oral medication that works by decreasing your heart rate and relaxing the blood vessels so that blood can flow more easily through the body. You patient states he feels fine and mentions that he is almost out of medication and does not plan to refill his prescription since the doctor wants to increase the dosage. Why would you warn your patient against that course of action?

• Psychological dependence

• Opiate withdrawal

• Altered metabolism

• Physiologic dependence

• Potentiation

Another celebrity has made it to the tabloids for a drug problem. The publicist has announced that Justin Bieber is boldly getting help for opiate withdrawals. Which of the following is not a symptoms he would be experiencing from OPIATE withdrawls? 

• Piloerection

• Diarrhea

• Seizures

• Insomnia

• Irritability

During a pharm party people will bring pharmaceutical drugs and randomly take them not knowing what they are for. An 18yr old girl has just ingested two pills, because she's dumb she didn't realize that each of the drugs she took has CNS depressant effects. She is now feeling extremely sedated because the result of the two drugs is twice the CNS depressant effects experienced by the patient. This is an example of what kind of drug interaction?

• Chelation

• Antagonism

• Additive Effects

• Synergism

• Potentiation

You patient was previously admitted to the Emergency Department (ED) for bacterial endocarditis. The attending physician was very aggressive with treatment and prescribed a course of medication with both Vancomysin and Gentamicin. The result is that the combination of these medications is more effective in killing the bacteria causing the infection than the effect that would be achieved by using either of the antibiotics.

• Chelation

• Antagonism

• Additive Effects

• Synergism

• Potentiation

A patient was in a traumatic car accident. Upon arrival to a primitive hosipital the patient was given morphine for the pain ( they didn't have the really good stuff). After a few days the patient was given Naloxone to reverse the effect of morphine so they could get him out of the ED to make room for another poor sap. By itself naloxone typically does nothing, it's action is revealed after it is coupled with an opiate. The CNS, cardiovascular and respiratory depressant effect of morphine is reversed. This is an example of what kind of drug interaction?

• Chelation

• Antagonism

• Additive Effects

• Synergism

• Potentiation

Clavulanate is a drug with no clinical effect. However coupled with amoxicillin it has been found to be particularly useful against bacteria that are resistant to treatment with amoxicillin alone. Clavulanate provides protection to amoxicillin by keeping the beta-lactact ring within the amoxicillin structure in tact. This is an example of what kind of drug interaction?

• Altered absorption

• Synergism

• Potentiation

• Additive effect

• Formulation

Altered absorption is always due to chelation

• True

• False

Most drugs are absorbed in the doudenum and the _____. Few medications are absorbed in the _____ lining.

Cisplatin is a type of platinum-based chemotherapy drug that has been commonly used in the chemical treatment of various cancers, including sarcomas, lymphomas, germ cell tumors and certain carcinomas. Your patients's nephrologist has suggested adding mannitol to cisplatinum therapy minimizes the renal tubular damage that can occur with administration of cisplatinum along. The diuretic effect of mannitol prevents prolonged cisplatinum contact time which lessens the potential for cellular damage. This is an example of what kind of drug interaction?

• Altered excretion

• Altered metabolism

• Altered absorption

• Tolerance

• Additive Effects

• First Pass effect

Regarding altered metabolism: interactions can occur when ____ enzymes are inhibted or induced.

Drugs that bind to serum proteins may compete with other drugs for the protein binding sites. Displacement of drug " A" from serum proteins by drug "B" may increase the concentration of unbound drug " A" in the serum

• True

• False

Select the false statement

• The generic name of a drug may also be referred to as the non-proprietary name. This name is irrespective of the manufacturer.

• The trade name and the proprietary name are also known as the brand name.

• The chemical name of the drug usually refers to the chemical structure of the drug.

• Bayer Aspirin is an example of a trade name

• Aspirin is an example of a chemical name that is irrespective of the manufacturer

The formulation of drugs is NOT dependent on the following factor:

• Drug stability

• Capability of the drug to pass through one or more barrier in the body

• Clinical situation

• Half life of the drug

• First pass effect

• Intended use of the drug

Intravenous medications might be needed in situations occurring in hospitals, whereas oral and opthalmic or other forms of medication are often more appropriate for outpatient use.

