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47 Cards in this Set
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The antifungal agents itraconazole, ketoconazole and voriconazole have safety issues that the pharmacist must address. These include the following: (Select ALL that apply.) Answer AAll are CYP 450 3A4 inhibitors; the dose of 3A4 substrates given concurrently may need to be lowered. BItraconazole and ketoconazole have pH-dependent absorption; avoid use with drugs that raise pH, such as antacids. CVoriconazole is an enzyme substrate and is subject to many drug interactions. DVoriconazole metabolism is initially first-order, but can become zero-order with higher doses, and toxicity can result. EWith severe renal impairment it is safer to use IV voriconazole only, rather than the oral formulation, due to the excipients in the tablets and oral suspension.
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AAll are CYP 450 3A4 inhibitors; the dose of 3A4 substrates given concurrently may need to be lowered. BItraconazole and ketoconazole have pH-dependent absorption; avoid use with drugs that raise pH, such as antacids. CVoriconazole is an enzyme substrate and is subject to many drug interactions. DVoriconazole metabolism is initially first-order, but can become zero-order with higher doses, and toxicity can result. |
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Which of the following statements best describes warfarin metabolism? Answer AWarfarin is racemic; the S-isomer is more potent and is (primarily) a substrate of CYP 2C9. BWarfarin is renally cleared. CWarfarin is a potent enzyme inducer and has interactions with many other drugs. DWarfarin is racemic; the R-isomer is more potent and is (primarily) a substrate of CYP 2D6. EWarfarin is subject only to pharmacodynamic interactions.
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AWarfarin is racemic; the S-isomer is more potent and is (primarily) a substrate of CYP 2C9. |
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Select the correct statements concerning the drug interaction between valproic acid and lamotrigine. (Select ALL that apply.) Answer AValproic acid inhibits lamotrigine metabolism. BThis interaction increases the risk for a severe lamotrigine-induced rash. CThis interaction increases the risk for severe valproate-induced pancreatitis. DWhen using these two medications concurrently, the Lamictal Dose Titration pack cannot be used; lower doses will be required. EThis interaction increases the risk for severe valproate-induced hepatotoxicity. |
AValproic acid inhibits lamotrigine metabolism. BThis interaction increases the risk for a severe lamotrigine-induced rash.
DWhen using these two medications concurrently, the Lamictal Dose Titration pack cannot be used; lower doses will be required. |
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CYP 450 enzymes are found in many cells, but are primarily located in the liver and intestine. The majority of drugs are metabolized by CYP 450 enzymes, and half of these are metabolized by this enzyme, the primary drug metabolizing enzyme: Answer ACYP 450 2D6 BCYP 450 1A2 CCYP 450 2C19 DCYP 450 2C8 ECYP 450 3A4 |
ECYP 450 3A4 |
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Drug A is a substrate of enzyme X. Drug B is an inhibitor of enzyme X. A patient has been using Drug A with good results. The patient has now started therapy with Drug B. What will happen to the concentration of Drug A? Answer AIncrease BDecrease CStay the same DNot enough information is provided to draw a conclusion ENone of the above |
AIncrease |
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A patient is using codeine for pain. She is a CYP 450 2D6 rapid metabolizer. What would be the effect of the conversion of codeine to morphine by the 2D6 enzyme? Answer AThe morphine concentration would decrease. BThe morphine concentration would stay the same. CThe morphine concentration would increase. DThe morphine would become subtherapeutic. ECodeine is not metabolized by the 2D6 enzyme. |
CThe morphine concentration would increase. |
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Blanca uses Kariva estrogen-progestin birth control pills. The pills would be expected to have reduced efficacy if she uses the following medication: Answer AThe drug of choice for infective endocarditis prevention in a patient with no known drug allergies. BThe "RIPE" regimen for treating active tuberculosis. CThe drug of choice for infective endocarditis prevention in a patient with penicillin drug allergy. DThe drug of choice for initial treatment of mild-to-moderate C. difficile infection. EThe drug of choice for initial treatment of a rickettsial infection. |
BThe "RIPE" regimen for treating active tuberculosis. |
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Which of the following statements concerning drug interactions are correct? (Select ALL that apply.) Answer AA prodrug is a compound that is inactive until it is converted into an active form. BInduction has a "lag" effect which means that the full effect of adding an inducer is not seen right away, and it takes time for the induction to dissipate once the inducer has been discontinued. CInhibition has a "lag" effect which means that the full effect of adding an inhibitor is not seen right away, and it takes time for the inhibition to dissipate once the inhibitor has been discontinued. DMany of the same inhibitors of cytochrome P 450 enzymes also inhibit the P-gp efflux pump. EThe P-gp efflux pump moves drug from inside the body to outside by "pumping" the drug into the gut, where it can be eliminated. |
AA prodrug is a compound that is inactive until it is converted into an active form. BInduction has a "lag" effect which means that the full effect of adding an inducer is not seen right away, and it takes time for the induction to dissipate once the inducer has been discontinued.
