Exam one add-ons

Question 1

During phase 1 of clinical drug trials, potential uses and effects are determined by what action?

a. Giving doses to healthy volunteers
b. Giving doses to people with the disease
c. Utilizing double blind studies
d. Utilizing crossover studies

Answer 1

a. Giving doses to healthy volunteers

Question 2

Pharmacodynamics involves the biological effects of a drug that is exerted on a living system. This occurs by ligand complexes with all of the following except

a. Membrane receptors
b. Enzymes
c. Albumin
d. Intracellular receptors

Answer 2

c. Albumin

Question 3

What is an example of a drug that has affinity for a receptor but does not elicit a response?

a. Albuterol
b. Lisinopril
c. Metoprolol
d .morphine

Answer 3

c. Metoprolol

Question 4

Anaphylactic shock is a:

a. Type I reaction called immediate hypersensitivity reaction.
b. Type II reaction, called cytotoxic hypersensitivity reaction
c. Type III allergic reaction, call the noon complex hypersensitivity
d. Type IV reaction, called delayed hypersensitivity reaction.

Answer 4

a. Type I reaction called immediate hypersensitivity reaction.

Question 5

Which receptor type acts as a binding site for many hormones, adrenoreceptors and chemokines?

a. Transmembrane G protein coupled receptor
b. Transmembrane ligand gated ion channels
c. Enzyme linked receptors
d. nuclear receptor

Answer 5

a. Transmembrane G protein coupled receptor

Question 6

What is the effect of drug antagonism?

a. There is an increased physiological response of endogenous hormones.
b. The drug is modified by the concurrent administration of another drug
c. The drug cannot be metabolize before another dose is administered
d. There is a decreased physiological response when combined with another drug.

Answer 6

d. There is a decreased physiological response when combined with another drug.

Question 7

Which of the following is a true statement about drug A that reaches maximum effect at 10 mg as opposed to drug B that requires 100 mg to produce the same effect?

a. Drug A is more efficacious
b. Drug B has a lower affinity
c. Drug A is more potent
d. Drug A is more selective

Answer 7

c. Drug A is more potent

Question 8

Lock and key

Answer 8

Specificity

Question 9

Greater affinity for certain receptor subtypes

Answer 9

Selectivity

Question 10

Dose of a drug required to produce a specific effect

Answer 10

Potency

Question 11

Determines what happens at a receptor

Answer 11

Efficacy

Question 12

Attraction to the receptor

Answer 12

Affinity

Question 13

In general, the effect of a drug is limited by which one of the following?

a. All available receptors are saturated
b. There are not enough receptors present.
c. The drug dose is too small
d. The receptor is allosteric in structure

Answer 13

a. All available receptors are saturated

Question 14

These respond to peptide ligands

Answer 14

Cytokine receptors

Question 15

These require second messengers

Answer 15

G protein linked receptors

Question 16

these ligands bind to ion channels

Answer 16

ligand gated ion channel receptors

Question 17

Protein that interacts with the ligand, typically on the plasma membrane

Answer 17

Receptor

Question 18

ligand receptor binding process

Answer 18

1) ligand binding
2) Signal transduction; produces the biological effect
3) Cellular response - through first or second messengers

Question 19

What individual characteristics of a person can affect pharmacodynamics

Answer 19

Age, sex, ethnicity

Question 20

Any drug or chemical that has an opposite effect but through different physiological pathways

Answer 20

Physiologic antagonist

Question 21

binds to the agonist (not the receptor) via ionic binding and deactivates the agonist

Answer 21

Chemical antagonist

Question 22

Defined as the ratio of the median effective dose ED50 to the medium toxic dose TD50?

Answer 22

Therapeutic index

Question 23

A high degree of plasma protein binding can result in restricted drug distribution?

True or false?

Answer 23

True. When medications are highly protein-bound, it is only the unbound portion of the drug that is distributed and active. For example, if the medication is 99% protein-bound, then only one 1 % is unbound an active in the system to cause pharmacologic effects.

