Assessing Genomic Variation In Drug Response

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Question 1

Free

Multiple Choice

Which of the following is a goal of pharmacogenetics?

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Producing "blockbuster drugs" that will work equally well for everyone

Bringing down the cost of pharmaceutical manufacturing

Developing drugs that will treat very rare diseases

Reducing adverse reactions

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Question 2

Free

Multiple Choice

Which processes of drug response are most subject to genetic variation?

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Drug dissolution in body fluids and drug binding to plasma proteins

Rates of drug movement into and through the gastrointestinal tract

Drug activation or deactivation and duration of drug actions

Drug binding with receptors and drug blocking of receptors

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Question 3

Free

Multiple Choice

Which statement about agonist and antagonist drugs is true?

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Both drugs types must interact with receptors to produce their intended responses.

The primary target tissues for these types of drugs are invading bacteria and viruses.

Antagonists drugs produce only intended responses, and agonist drugs produce both intended responses and side effects.

These types of drugs are less likely to cause allergic responses than drugs that are neither agonists nor antagonists.

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Question 4

Free

Multiple Choice

What is the expected heart-rate response when a patient is taking a drug that is an adrenaline antagonist?

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Heart rate is unchanged.

Heart rate decreases.

Heart rate increases.

Heart rate is irregular.

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Question 5

Free

Multiple Choice

How do genetic/genomic issues influence individual variation in the response to a specific drug?

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Polymorphisms of genes encoding metabolizing enzymes

Age-related loss of alleles within the cells lining the intestinal tract

Single-gene disorders that reduce the function of the kidneys or the liver

Genetic-based behavior problems that promote poor adherence to prescribed drug regimens

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Question 6

Multiple Choice

Which organ has the greatest concentration of cytochrome P (CYP) 450 enzymes?

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Stomach

Kidney

Brain

Liver

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Question 7

Multiple Choice

How are the actions of naturally occurring estrogen changed when a patient is taking a drug that is an estrogen agonist?

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Actions are increased.

Actions are decreased.

Actions are eliminated.

Actions are unchanged.

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Question 8

Multiple Choice

Which type of parent compound must undergo first-phase metabolism to produce the intended response after it enters the body?

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A prodrug

An active metabolite

An inactive metabolite

A sustained-released drug

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Question 9

Multiple Choice

What would be the patient's response to a normal drug dose that, because of a genetic variation in an enzyme that prepares the drug for elimination, results ina blooddrug level that is below the minimum effective concentration (MEC)?

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Drug entry exceeds drug elimination.

The risk for toxic side effects is increased.

The intended response fails to be produced.

The drug's duration of action is longer than expected.

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Question 10

Multiple Choice

A patient has a very high concentration of insulin receptors on cells that require insulin for glucose to enter. How should insulin dosages be adjusted for this patient to have blood glucose levels within the normal range?

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Insulin dosages should be given less frequently because the drug will remain bound to receptors longer.

Insulin dosages should be decreased because the drug will exert its actions at lower concentrations.

Insulin dosages should be given more frequently because the drug will be eliminated at a faster rate.

Insulin dosages should be increased because cells will be less sensitive to the presence of active insulin.

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Question 11

Multiple Choice

Which condition or factor improves the initial bioavailability of a drug agonist that has extensive first-pass loss as a result of the patient's enhanced liver enzymeactivity?

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Increasing the patient's fluid intake

Co-administering the drug with an antagonist

Administering the drug by the intravenous route

Crushing the oral form of the drug before administration

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Question 12

Multiple Choice

A patient with a fractured elbow in the emergency department states that he needs morphine for pain rather than codeine because the last time he had a painfulinjury,codeine was not effective in managing his pain. What is the nurse's best response or action?

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Ask the patient how much alcohol he ingests daily.

Communicate this information to the admitting physician.

Alert the health-care provider that this patient is "drug-seeking."

Reassure the patient that he will receive progressively higher dosages of codeine until his pain is controlled.

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Question 13

Multiple Choice

A patient is identified as an ultra-rapid metabolizer for drugs that are prepared for elimination by CYP2D6. What effect will this have on the patient's ability tobenefit from any active drug that is metabolized by this enzyme?

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Intended responses increase, whereas side effects decrease.

Intended responses decrease, whereas side effects increase.

Both intended responses and side effects increase.

Both intended responses and side effects decrease.

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Question 14

Multiple Choice

What is the most likely outcome for a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency when he or she takes aspirin or an antimalarial drug?

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Rapid elimination of the drug with no benefit

Liver damage or failure

Hemolytic anemia

Fluid retention

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Question 15

Multiple Choice

An Asian American man and his Caucasian wife are both taking warfarin (Coumadin) daily because of atrial fibrillation. The husband asks why he is prescribed amuch-smaller-than-average dose of the drug to keep his international normalized ratio (INR) at 2.0, whereas his wife takes the average dose, even though he is taller and heavier than she is. What is the nurse's best response?

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"Body size is not important for warfarin, but gender differences are because testosterone improves its action."

"You are probably anemic, which would reduce your ability to form blood clots, so your doses can be lower."

"Many Asian Americans do not break down warfarin as fast as Caucasians, so the drug is more effective at lower dosages."

"Caucasians have higher levels of the enzyme that breaks down warfarin, requiring higher dosages for the same effect on INR."

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Question 16

Multiple Choice

Your patient has been identified as a poor metabolizer of a drug that has just been ordered, and the drug is formulated as an active compound. What will be the mostlikely result if you give this active drug at the standard dose?

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No therapeutic response

Increased adverse reactions and possible toxicity

Therapeutic response as expected in the general population

Drug inactivation occurs more rapidly, and the therapeutic response is limited.

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Question 17

Multiple Choice

You are caring for a child with acute lymphoblastic leukemia. She has been genotyped and is homozygous for a TPMT polymorphism, producing very little of the enzymeneeded for this drug's metabolism. How would you expect this to affect dosing of the drug 6-mercaptopurine?

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This child should receive only a small fraction of the standard dose.

This child should receive the drug intravenously rather than orally.

This child should receive higher doses than the standard dose.

This child should receive the standard dose.

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