DMany of the same inhibitors of cytochrome P 450 enzymes also inhibit the P-gp efflux pump. EThe P-gp efflux pump moves drug from inside the body to outside by "pumping" the drug into the gut, where it can be eliminated. |
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Which of the following drugs can cause hearing damage? (Select ALL that apply.) Answer ADemadex BAmikacin CTobramycin DLasix EAdalimumab |
ADemadex BAmikacin CTobramycin DLasix |
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Mark is using dipyridamole with aspirin, per his doctor's recommendation. Other prescription medications includeDemadex, Crestor, Toprol XL, Lotensin, Cardizem, Klor-Con and nitroglycerin sublingual as-needed. His OTC products include 3 fish oil capsules daily and DHEA. Which of the following statements are correct? (Select ALL that apply.) Answer AIbuprofen should not be used in this patient. BThe patient is at high clotting risk and OTC antiplatelet agents should be encouraged. CThe patient is using two agents that lower heart rate; heart rate should be monitored. DDue to the cardiovascular conditions, the patient likely has erectile dysfunction; the pharmacist should recommend Levitra as the safer PDE-5 inhibitor. EThe patient would be expected to have a severe drop in blood pressure if he used a PDE-5 inhibitor. |
AIbuprofen should not be used in this patient.
CThe patient is using two agents that lower heart rate; heart rate should be monitored.
EThe patient would be expected to have a severe drop in blood pressure if he used a PDE-5 inhibitor. |
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Bailey is using estrogen and progestin birth control pills for contraception. She recently received a prescription for phenytoin. Select the best description for the interaction between these medications: Answer AThe phenytoin is an inhibitor of the metabolism of the estrogen in the birth control pill; it will increase the levels of the contraceptive pills and could result in clotting. BThe phenytoin is an inducer of the metabolism of the estrogen in the birth control pill; it will reduce the effectiveness of the contraception. CThe phenytoin is an inhibitor of the metabolism of the estrogen in the birth control pill; it will reduce the effectiveness of the contraception. DThe birth control pill is a prodrug and the use of the phenytoin will have no effect. EThe phenytoin is an inducer of the metabolism of the estrogen in the birth control pill; it will increase the levels of the contraceptive pills and could result in clotting. |
BThe phenytoin is an inducer of the metabolism of the estrogen in the birth control pill; it will reduce the effectiveness of the contraception. |
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Which of the following are inhibitors of CYP 450 3A4? (Select ALL that apply.) Answer ACodeine BCordarone CHydromorphone DTagamet ENizoral |
BCordarone
DTagamet ENizoral |
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A patient with atrial fibrillation has been using warfarin for nine months. The INR is stable between 2.3 - 2.7. Select the correct interactions that can occur with the addition of other drugs: (Select ALL that apply.) Answer AIf nutritional drinks rich in vitamin K are added, the INR would decrease, bleeding risk would be lowered, but clot risk would be increased. BIf ginkgo is added, the INR would stay at about the same level, but bleeding risk would be elevated. CIf ginkgo is added, the INR would increase and bleeding risk would be elevated. DIf high doses of fish oils or dong quai are added, the bleeding risk may become elevated. EIf nutritional drinks rich in vitamin K are added, the INR would increase and bleeding risk would be elevated. |
AIf nutritional drinks rich in vitamin K are added, the INR would decrease, bleeding risk would be lowered, but clot risk would be increased. BIf ginkgo is added, the INR would stay at about the same level, but bleeding risk would be elevated.
