NR565 MIDTERM, WEEK 4 QUESTIONS
WITH CORRECT ANSWERS
whatXmakesXclopidogrelXuniqueXamongXotherXP2Y12Xinhibitors?X-XCORRECTXANSWERX-
reliesXonXcytochromeXP450XenzymeXtoXconvertXintoXactiveXmetaboliteX(CYP2C19)XthusXrequiringXthisXgeneX
toXbeXpresentXtoXbeXanXeffectiveXdrugXinXclotXformation
AlternativesXtoXclopidogrelX-XCORRECTXANSWERX-
BrilintaX(ticagrelor)XorXEffientX(Prasugrel)XbecauseXtheyXareXnotXdependentXonXCYP2C19Xgenotype
NameXtheX4XmedicationsXthatXREQUIREXpharmacogeneticXtestingX-XCORRECTXANSWERX-
Cetuximab,Xtrastuzumab,Xmaraviroc,Xdasatinib
2XmedicationsXprescribedXtogetherXthatXareXhighlyXproteinXbound,XwhatXisXclinicalXoutcome?X-
XCORRECTXANSWERX-
TheXtwoXdrugsXcompeteXforXavailabilityXofXplasmaXproteinsXandXoneXorXtheXotherXbecomesXincreasinglyXeff
ective,XthinkXextraXmedicationXisXfloatingXaroundXasXitXcannotXbindXtoXplasmaXproteins.XWarfarinXisXhighlyXp
roteinXbound.
WhatXareasXofXhealthcareXmostXheavilyXintegrateXpharmacogeneticsXintoXclinicalXpractice?X-
XCORRECTXANSWERX-OncologyX&XcysticXfibrosisXpopulation
ThinkXHER2XwithXbreastXcancerXandXCFXhaveX2XdefectiveXCFTRXgenes
BarrierXinXunderstandingXracialXdifferencesXinXdrugXpharmacokineticsXwithXAmericanXIndianXorXAlaskanXNa
tives?X-XCORRECTXANSWERX-LimitedXtoXnoXresearchXinXracialXconsiderations
PurposeXofXgeneticXtestingXwithXTamoxifen?X-XCORRECTXANSWERX-
ReduceXtheXriskXofXtherapeuticXfailureXasXvariationXofXCYP2D6XwillXnotXallowXforXactivationXandXconversionX
toXendoxifenXwhichXisXnecessaryXforXtreatingXestrogenXsensitiveXcancers.
LiverXandXKidneyXfunctionsXlabsXforXmonitoring?X-XCORRECTXANSWERX-
Creatinine,XBUN,XGFR,XAST,XALT,XBilirubin
DoseXofXpropranololXinXmigraineXreductionX-XCORRECTXANSWERX-20-80mgX3-4XXdaily
, increasesXlevelsXofXserotonin,XpreventsXbetaXreceptorXvasodilation
allowX4-6XweeksXtoXtrialXtreatment
FirstXconsiderationXinXselectingXmostXappropriateXbetaXblocker?X-XCORRECTXANSWERX-CardioXselectivity
PregnancyXCategoriesXBXvsXDXwithXbetaXblockersX-XCORRECTXANSWERX-AtenololX-XD
betaxolol,Xacebutolol,Xmetoprolol,Xnadolol,Xnebivolol,Xtiolol,XpropranololX-XC
WhereXareXbetaX2XreceptorsXlocatedXandXwhatXdoXtheyXdo?X-XCORRECTXANSWERX-
smoothXmuscleXofXeye,Xarterioles,Xvenules,Xbronchioles,Xliver,Xpancreas,XGI,XGU
StimulateXadneylylXcyclase,XincreaseXcAMP,XactivateXcardiacXG1
DrugXofXchoiceXforXHTNXwithXconcomitantXBPHX-XCORRECTXANSWERX-AlphaX1XadrenergicXantagonist
BetaXblockersXthatXrequireXdosageXadjustmentXinXpatientsXwithXrenalXimpairmentX-XCORRECTXANSWERX-
acebutolol,Xatenolol,Xnadolol,XandXnebivolol
DosingXscheduleXofXdonepizilX-XCORRECTXANSWERX-5mgXnightlyXatXbedtime,XincreaseXatX4-
6XweekXintervals,XmaxXdoseXisX10XmgXdaily.