• True

• False

Select the route of drug administration you might prefer to use during an emergency or very urgent situation according to Dr. J.

• Oral

• Ophthalmic

• Subcutaneous

• Intravenous

• Intramuscular

Drugs such as insulin are denaturated by acid and are not effective when administered orally because they may be destroyed in the low pH environment of the stomach. What kind of consideration would this be in drug formulation?

• Drug stability of preparation

• First pass effect

• Altered excretion

• Drug stability in various physiologic environments

Blood from the mesenteric circulation ( GI) passes through the liver before entering other organs. Medications absorbed through the GI tract which pass through the liver can undergo some degree of metabolism on the first pass through the liver. At times, the effect can be so significant, that the oral dose must be much higher than the parenteral dose in order to assure effective serum concentraction levels after the initial pass through the liver. What is this phenomenon typically called?

The dosage for metoprolol/lopressor when prescribed orally is typically 25-50mg. This particular drug's dosage is affected by the first pass effect. If prescribed intravenously what dosage would you expect for metoprolol?

• 100mg

• 50mg

• 25mg

• 2.5mg

If a doctor is wants to prescribe medication that will allow the patient maximum ease to dose themselves what route of drug administration would be recommended?

• Sublingual

• Rectal (PR)

• Ophthalmic

• Oral

• Dermatologic

Current National Patient Safety Guidelines discourage use of"SL" as an abbreviation for sublingual.

• True

• False

If a patient has been prescribed tylenol or aspirin but the chart says the patient is NPO, how would you administer the medication?

• Oral

• Sublingual

• IV bolus

• PR

• Otic

Which of the following elements is required for a California -licensed prescriber to include on a new prescription?

• Pt's age

• Generic name of the drug

• The number of refills authorized

• Date that the prescription is issued

• Trade name of the drug

A diabetic patient with impaired gastroparesis will have trouble with which of the routes of drug administration?

• Rectal (PR)

• Dermatologic

• Oral

• Nasal

• Parenteral

• Subcutaneous

Which of the following statements is false concerning the dermatologic route of drug administration.

• It includes topical transdermal patches, where drugs are placed into adhesive patches applied to the skin.

• Drugs can be absorbed through the skin and into the capillary bed for distribution via systemic circulation

• The location of the dermatologic patch may be indicative of use, for example estrogen patches are typically placed on the lower back

• It can be administered beneath the cutaneous layer of the skin

Which of the following is not true regarding the parenteral route of drug administration?

• They are administration techniques which bypass or avoid use of the gastrointestinal tract for medication absorption

• Intrathecal, intra-arterial and intracardiac are examples of parenteral

• Drug solubility and formulation does not limit the ability of drugs to be administered intravenously

• Drug and solution compatibility may also limit intravenous drug use

• Subcutaneous administration of medication beneath the cutaneous layer of the skin then enters the systemic circulation through the capillaries.

Convert the following prescription into shorthand: Metoprolol 25 milligram tablet, take two tablets orally twice daily

• Metoprolol 50mg PO B.I.D

• Metoprolol 2 TABs B.I.D

• Metoprolol 25mg TAB, two TABs PO B.I.D

• Metoprolol 100mg PO daily

Select the best answer : Convert the following prescription: Artifical tears instill two drops in both eyes as needed for dryness/itching

• Artificial tears 2 gtts OD/OS PRN dryness/itching

• Artificial tears 2 gtts OU PRN dryness/itching

• Artificial tears 2 gtts PRN dryness/itching

• Artificial tears OU PRN dryness/itching

Convert the following shorthand to lay person terms select the best option: Docusate sodium 100mg. one tab P.O. B.I.D PRN constipation

• Docusate sodium 100 milligrams, one tablespoon orally twice daily as needed for constipation

• Docusate sodium 100 milligrams, one tablet orally twice daily as needed for constipation

• Docusate sodium 100 milligrams, one tablet orally before bedtime as needed for constipation

• Docusate sodium 100 milligrams, one tablespoon orally aftr meals twice a day as needed

Convert the following shorthand to lay person terms, select the best option: Clindamycin 600mg, one tab. P.O. q8hr x 7days

• Clindamycin 600 milliliters, one tablet orally every eight hours for a treatment course of seven days

• Clindamycin 600 milligrams, one tablet orally every eight hours for a treatment course of seven days

• Clindamycin 600 milligrams, one tablespoon orally at 8 am and 8 pm for a treatment course of seven days

• Clindamycin 600milliliters one tablet orally at 8am and 8pm for a treatment course of seven days.