DIf high doses of fish oils or dong quai are added, the bleeding risk may become elevated. |
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A patient with atrial fibrillation has been using warfarin for nine months. The INR is stable around 2.3. The patient is having a return of major depressive disorder, which she has had in the past and treated (unsuccessfully) with over-the-counter St. John's wort. She has asked for a prescription agent that will not interact with her other daily medications. Which of the following agents would not increase bleeding risk in this patient and could be used for a suitable trial? (Select ALL that apply.) Answer ABupropion BEffexor CPristiq DLexapro ECymbalta |
ABupropion |
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A 74-year-old woman had been taking metoprolol ext-release 100 mg daily and warfarin 4 mg daily (both for atrial fibrillation) and amitriptyline 50 mg QHS (for migraine prophylaxis) for several years. Shortly after the death of her spouse, she experienced very sad moods. Initially she was prescribed citalopram 40 mg daily. When this was not very effective, the physician added on paroxetine 10 mg daily (as he did not wish to increase the citalopram dose). What is this patient at risk for due to the drug combinations? Answer AIncreased bleeding risk but decreased risk of arrhythmia. BIncreased risk of clotting but decreased risk of bleeding. CIncreased risk of bleeding and increased risk of arrhythmia. DIncreased risk of worsening depression. EWorsening depression and increased clotting risk. |
CIncreased risk of bleeding and increased risk of arrhythmia. |
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Choose the correct statements concerning tetracycline and doxycycline. (Select ALL that apply.) Answer ASeparate tetracycline, but not doxycycline, from compounds containing aluminum, calcium, magnesium and iron-including antacids, supplements and dairy products. BSeparate doxycycline, but not tetracycline, from compounds containing aluminum, calcium, magnesium and iron-including antacids, supplements and dairy products. CBoth doxycycline and tetracycline must be separated from compounds containing aluminum, calcium, magnesium and iron-including antacids, supplements and dairy products. DThe tetracycline class works by reversibly binding to the 30S ribosomal subunit, which prevents protein transcription. ETetracyclines cause photosensitivity; patients should be counseled about proper sun protection. |
CBoth doxycycline and tetracycline must be separated from compounds containing aluminum, calcium, magnesium and iron-including antacids, supplements and dairy products. DThe tetracycline class works by reversibly binding to the 30S ribosomal subunit, which prevents protein transcription. ETetracyclines cause photosensitivity; patients should be counseled about proper sun protection. |
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A patient with heart failure is using many medications, including digoxin, warfarin and pravastatin. She has been stable on these medications until she was admitted with a suspected lung infection and found to be in afibrillation. She will be started on amiodarone. She is put on ertapenem and sputum cultures are ordered. Which of the following statements are correct? (Select ALL that apply.) Answer AThe INR will increase; the warfarin dose will need to be reduced. BThe digoxin will increase; the digoxin dose will need to be reduced. CThe pravastatin level will increase; the pravastatin dose will need to be reduced. DAmiodarone and digoxin will have additive bradycardia. EErtapenem will block the anticoagulant activity of warfarin and should not be used.
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AThe INR will increase; the warfarin dose will need to be reduced. BThe digoxin will increase; the digoxin dose will need to be reduced.
DAmiodarone and digoxin will have additive bradycardia.
