Variability

Question 1

what drug has higher plasma concentrations in Asians

Answer 1

rosuvastatin

Question 2

which race is more sensitive to propranolol

Answer 2

Chinese

Question 3

which CYP has a lot of genetic variability

Answer 3

CYP2D6

Question 4

what drug has higher concentrations with less functional CYP2D6 genes

Answer 4

nortriptyline

Question 5

renal clearance of which two drugs rise from birth before peaking and declining with age

Answer 5

ceftriaxone
theophylline

Question 6

this drug has a half life and Vd that increases and CL that decreases with age

Answer 6

diazepam

Question 7

this drug shows higher Cp and lower CL in the elderly
EC50 is also at a lower concentration, so they have reduced metabolism and greater sensitivity

Answer 7

midazolam

Question 8

what is generally expected of metabolism and clearance with age

Answer 8

decreased drug metabolism and renal clearance

Question 9

neonates haw low clearance, long half lives, and high Vd for this drug

Answer 9

theophylline

Question 10

which gender has increased CYP3A4 activity (ex. lovastatin)

Answer 10

females

Question 11

which gender has increased CYP2D6 activity (ex. metoprolol) and CYP1A2 (ex. theophylline)

Answer 11

males

Question 12

males and females have the same activity in which CYP

Answer 12

CYP2C19 (ex. omeprazole)

Question 13

with methylprednisolone, females show

Answer 13

higher sensitivity and clearance (CYP3A4)

Question 14

which class of drugs have higher AUCs in women, so they are more likely to have toxic concentrations

Answer 14

antiretrovirals (ritonavir, atazanavir, CYP3A4 and 2D6)

Question 15

metoprolol shows what in females

Answer 15

higher concentrations and lower CL

Question 16

females are more sensitive to what AE when taking quinidine (CYP3A4)

Answer 16

ECG changes

Question 17

which drug showed a DDI with antifungals (-azoles) leading to QT interval changes in females

Answer 17

terfenadine (seldane)

Question 18

aspirin showed __ reduction in CV events in women than men

Answer 18

less reduction

Question 19

drugs show reduced renal clearance at what time of day

Answer 19

night

Question 20

theophylline shows less AEs when administered with or without food?

Answer 20

without

with food increases incidence of AE

Question 21

effects of food on drug absorption

Answer 21

delayed gastric emptying
increases dissolving poorly soluble drugs
changed GI pH
stimulated bile flow
etc

Question 22

which 2 drugs showed higher peak concentrations when given with food

Answer 22

tizanidine
desvenlafaxine

Question 23

GFJ inactivates GI CYP3A4, increasing the AUC of which drug

Answer 23

simvastatin

Question 24

vitamins should always be taken ___ food

Answer 24

with

Question 25

are there absorption changes with obesity

Answer 25

no

Question 26

drug distribution may be affected in obesity and depends on

Answer 26

water, fat, logP

Question 27

what effect does obesity have on CL

Answer 27

increase in CrCl, partial increase in renal Cl

Question 28

which drug shows increased ddrug clearance in obesity

Answer 28

lithium

Question 29

what metabolism changes occur in obesity

Answer 29

variable, CLm can increase, decrease, or not change

Question 30

which drug shows lower CLm in obesity and why

Answer 30

methylprednisolone liver is larger, but behaves as though it is impaired

Question 31

which drug has higher EC50 in the obese, so they are less sensitive to drug effects

Answer 31

atracarium

Question 32

enzyme induction of CYP1A2 in smoking leads to what ADME change?

Answer 32

increased CL or elimination enhanced disposition

Question 33

which drugs show increases CL with smoking

Answer 33

propranolol, tizanidine

Question 34

which drugs induce CYP3A4

Answer 34

anticonvulsants, St Johns Wort

Question 35

which drug induces CYP1A2

Answer 35

omeprazole

Question 36

which drug induces CYP2E1

Answer 36

ethanol

Question 37

OCs induce which metabolic pathway

Answer 37

conjugation

Question 38

chronic liver disease --> reduce liver cell mass and enzyme activity due to alteration --> what effect on metabolism?

Answer 38

impaired drug metabolism

Question 39

sinusoidal capillarization --> uptake of certain drugs in liver cells may be impaired --> what effect on metabolism (chronic liver disease)?

Answer 39

reduced metabolism

Question 40

how does liver disease affect CL

Answer 40

reduced bile formation --> decreased CL cirrhosis causes reduced plasma blood flow and GFR --> decreased renal Cl

Question 41

hepatic CL of high CL drugs if limited by what

Answer 41

blood flow

Question 42

hepatic CL of low CL drugs is influenced by

Answer 42

blood binding and CLint

Question 43

do high and low CL drugs have low or high bioavailability

Answer 43

high CL -- low F low CL -- high F

Question 44

cirrhosis reduced pre-systemic hepatic metabolism which affects oral bioavailability how

Answer 44

increases oral bioavailability

Question 45

cockcroft gault equation

Answer 45

CrCl = [140-age]*IBW / 72*Scr

Question 46

IBW =

Answer 46

M = 50 + 2.3 (ht over 5 ft) F = 45.5 + 2.3 (ht over 5 ft)

Question 47

for cockcroft gault, if ABW < IBW use what in the equation

Answer 47

ABW

Question 48

for cockcroft gault if patient is >65 and Cr concentration is <1 use what to calculate CrCl

Answer 48

1

Question 49

what effect might renal disease have on absorption

Answer 49

Tmax may slightly increase- negligible consequences Impaired metabolism may increase oral bioavailability

Question 50

plasma protein biding of ACIDIC drugs is ___ in renal dysfunction

Answer 50

decreased

Question 51

plasma protein binding of basic drugs is ___ in renal dysfunction

Answer 51

unaffected

Question 52

Vd of drugs is ___ in renal dysfunction

Answer 52

increased

Question 53

is non-renal CL affected by renal dysfunction

Answer 53

can be altered, impaired drug metabolism

Question 54

is renal metabolism impaired in renal dysfunction

Answer 54

yes

Question 55

is renal excretion impaired in renal dysfunction? what is the effect

Answer 55

yes excessive drug accumulation

Question 56

which rule says elimination rate constant (ke) depends linearly on GFR dose is adjusted to renal function proportional to ke, and interval stays the same

Answer 56

Dettli RUle 1 CKD

Question 57

which rule says half the starting dose is given every 1 half life

Answer 57

Kunin RUle CKD

Question 58

which rule says a normal dose is given at longer intervals, which is prolonged proportional to the CL ration

Answer 58

Dettli RUle 2 CKD

Question 59

distribution is affected in diabetes due to altered what?

Answer 59

albumin and reduced binding

Question 60

is metabolism affected in diabetes

Answer 60

may be if liver dysfunction develops

Question 61

which model shows how a disease progresses over time

Answer 61

disease progression model

Question 62

phenytoin is effective at ___ plasma concentrations in T2DM

Answer 62

lower

Question 63

ADME changes in CHF

Answer 63

reduced metabolism reduced renal function/CL decreased hepatic BF increased IL6

Question 64

which drug shows impaired metabolism in HF

Answer 64

lidocaine

Question 65

which drug has reduced CL in CHF

Answer 65

vancomycin

Question 66

which ADME changes are seen in thyroid disease

Answer 66

CLm and CLr increase in hyperthyroidism and decrease in hypothyroidism

Question 67

which ADME change is seen in cystic fibrosis which drugs are an example

Answer 67

increased renal clearance dicloxacillin, prednisolone, lorazepam

Question 68

which mediator is increased in inflammatory states, and how does it affect CL

Answer 68

IL6 increases which reduces drug CL