NR565 MIDTERM EXAM
QUESTIONS AND
ANSWERS
1. What makes clopidogrel unique among other p2y12 inhibitors?
ANSWER - relies on cytochrome P450 enzyme to convert into active metabolite
(CYP2C19) thus requiring this gene to be present to be an effective drug in clot
formation.
2. Alternatives to clopidogrel
ANSWER - Brilinta (ticagrelor) or Effient (Prasugrel) because they are not dependent on
CYP2C19 genotype.
3. Name the 4 medications that REQUIRE pharmacogenetic testing.
ANSWER - Cetuximab, trastuzumab, maraviroc, dasatinib
4. 2 medications prescribed together that are highly protein bound, what is clinical
outcome?
ANSWER - The two drugs compete for availability of plasma proteins and one or the
other becomes increasingly effective, think extra medication is floating around as it
cannot bind to plasma proteins. Warfarin is highly protein bound.
5. What areas of healthcare most heavily integrate pharmacogenetics into clinical practice?
ANSWER - Oncology & cystic fibrosis population
6. Barrier in understanding racial differences in drug pharmacokinetics with American
Indian or Alaskan Natives?
ANSWER - Limited to no research in racial considerations
7. Purpose of genetic testing with Tamoxifen?
ANSWER - Reduce the risk of therapeutic failure as variation of CYP2D6 will not allow
for activation and conversion to endoxifen which is necessary for treating estrogen
sensitive cancers.
8. Liver and Kidney functions labs for monitoring?
ANSWER - Creatinine, BUN, GFR, AST, ALT, Bilirubin
, 9. Dose of propranolol in migraine reduction.
ANSWER - 20-80mg 3-4X daily increases levels of serotonin, prevents beta receptor
vasodilation allow 4-6 weeks to trial treatment.
10. First consideration in selecting most appropriate beta blocker?
ANSWER - Cardio selectivity
11. Pregnancy Categories B vs D with beta blockers.
ANSWER - Atenolol – D betaxolol, acebutolol, metoprolol, nadolol, nebivolol, tiolol,
propranolol - C
12. Where are beta 2 receptors located and what do they do?
ANSWER - smooth muscle of eye, arterioles, venules, bronchioles, liver, pancreas, GI,
GU Stimulate adenylyl cyclase, increase cAMP, activate cardiac G1
13. Drug of choice for HTN with concomitant BPH.
ANSWER - Alpha 1 adrenergic antagonist
14. Beta blockers that require dosage adjustment in patients with renal impairment.
ANSWER - acebutolol, atenolol, nadolol, and nebivolol
15. Dosing schedule of donepezil
ANSWER - 5mg nightly at bedtime, increase at 4–6-week intervals, max dose is 10 mg
daily.
16. Elicits parasympathetic response.
ANSWER - Acetylcholine, ACh
17. Sympathetic nervous system responses elicited by:
ANSWER - Epi, Norepi, Dopa
18. First line treatments for HTN.
ANSWER - CCB, ACEI, ARB, or thiazide consider comorbidities.
19. Patients with HTN and comorbidities of essential tremor, migraine, arrhythmia, CAD,
symptomatic HF with reduced EF can be treated with?
ANSWER - beta blocker
20. 2 drugs that require tapering when discontinuing in relation to HTN tx.
ANSWER - beta blockers and clonidine
21. G protein-coupled receptors (GPCRs)
QUESTIONS AND
ANSWERS
1. What makes clopidogrel unique among other p2y12 inhibitors?
ANSWER - relies on cytochrome P450 enzyme to convert into active metabolite
(CYP2C19) thus requiring this gene to be present to be an effective drug in clot
formation.
2. Alternatives to clopidogrel
ANSWER - Brilinta (ticagrelor) or Effient (Prasugrel) because they are not dependent on
CYP2C19 genotype.
3. Name the 4 medications that REQUIRE pharmacogenetic testing.
ANSWER - Cetuximab, trastuzumab, maraviroc, dasatinib
4. 2 medications prescribed together that are highly protein bound, what is clinical
outcome?
ANSWER - The two drugs compete for availability of plasma proteins and one or the
other becomes increasingly effective, think extra medication is floating around as it
cannot bind to plasma proteins. Warfarin is highly protein bound.
5. What areas of healthcare most heavily integrate pharmacogenetics into clinical practice?
ANSWER - Oncology & cystic fibrosis population
6. Barrier in understanding racial differences in drug pharmacokinetics with American
Indian or Alaskan Natives?
ANSWER - Limited to no research in racial considerations
7. Purpose of genetic testing with Tamoxifen?
ANSWER - Reduce the risk of therapeutic failure as variation of CYP2D6 will not allow
for activation and conversion to endoxifen which is necessary for treating estrogen
sensitive cancers.
8. Liver and Kidney functions labs for monitoring?
ANSWER - Creatinine, BUN, GFR, AST, ALT, Bilirubin
, 9. Dose of propranolol in migraine reduction.
ANSWER - 20-80mg 3-4X daily increases levels of serotonin, prevents beta receptor
vasodilation allow 4-6 weeks to trial treatment.
10. First consideration in selecting most appropriate beta blocker?
ANSWER - Cardio selectivity
11. Pregnancy Categories B vs D with beta blockers.
ANSWER - Atenolol – D betaxolol, acebutolol, metoprolol, nadolol, nebivolol, tiolol,
propranolol - C
12. Where are beta 2 receptors located and what do they do?
ANSWER - smooth muscle of eye, arterioles, venules, bronchioles, liver, pancreas, GI,
GU Stimulate adenylyl cyclase, increase cAMP, activate cardiac G1
13. Drug of choice for HTN with concomitant BPH.
ANSWER - Alpha 1 adrenergic antagonist
14. Beta blockers that require dosage adjustment in patients with renal impairment.
ANSWER - acebutolol, atenolol, nadolol, and nebivolol
15. Dosing schedule of donepezil
ANSWER - 5mg nightly at bedtime, increase at 4–6-week intervals, max dose is 10 mg
daily.
16. Elicits parasympathetic response.
ANSWER - Acetylcholine, ACh
17. Sympathetic nervous system responses elicited by:
ANSWER - Epi, Norepi, Dopa
18. First line treatments for HTN.
ANSWER - CCB, ACEI, ARB, or thiazide consider comorbidities.
19. Patients with HTN and comorbidities of essential tremor, migraine, arrhythmia, CAD,
symptomatic HF with reduced EF can be treated with?
ANSWER - beta blocker
20. 2 drugs that require tapering when discontinuing in relation to HTN tx.
ANSWER - beta blockers and clonidine
21. G protein-coupled receptors (GPCRs)