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Thomas is using simvastatin and requires another agent to lower his triglycerides. He cannot afford Lovaza or Vascepa. Of the following agents, which has the highest risk for additive toxicity when added to the statin therapy? Answer ATrilipix BTriglide CAntara DLopid ETricor |
DLopid |
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A patient with a deep vein thrombosis has been using warfarin for four months. The INR is stable around 2.5. Which of the following interactions is correct? Answer AIf amiodarone is added, the INR would decrease. BIf trimethoprim/sulfamethoxazole is added, the INR would decrease. CIf phenobarbital is added, the INR would increase. DIf rifampin is added, the INR would decrease. EIf phenytoin is added, the INR would increase. |
DIf rifampin is added, the INR would decrease. |
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Meryl is a patient with severe renal insufficiency and moderate heart failure. She has been using levofloxacin for the past five weeks in an attempt to treat osteomyelitis. Her other medications include methadone and amitriptyline 150 mg QHS for neuropathic pain. Which agents could cause the QT interval to be increased and put the patient at risk for torsades de pointes? (Select ALL that apply.) Answer ALevofloxacin BMethadone CMupirocin DCascara EAmitriptyline |
ALevofloxacin BMethadone
EAmitriptyline |
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A patient is using digoxin. If he is prescribed the following drug, the digoxin dose will need to be decreased: Answer ADiazepam BPhenytoin CCyclosporine DCarbamazepine ECancidas |
CCyclosporine |
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Martin has been using a monoamine oxidase inhibitor to help control his depression for many years. He is careful to check that other drugs and foods do not interact with his medicine. Which of the following drugs can be dispensed to Martin and will not cause concern with the concurrent use of his antidepressant? (Select ALL that apply.) Answer ABupropion BMeperidine CToprol XL DPseudoephedrine EAlprazolam
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CToprol XL
EAlprazolam |
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Amiodarone is both a substrate and an inhibitor of CYP 450 2C9, 2D6, and 3A4. The pharmacist is aware that these medications must have their doses reduced when dispensing amiodarone: (Select ALL that apply.) Answer AQuinidine BWarfarin CLithium DPravastatin EDigoxin |
AQuinidine BWarfarin
EDigoxin |
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Ann lives in Florida and occasionally eats grapefruit. Choose the correct statement/s concerning grapefruit-drug interactions: (Select ALL that apply.) Answer ADo not use grapefruit with cyclosporine. BDo not use grapefruit with buspirone. CIf a drug interacts with grapefruit, use a long gut separation period, such as taking the grapefruit two hours before or four hours after the interacting drug. DDo not use grapefruit with rivaroxaban. EDo not use grapefruit with valproate.
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ADo not use grapefruit with cyclosporine. BDo not use grapefruit with buspirone.
DDo not use grapefruit with rivaroxaban. |
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Sandra is about to get on the waiting list for a kidney transplant. She has a creatinine clearance of 16 mL/min and experiences frequent bouts of hyperkalemia. She cannot use any medicines that elevate potassium because in this patient even small increases in potassium trigger an arrhythmia. Which medications elevate potassium and would put Sandra at risk for arrhythmia? (Select ALL that apply.) Answer AAltoprev BDyazide CInspra DAldactone EYasmin |
BDyazide CInspra DAldactone EYasmin |
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Jessica is a 77 year old female who fell and broke her ankle. It has not healed well and she is using an assistive device to walk. She is very scared about having another fall. Jessica does not have any children to help her and worries that if she has a hip fracture it will put her into a nursing home. Which of the following agents increase the risk of the patient having a fall that could result in fracture? (Select ALL that apply.) Answer ANucynta BMiacalcin CFlonase DEvening martini EPercocet |
ANucynta
DEvening martini EPercocet |
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Violet uses Imitrex for migraines 2-4 times each month. Recently she began to use Sarafem 10 mg daily for premenstrual dysphoric disorder. In addition, she uses meperidine once or twice daily for headache relief. Violet is at risk for the following symptoms: (Select ALL that apply.) Answer ATremor, agitation, confusion, hallucinations BTachycardia, sweating CDiarrhea DMuscle rigidity, shivering EAcute bradycardia |
ATremor, agitation, confusion, hallucinations BTachycardia, sweating CDiarrhea DMuscle rigidity, shivering |
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Which of the following is an inducer of CYP 450 3A4? Answer AKetoconazole BErythromycin CClarithromycin DPhenobarbital EAmiodarone
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DPhenobarbital |
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Oxycodone cannot be used safely with CYP 450 3A4 inhibitors. What could happen if a pharmacist missed this interaction? (Select ALL that apply.) Answer ALiver toxicity BAnxiety, Irritation CRespiratory depression DSedation EInsomnia |
CRespiratory depression DSedation |
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Which of the following statins has the lowest risk of drug interactions? Answer AAtorvastatin BPravastatin CLovastatin DSimvastatin EFluvastatin |
BPravastatin |
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Which of the following statements concerning drug interactions are correct? (Select ALL that apply.) Answer AIf a compound is a P-gp pump inhibitor, it can cause the levels of P-gp substrates to decrease if given concurrently. BIf a compound is a P-gp pump inducer, it can cause the levels of P-gp substrates to decrease if given concurrently. CInducers cause more metabolism of drugs that are substrates of the affected enzymes. DInhibitors reduce or knock out the ability of the enzyme to work; this increases metabolism of the substrates. ETacrolimus is a substrate of the P-gp efflux pump. |
BIf a compound is a P-gp pump inducer, it can cause the levels of P-gp substrates to decrease if given concurrently. CInducers cause more metabolism of drugs that are substrates of the affected enzymes.
