Weekly Quizzes
Week 1: Overview of General Principles of Pharmacology, Pharmacodynamics, and Pharmacokinetics
A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing drug is prescribed, what drug
adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate?
❖ Increase dosage of the CYP3A4 inducer.
❖ Increase dosage of the CYP3A4 substrate.
❖ Decrease dosage of the CYP3A4 substrate.
❖ Decrease dosage of the CYP3A4 inducer.
➢ A drug that acts as an inducing agent for an enzyme system increases the metabolism of drugs metabolized by that
enzyme system, thereby lowering the level of those drugs in the body and requiring higher doses to maintain drug
effectiveness. Although decreasing the dosage of the drug that induces metabolism may seem reasonable at first glance,
this may decrease the therapeutic level of the drug making it ineffective in treating the condition for which it was
prescribed.
A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement
informs the prescriber’s response when explaining this phenomenon to the patient?
❖ Because the drug preparations are chemically equivalent, the actions of the two brands must be identical.
❖ Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a
placebo effect.
❖ The bioavailability of a drug is determined by the amount of the drug in each dose.
❖ Inactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug’s
onset of action.
➢ Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical
compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different
manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect
the bioavailability of the drug.
When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity?
❖ Avoid exercise for 2 hours after administration.
❖ Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
❖ Substitute grapefruit juice with orange juice.
❖ Take the medication with an NSAID or other anti-inflammatory drug.
➢ Grapefruit juice can inhibit the metabolism of certain drugs including statins like lovastatin. The juice raises drug
levels decreasing the intestinal metabolism of the drug resulting in increased drug levels which increases the risk
for adverse effects such as muscle toxicity. Taking the drug with an anti-inflammatory drug and avoiding
exercise after administration are not supported by science. Monitoring AST and ALT detects liver toxicity, not
muscle toxicity.
,A drug can cause symptoms that resemble those of Parkinson disease. What action should the prescriber take to minimize
the potential patient risk?
❖ Explain that these are teratogenic effects that must be reported immediately.
❖ Order an evaluation of the patient’s genetic predisposition to these effects.
❖ Thoroughly educate the patient about recognizing such symptoms and the need to notify the office immediately.
❖ Educate the patient about these symptoms and provide reassurance that the condition is expected.
➢ Some drugs can cause iatrogenic conditions, which are conditions whose symptoms are the same as those of a
known disease. The patient should be prepared for this possibility and be prepared to recognize and report the
symptoms immediately. Such effects are not teratogenic, since teratogenic effects affect the fetus. Patients with a
genetic predisposition to respond differently to drugs are known to have idiosyncratic effects. Although
reassurance may dispel some fear on the part of the patient, it does provide the patient with actions (e.g.,
notifying the provider) that can allow for symptom management.
A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms that the dosing is correct.
Which possible cause of this situation will the provider explore?
❖ Whether a loading dose was administered
❖ If the ordered dose frequency is longer than the gentamicin half-life
❖ Whether patient is taking a medication that binds to serum albumin
❖ If the drug was completely dissolved in the IV solution
➢ Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can
rise to toxic levels in blood serum. A loading dose increases the initial amount of a drug and is used to bring drug
levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing
embolism but this addresses a different concern. A drug given at a frequency longer than the drug half-life will
likely be at subtherapeutic levels and not at toxic levels.
An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work
reveals an extremely low serum drug level of the drug used to treat this condition. The patient’s renal and hepatic function tests
are normal. What might the provider suspect as a likely cause of this finding?
❖ Increased tolerance to the drug’s effects
❖ Concurrent administration of two highly protein-bound drugs
❖ Chronic constipation
❖ Nonadherence to the medical regimen
➢ Nonadherence is the most common cause of a subtherapeutic drug level. For example, older adult patients who
have financial concerns about paying for medications often take less of the drug or take it less often to make the
drug last longer. Chronic constipation would be more likely to cause a slight elevation of drug level due to the
prolonged time for drug absorption. A patient with increased tolerance to a drug’s effects would require more of
the drug to get effects. Concurrent administration of two highly protein-bound drugs would result in increased
serum levels of one or both drugs.
, Which type of medication prescribed to a pregnant patient is more likely to have effects on her fetus?
❖ Drugs that are highly polar
❖ Ionized drugs
❖ Lipid-soluble drugs
❖ Protein-bound drugs
➢ Lipid-soluble drugs cross the placenta more readily. Drugs that are highly polar, ionized, or protein bound cross
the placenta with difficulty.