Convert the following shorthand to lay person terms, select the best option: Regular insulin 5 units, SC qAC, HS

• Regular Insulin 5 units, subcutaneous before every meal and before bedtime

• Regular Insulin 5 units, subcutaneous after every meal and every half hour

• Regular insulin 5 U, without correction around the clock and before every nap

• Regular insulin 5 units,discontinue before every meal and before bedtime

Convert the follow to shorthand: Levothyroxine 75 micrograms, take one tablet orally every morning one hour before breakfast

• Levothyroxine 75mg, one tab P.O. qAM one hr prior to breakfast

• Levothyroxine 75mcg, one tab P.O. qAM one hr prior to breakfast

• Levothyroxine 0.0750 mcg, one tab P.O. qAM one hr prior to breakfast

• Levothyroxine 75mcg, one tab P.O. qAC

Which of the following drug information monograph sections below should an OD review in order to find information on how the drug acutally works to produce its clinical effects.

• Indications

• Mechanism of action

• Pharmocodynamics/kinetics

• Dosage

• All the above

Which of the following FDA preg. Risk factor categories is identified by the following description/ there is a positive evidence of human fetal risk, but the benefits from use during pregnancey may be acceptable despite the risk.

• Cat B

• Cat. C

• Cat. D

• Cat. X

How many half lives would be needed before 95% or more of an administered drug dose is eliminated ? at 7am the first dose is 100mg.

• 3

• 5

• 7

• 10

Select the false statement

• With continuous infusion, the serum concentration of the drug will reach steady state after 4-5 half lives.

• If a drug that is dependent on drug serum concentraction has trouble reaching the site of action this will result in a shorter half life.

• With continuous infusion, increasing the rate of infusion will increase the serum concentration of the drug at steady state, but will not shorten the time needed to achieve steady state levels.

• On a graph of intermittent dose serum concentration peaks are the high points in the concentration fluctuations; troughs are the low points

• Drugs administered intravenously reach maximum serum concentration rapidly compared to drugs administered by many other routes.

_____ doses are given to reach therapeutic serum drug concentrations more quickly than administering routine intermittent doses. The first dose of the drug is calculated to be higher than the doses that will follow.

Which of the following is not a drug based factor that can affect the absorption through tissues and membranes?

• Formulation

• Water solubility

• Molecular weight

• Ionization

• Lipid solubility

• None of the above

What drug transport mechanism would most likely be the quickest route for small, nonionic, lipophilic drug molecules?

• Active transport

• Hydrophilic channels

• Carrier assisted diffusion

• Passive diffusion

Which of the following drug transport mechanisms requires a transport carrier?

• Passive diffusion

• Active transport

• Hydrophilic channels

• Carrier assisted diffusion

What drug transport mechanism best fits the following description?: It does not require energy or a transport carrier to function. Drugs with a MW less than 200 are able to diffuse along concentration gradient via this route.

• Passive diffusion

• Carrier assisted diffusion

• Hydrophilic channels

• Active transport

Concerning drug transport mechanisms - molecules that are structurally similar can compete for carriers. Noncovalent binding binds drugs to carriers which then facilitate diffusion or carrier assisted diffusion.

• True

• False

Select the true statement

• Ionization makes a drug molecule more lipid soluble

• Ionization makes a drug molecule more water soluble

• Ionization makes a drug molecule less lipid soluble

• Ionization increases serum protein binding

• Ionization decreases serum protein binding

When drugs bind to albumin or other serum proteins, the amount of free, unbound drug is ______ ( increased or decreased ).

Some drugs can deposit in specific tissues and accumulate there. This may result in ____ ( slower or faster ) drug release or eventual changes in the tissues. Examples of drugs with drug deposition issues include amiodarone/Pacerone and doxycycline/Vibramycin.