ETacrolimus is a substrate of the P-gp efflux pump. |
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Which of the following are inhibitors of CYP 450 3A4? (Select ALL that apply.) Answer AVFEND BBiaxin CDiovan DCardizem EGrapefruit |
AVFEND BBiaxin
DCardizem EGrapefruit |
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A patient is taking immediate release niacin 1 gram three times daily. He is put on atorvastatin 40 mg daily. Choose the correct statements concerning the use of concomitant statin and niacin therapy. (Select ALL that apply.) Answer ANiacins and statins taken together have a lower risk of muscle toxicity due to inhibition of statin metabolism. BNiacins and statins taken together have increased risk of muscle toxicity. CNiacins and statins used concurrently enable the patient to use lower statin doses, resulting in lower risk of muscle damage. DNiaspan is contraindicated with any of the statins. EIf a patient uses both niacin and a statin it would be expected that both the LDL and the triglycerides would be lowered more than with the use of either agent alone. |
BNiacins and statins taken together have increased risk of muscle toxicity.
EIf a patient uses both niacin and a statin it would be expected that both the LDL and the triglycerides would be lowered more than with the use of either agent alone. |
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The phosphodiesterase inhibitors, such as tadalafil, cannot be used safely with nitrates. What is most likely to happen if a pharmacist missed this interaction? Answer AQT prolongation BHypertensive crisis CCerebrovascular accident DAcute drop in blood pressure ESerotonin syndrome |
DAcute drop in blood pressure |
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A patient with atrial fibrillation has been using warfarin for four months. The INR is stable around 2.3. Select the interaction that can occur with the addition of these other medications: Answer AIf clopidogrel is added, the INR would increase and bleeding risk would be elevated. BIf Aleve is added, the INR would stay the same and bleeding risk would be elevated. CIf naproxen is added, the INR would increase and bleeding risk would be elevated. DIf naproxen is added, the INR would decrease and bleeding risk would be reduced. EIf acetaminophen is taken at a one-time dose of 500 mg, the INR would stay the same but bleeding risk would be lowered. |
BIf Aleve is added, the INR would stay the same and bleeding risk would be elevated. |
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Cyclosporine is an inhibitor of the P-glycoprotein (P-gp) efflux transporter. If a drug is a substrate of P-gp, what will happen to the drug concentration if it is given to a patient receiving cyclosporine? Answer AThe concentration of the substrate drug will decrease. BThe concentration of the substrate drug will increase. CThe concentration of the substrate drug will stay the same. DThe concentration may increase or decrease. ENo change in concentration will occur. |
BThe concentration of the substrate drug will increase. |
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Theophylline is a substrate of CYP 450 1A2. A patient on long-term theophylline, who has been well-controlled with infrequent use required of her albuterol inhaler, developed a UTI that was difficult to treat. The physician prescribed a 7-day course of ciprofloxacin. Which of the following is most likely to occur. Answer AWorsening asthma control BImproved asthma control CIncreased seizure risk from ciprofloxacin DPossible theophylline toxicity EUntreated UTI; poor treatment outcome |
DPossible theophylline toxicity |
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A patient with COPD and seizures has been using theophylline and valproate for many years. Recently, the neurologist took the patient off valproate and started phenytoin due to an increase in seizure activity. The patient has been under a lot of stress lately and took up smoking again. She uses about 15 or 20 cigarettes daily. Which of the following statements are correct? (Select ALL that apply.) Answer AThe phenytoin will decrease the theophylline level and the patient may have impaired asthma control. BThe smoking will decrease the theophylline level and the patient may have impaired asthma control. CThe smoking will increase the theophylline level and the patient may experience toxicity. DSmoking is a potent enzyme inhibitor. ESmoking has little effect on theophylline levels but has a significant effect on clozapine levels. |
AThe phenytoin will decrease the theophylline level and the patient may have impaired asthma control. BThe smoking will decrease the theophylline level and the patient may have impaired asthma control. |
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Gerri has been using a monoamine oxidase inhibitor to help control her depression for many years. She is careful to check that other drugs and foods do not interact with her medicine. Which of the following drugs can be dispensed to Gerri and will not cause concern with the concurrent use of her antidepressant? (Select ALL that apply.) Answer APrempro BBoniva CZolmitriptan DXalatan ESumatriptan |
APrempro BBoniva
DXalatan |
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Which of the following drugs can cause hearing damage? (Select ALL that apply.) Answer ADoans Extra Strength BVancocin CGentamicin DEdecrin EBumex |
ADoans Extra Strength BVancocin CGentamicin DEdecrin EBumex |
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Many patients occasionally eat grapefruit or drink grapefruit juice. Choose the correct statements concerning grapefruit-drug interactions: (Select ALL that apply.) Answer ADo not use grapefruit with tacrolimus. BDo not use grapefruit with Prograf. CDo not use grapefruit with alendronate. DDo not use grapefruit with ticragelor. EDo not use grapefruit with Sandimmune. |
ADo not use grapefruit with tacrolimus. BDo not use grapefruit with Prograf.