A pregnant woman asks why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy.
Which response will the provider offer to address the patient’s concern?
❖ “Clinical trials to determine teratogenic effects would put the fetus at risk.”
❖ “Most women are reluctant to admit taking medications while they are pregnant.”
❖ “It is safer to recommend that pregnant women avoid medications while pregnant.”
❖ “The relatively new MEPREP study will allow testing of medications during pregnancy in the future.”
➢ One of the greatest challenges in identifying drug effects on a developing fetus has been the lack of clinical trials,
which, by their nature, would put the developing fetus at risk of harm. Many pregnant women need prescription
medications and not taking those would put the fetus at risk by compromising the health of the mother. The
MEPREP study is a retrospective study to learn about possible outcomes related to known maternal drug
exposure.
A provider speaking to a class or a group of pregnant patients correctly teaches that the highest risk of teratogen-induced gross
malformations exists during which time period?
❖ Immediately before conception
❖ During the second trimester
❖ During the third trimester
❖ During the first trimester
➢ Gross malformations are caused by exposure to teratogens during the embryonic period, which is considered the
first trimester. This is the time when the basic shape of internal organs and other structures is established. No risk
exists immediately before conception. Teratogen exposure during the second and third trimesters usually disrupts
function rather than gross anatomy.
An infant developed a pruritic rash following exposure to an allergen. The infant’s parents ask the provider about using a topical
antihistamine. What information should the provider use to address the parents’ question?
❖ The child will also need oral medication to achieve effective results.
❖ Topical medications have fewer side effects than those given by other routes.
❖ Applying an antihistamine to the skin can cause toxicity in this age group.
❖ Antihistamines given by this route are not absorbed as well in children.
➢ Drug absorption through the skin is more rapid in infants, because their skin is thinner and has greater blood
flow; therefore, infants are at increased risk of toxicity from topical drugs. Because of increased drug absorption
through the skin, infants should not be given additional drugs via other routes. If a drug is more likely to be
absorbed rapidly, it will have more side effects.
Week 1: Overview of General Principles of Pharmacology, Pharmacodynamics, and Pharmacokinetics
A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing drug is prescribed, what drug
adjustment may be necessary to maintain a therapeutic level of CYP3A4 substrate?
❖ Increase dosage of the CYP3A4 inducer.
❖ Increase dosage of the CYP3A4 substrate.
❖ Decrease dosage of the CYP3A4 substrate.
❖ Decrease dosage of the CYP3A4 inducer.
➢ A drug that acts as an inducing agent for an enzyme system increases the metabolism of drugs metabolized by that
enzyme system, thereby lowering the level of those drugs in the body and requiring higher doses to maintain drug
effectiveness. Although decreasing the dosage of the drug that induces metabolism may seem reasonable at first glance,
this may decrease the therapeutic level of the drug making it ineffective in treating the condition for which it was
prescribed.
A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same drug. Which statement
informs the prescriber’s response when explaining this phenomenon to the patient?
❖ Because the drug preparations are chemically equivalent, the actions of the two brands must be identical.
❖ Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a
placebo effect.
❖ The bioavailability of a drug is determined by the amount of the drug in each dose.
❖ Inactive ingredients used in composition can result in differing rates of dissolution, which can alter the drug’s
onset of action.
➢ Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical
compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different
manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect
the bioavailability of the drug.
When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle toxicity?
❖ Avoid exercise for 2 hours after administration.
❖ Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
❖ Substitute grapefruit juice with orange juice.
❖ Take the medication with an NSAID or other anti-inflammatory drug.
➢ Grapefruit juice can inhibit the metabolism of certain drugs including statins like lovastatin. The juice raises drug
levels decreasing the intestinal metabolism of the drug resulting in increased drug levels which increases the risk
for adverse effects such as muscle toxicity. Taking the drug with an anti-inflammatory drug and avoiding
exercise after administration are not supported by science. Monitoring AST and ALT detects liver toxicity, not
muscle toxicity.
,A drug can cause symptoms that resemble those of Parkinson disease. What action should the prescriber take to minimize
the potential patient risk?
❖ Explain that these are teratogenic effects that must be reported immediately.
❖ Order an evaluation of the patient’s genetic predisposition to these effects.
❖ Thoroughly educate the patient about recognizing such symptoms and the need to notify the office immediately.