Question 24

When drugs have been metabolized & reach the kidney tubule, if the drug is ionized and lipophobic, the drug will tend to

a. Be passively illuminated in the urine
b. Be actively reabsorbed through the tubular lumen

Answer 24

a. Be passively illuminated in the urine

(the drug that is ionized also cannot easily pass through the lipid bilayer, so will not be reabsorbed and rather will be passively eliminated in the urine)

Question 25

Rifampin is a nonspecific CYP450 inducer. How might this impact metabolism of another drug that is metabolized by the CYP450 enzymes that is co-administered?

a. This leads to toxic levels of Rifampin
b. This leads to toxic levels of both drugs
c. This could lead to therapeutic failure of the second drug.
d. This would cause nonspecific changes in drug metabolism

Answer 25

c. This could lead to therapeutic failure of the second drug.

Question 26

If the patient is a poor metabolism phenotype, what do you need to consider as a prescriber?

a. There may be slow metabolism of a pro drug into an active drug
b. There maybe an accumulation of inactive metabolites of drugs
c. You may need to increase dosages of the medication
d. There may be increased metabolism of a pro drug into an active drug

Answer 26

a. There may be slow metabolism of a pro drug into an active drug

Question 27

If the patient has an ultra rapid metabolism phenotype, what do you need to consider as a prescriber?

a. Decrease dosages of drugs to prevent drug accumulation
b. Increase metabolism of a Prodrug into an active drug, leading to therapeutic failure
c. Increase elimination of active, non-metabolized drug
d. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug

Answer 27

b. Increase metabolism of a Prodrug into an active drug, leading to therapeutic failure

Question 28

Which variable is a factor in drug absorption?

A. the smaller the surface area for absorption, the more rapidly the drug is absorbed

b. A rich blood supply to the area of absorption leads to better absorption
c. The less soluble the drug the more easily it is absorbed
d. ionized drugs are easily worked across the cell membrane

Answer 28

b. A rich blood supply to the area of absorption leads to better absorption

Question 29

What is an advantage of prescribing sublingual medications?

a. Excreted rapidly
b. Less side effects
c. Distributed equally
d. avoids first past metabolism effect

Answer 29

d. avoids first past metabolism effect

Question 30

What may occur when drug A uses the CYP3A4 isoenzyme for metabolism?

a. Induces the metabolism of drug B that also uses that pathway for metabolism
b. Inhibits the metabolism of drug B that also uses the pathway for metabolism
c. Both A and B
d. Neither A nor B

Answer 30

c. Both A and B

Question 31

The difference between the effective dose and the lethal dose is referred to as

a. Dose response algorithm
b. ED50
c. Serum concentration
d. Therapeutic index

Answer 31

d. Therapeutic index

(You have learned that during drug development, concepts like selectivity, specificity, and others are considered. It is known that a specific plasma concentration of a drug must be achieved in order for that drug to be effective and to be therapeutic. For some of the drugs, the range of plasma concentration of a drug is quite large between effective and lethal dose. In some cases, this range can be quite narrow and produce a potentially dangerous situation for our patients. Therapeutic index is the difference between ED50, or the Effective Dose for 50% of the study population, and LD50, which is the Lethal Dose for 50% of the study population. Mind you, it’s an animal population, not human.)

Question 32

If an NP abruptly terminates an antihypertensive agent like a beta blocker, what is the predictable receptor adaptation called?

a. Upregulation
b. Tolerance
c. Downregulation
d. Reversible agonism

Answer 32

a. Upregulation

(The longterm exposure of this antagonist drug at the receptor site has essentially increased the receptor affinity and responsiveness to the naturally occurring, or endogenous, agonist. In this case, abrupt withdrawal of the antihypertensive antagonist causes upregulation of the receptors. And now your patient is at great risk for a hypertensive crisis)

Question 33

True or false?

A high degree of plasma protein binding can result in restricted drug distribution.

Answer 33

true

(When medications are highly protein bound, it is only the unbound portion of the drug that is distributed and active. For example, if a medication is 99% protein bound then only 1% is unbound and active in the system to cause pharmacologic effects)