ElicitsXparasympatheticXresponseX-XCORRECTXANSWERX-Acetylcholine,XACh
SympatheticXnervousXsystemXresponsesXelicitedXby:X-XCORRECTXANSWERX-Epi,XNorepi,XDopa
FirstXlineXtreatmentsXforXHTNX-XCORRECTXANSWERX-CCB,XACEI,XARB,XorXthiazide
considerXcomorbidities
PatientsXwithXHTNXandXcomorbiditiesXofXessentialXtremor,Xmigraine,Xarryhthmia,XCAD,XsymptomaticXHFXwit
hXreducedXEFXcanXbeXtreatedXwith?X-XCORRECTXANSWERX-betaXblocker
WITH CORRECT ANSWERS
whatXmakesXclopidogrelXuniqueXamongXotherXP2Y12Xinhibitors?X-XCORRECTXANSWERX-
reliesXonXcytochromeXP450XenzymeXtoXconvertXintoXactiveXmetaboliteX(CYP2C19)XthusXrequiringXthisXgeneX
toXbeXpresentXtoXbeXanXeffectiveXdrugXinXclotXformation
AlternativesXtoXclopidogrelX-XCORRECTXANSWERX-
BrilintaX(ticagrelor)XorXEffientX(Prasugrel)XbecauseXtheyXareXnotXdependentXonXCYP2C19Xgenotype
NameXtheX4XmedicationsXthatXREQUIREXpharmacogeneticXtestingX-XCORRECTXANSWERX-
Cetuximab,Xtrastuzumab,Xmaraviroc,Xdasatinib
2XmedicationsXprescribedXtogetherXthatXareXhighlyXproteinXbound,XwhatXisXclinicalXoutcome?X-
XCORRECTXANSWERX-
TheXtwoXdrugsXcompeteXforXavailabilityXofXplasmaXproteinsXandXoneXorXtheXotherXbecomesXincreasinglyXeff
ective,XthinkXextraXmedicationXisXfloatingXaroundXasXitXcannotXbindXtoXplasmaXproteins.XWarfarinXisXhighlyXp
roteinXbound.
WhatXareasXofXhealthcareXmostXheavilyXintegrateXpharmacogeneticsXintoXclinicalXpractice?X-
XCORRECTXANSWERX-OncologyX&XcysticXfibrosisXpopulation
ThinkXHER2XwithXbreastXcancerXandXCFXhaveX2XdefectiveXCFTRXgenes
BarrierXinXunderstandingXracialXdifferencesXinXdrugXpharmacokineticsXwithXAmericanXIndianXorXAlaskanXNa
tives?X-XCORRECTXANSWERX-LimitedXtoXnoXresearchXinXracialXconsiderations
PurposeXofXgeneticXtestingXwithXTamoxifen?X-XCORRECTXANSWERX-
ReduceXtheXriskXofXtherapeuticXfailureXasXvariationXofXCYP2D6XwillXnotXallowXforXactivationXandXconversionX
toXendoxifenXwhichXisXnecessaryXforXtreatingXestrogenXsensitiveXcancers.
LiverXandXKidneyXfunctionsXlabsXforXmonitoring?X-XCORRECTXANSWERX-
Creatinine,XBUN,XGFR,XAST,XALT,XBilirubin
DoseXofXpropranololXinXmigraineXreductionX-XCORRECTXANSWERX-20-80mgX3-4XXdaily
, increasesXlevelsXofXserotonin,XpreventsXbetaXreceptorXvasodilation
allowX4-6XweeksXtoXtrialXtreatment
FirstXconsiderationXinXselectingXmostXappropriateXbetaXblocker?X-XCORRECTXANSWERX-CardioXselectivity
PregnancyXCategoriesXBXvsXDXwithXbetaXblockersX-XCORRECTXANSWERX-AtenololX-XD
betaxolol,Xacebutolol,Xmetoprolol,Xnadolol,Xnebivolol,Xtiolol,XpropranololX-XC
WhereXareXbetaX2XreceptorsXlocatedXandXwhatXdoXtheyXdo?X-XCORRECTXANSWERX-
smoothXmuscleXofXeye,Xarterioles,Xvenules,Xbronchioles,Xliver,Xpancreas,XGI,XGU
StimulateXadneylylXcyclase,XincreaseXcAMP,XactivateXcardiacXG1
DrugXofXchoiceXforXHTNXwithXconcomitantXBPHX-XCORRECTXANSWERX-AlphaX1XadrenergicXantagonist
BetaXblockersXthatXrequireXdosageXadjustmentXinXpatientsXwithXrenalXimpairmentX-XCORRECTXANSWERX-
acebutolol,Xatenolol,Xnadolol,XandXnebivolol
DosingXscheduleXofXdonepizilX-XCORRECTXANSWERX-5mgXnightlyXatXbedtime,XincreaseXatX4-
6XweekXintervals,XmaxXdoseXisX10XmgXdaily.
ElicitsXparasympatheticXresponseX-XCORRECTXANSWERX-Acetylcholine,XACh
SympatheticXnervousXsystemXresponsesXelicitedXby:X-XCORRECTXANSWERX-Epi,XNorepi,XDopa
FirstXlineXtreatmentsXforXHTNX-XCORRECTXANSWERX-CCB,XACEI,XARB,XorXthiazide
considerXcomorbidities
PatientsXwithXHTNXandXcomorbiditiesXofXessentialXtremor,Xmigraine,Xarryhthmia,XCAD,XsymptomaticXHFXwit
hXreducedXEFXcanXbeXtreatedXwith?X-XCORRECTXANSWERX-betaXblocker