❖ Educate the patient about these symptoms and provide reassurance that the condition is expected.
➢ Some drugs can cause iatrogenic conditions, which are conditions whose symptoms are the same as those of a
known disease. The patient should be prepared for this possibility and be prepared to recognize and report the
symptoms immediately. Such effects are not teratogenic, since teratogenic effects affect the fetus. Patients with a
genetic predisposition to respond differently to drugs are known to have idiosyncratic effects. Although
reassurance may dispel some fear on the part of the patient, it does provide the patient with actions (e.g.,
notifying the provider) that can allow for symptom management.
A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms that the dosing is correct.
Which possible cause of this situation will the provider explore?
❖ Whether a loading dose was administered
❖ If the ordered dose frequency is longer than the gentamicin half-life
❖ Whether patient is taking a medication that binds to serum albumin
❖ If the drug was completely dissolved in the IV solution
➢ Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can
rise to toxic levels in blood serum. A loading dose increases the initial amount of a drug and is used to bring drug
levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing
embolism but this addresses a different concern. A drug given at a frequency longer than the drug half-life will
likely be at subtherapeutic levels and not at toxic levels.
An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work
reveals an extremely low serum drug level of the drug used to treat this condition. The patient’s renal and hepatic function tests
are normal. What might the provider suspect as a likely cause of this finding?
❖ Increased tolerance to the drug’s effects
❖ Concurrent administration of two highly protein-bound drugs
❖ Chronic constipation
❖ Nonadherence to the medical regimen
➢ Nonadherence is the most common cause of a subtherapeutic drug level. For example, older adult patients who
have financial concerns about paying for medications often take less of the drug or take it less often to make the
drug last longer. Chronic constipation would be more likely to cause a slight elevation of drug level due to the
prolonged time for drug absorption. A patient with increased tolerance to a drug’s effects would require more of
the drug to get effects. Concurrent administration of two highly protein-bound drugs would result in increased
serum levels of one or both drugs.
, Which type of medication prescribed to a pregnant patient is more likely to have effects on her fetus?
❖ Drugs that are highly polar
❖ Ionized drugs
❖ Lipid-soluble drugs
❖ Protein-bound drugs
➢ Lipid-soluble drugs cross the placenta more readily. Drugs that are highly polar, ionized, or protein bound cross
the placenta with difficulty.
A pregnant woman asks why more is not known about the teratogenic effects of maternal medication ingestion during pregnancy.
Which response will the provider offer to address the patient’s concern?
❖ “Clinical trials to determine teratogenic effects would put the fetus at risk.”
❖ “Most women are reluctant to admit taking medications while they are pregnant.”
❖ “It is safer to recommend that pregnant women avoid medications while pregnant.”
❖ “The relatively new MEPREP study will allow testing of medications during pregnancy in the future.”
➢ One of the greatest challenges in identifying drug effects on a developing fetus has been the lack of clinical trials,
which, by their nature, would put the developing fetus at risk of harm. Many pregnant women need prescription
medications and not taking those would put the fetus at risk by compromising the health of the mother. The
MEPREP study is a retrospective study to learn about possible outcomes related to known maternal drug
exposure.
A provider speaking to a class or a group of pregnant patients correctly teaches that the highest risk of teratogen-induced gross
malformations exists during which time period?
❖ Immediately before conception
❖ During the second trimester
❖ During the third trimester
❖ During the first trimester
➢ Gross malformations are caused by exposure to teratogens during the embryonic period, which is considered the
first trimester. This is the time when the basic shape of internal organs and other structures is established. No risk
exists immediately before conception. Teratogen exposure during the second and third trimesters usually disrupts
function rather than gross anatomy.
An infant developed a pruritic rash following exposure to an allergen. The infant’s parents ask the provider about using a topical
antihistamine. What information should the provider use to address the parents’ question?
❖ The child will also need oral medication to achieve effective results.
❖ Topical medications have fewer side effects than those given by other routes.
❖ Applying an antihistamine to the skin can cause toxicity in this age group.
❖ Antihistamines given by this route are not absorbed as well in children.
➢ Drug absorption through the skin is more rapid in infants, because their skin is thinner and has greater blood
flow; therefore, infants are at increased risk of toxicity from topical drugs. Because of increased drug absorption
through the skin, infants should not be given additional drugs via other routes. If a drug is more likely to be
absorbed rapidly, it will have more side effects.