DDo not use grapefruit with ticragelor. EDo not use grapefruit with Sandimmune. |
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Which of the following are inducers of CYP 450 3A4? (Select ALL that apply.) Answer ATrileptal BDilantin CTegretol DSt John's wort ENeoral |
ATrileptal BDilantin CTegretol DSt John's wort |
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Choose the correct statement/s concerning lithium and drug interactions: (Select ALL that apply.) Answer ALithium is a relatively safe drug in elderly patients if the serum creatinine is below 1 g/dL. BLithium is not considered serotonergic and can be mixed safely with meperidine, but not with tramadol. CIncreased salt intake increases serum lithium levels. DIf a drug has a high degree of nephrotoxicity it will likely not be a safe option in a patient using chronic lithium therapy. ELithium is not metabolized; it is excreted renally. |
DIf a drug has a high degree of nephrotoxicity it will likely not be a safe option in a patient using chronic lithium therapy. ELithium is not metabolized; it is excreted renally. |
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Jessica is a 77 year old female who fell and broke her ankle. It has not healed well and she is using an assistive device to walk. She is very scared about having another fall. Jessica does not have any children to help her and worries that if she has a hip fracture it will put her into a nursing home. Which of the following agents increase the risk of the patient having a fall that could result in fracture? (Select ALL that apply.) Answer AFlexeril BRemeron CNuvigil DBactrim ERestoril |
AFlexeril BRemeron
ERestoril |
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Drug A is a substrate of enzyme X. Drug A is also an inducer of enzyme Y. Drug B is a substrate of enzyme Y. Drug B is also an inhibitor of enzyme X. When these drugs are both administered, what will happen to the concentrations of Drug A and Drug B? Answer ALevels of both Drug A and Drug B will increase. BLevels of Drug A will increase and levels of Drug B will decrease. CLevels of Drug A will decrease and levels of Drug B will increase. DLevels of Drug A will increase and levels of Drug B will stay the same. EThere is not enough information given.
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BLevels of Drug A will increase and levels of Drug B will decrease. |
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Martin is a computer programmer who uses ibuprofen for occasional neck and shoulder pain. Martin has hypertension. He takes two over-the-counter ibuprofen tablets twice daily on work days. Lately, he has noticed his blood pressure is elevated more than usual. The pharmacist will suggest possible alternatives for his occasional pain. Which of the following would represent safe options that would not elevate his blood pressure? (Select ALL that apply.) Answer AAdvil or Aleve BThermaCare Activated Heat Wraps CAcetaminophen DA topical menthol analgesic patch, such as BenGay EAspirin |
BThermaCare Activated Heat Wraps CAcetaminophen DA topical menthol analgesic patch, such as BenGay |
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Drug A is a substrate of enzyme X. Drug B is an inducer of enzyme X. A patient has been using Drug A with good results. The patient has now started therapy with Drug B. What will happen to the concentration of Drug A? Answer AIncrease BDecrease CStay the same DNot enough information is provided to draw a conclusion ENone of the above |
BDecrease |
