Question 1

A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

Accepted Answer

A)  Decreased effectiveness of irinotecan in the treatment of cancer 
B)  Increased adverse drug reactions, such as neutropenia 
C)  Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 
D)  Increased concerns for irinotecan being carcinogenic 
A)  Decreased effectiveness of irinotecan in the treatment of cancer 
B)  Increased adverse drug reactions, such as neutropenia 
C)  Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 
D)  Increased concerns for irinotecan being carcinogenic B

Question 2

Ultra-rapid metabolizers of drugs may have:

Accepted Answer

A)  To have dosages of drugs adjusted downward to prevent drug accumulation 
B)  Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure 
C)  Increased elimination of active, nonmetabolized drug 
D)  Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug 
A)  To have dosages of drugs adjusted downward to prevent drug accumulation 
B)  Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure 
C)  Increased elimination of active, nonmetabolized drug 
D)  Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug B

Question 3

Genetic polymorphisms account for differences in metabolism, including:

Accepted Answer

A)  Poor metabolizers, who lack a working enzyme 
B)  Intermediate metabolizers, who have one working, wild-type allele and one mutant allele 
C)  Extensive metabolizers, with two normally functioning alleles 
D)  All of the above 
A)  Poor metabolizers, who lack a working enzyme 
B)  Intermediate metabolizers, who have one working, wild-type allele and one mutant allele 
C)  Extensive metabolizers, with two normally functioning alleles 
D)  All of the above D

Question 4

Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:

Accepted Answer

A)  Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele 
B)  Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele 
C)  Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele 
D)  Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine 
A)  Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele 
B)  Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele 
C)  Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele 
D)  Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine

Question 5

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Accepted Answer

A)  Toxic levels of warfarin building up 
B)  Decreased response to warfarin 
C)  Increased risk for significant drug interactions with warfarin 
D)  Less risk of drug interactions with warfarin 
A)  Toxic levels of warfarin building up 
B)  Decreased response to warfarin 
C)  Increased risk for significant drug interactions with warfarin 
D)  Less risk of drug interactions with warfarin

Question 6

A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

Accepted Answer

A)  Ensure the patient will not have increased adverse drug reactions to the tamoxifen 
B)  Identify potential drug-drug interactions that may occur with tamoxifen 
C)  Reduce the likelihood of therapeutic failure with tamoxifen treatment 
D)  Identify poor metabolizers of tamoxifen 
A)  Ensure the patient will not have increased adverse drug reactions to the tamoxifen 
B)  Identify potential drug-drug interactions that may occur with tamoxifen 
C)  Reduce the likelihood of therapeutic failure with tamoxifen treatment 
D)  Identify poor metabolizers of tamoxifen

Question 7

Patients who have a poor metabolism phenotype will have:

Accepted Answer

A)  Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 
B)  Accumulation of inactive metabolites of drugs 
C)  A need for increased dosages of medications 
D)  Increased elimination of an active drug 
A)  Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 
B)  Accumulation of inactive metabolites of drugs 
C)  A need for increased dosages of medications 
D)  Increased elimination of an active drug

Question 8

Rifampin is a nonspecific CYP450 inducer that may:

Accepted Answer

A)  Lead to toxic levels of rifampin and must be monitored closely 
B)  Cause toxic levels of drugs, such as oral contraceptives, when coadministered 
C)  Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure 
D)  Cause nonspecific changes in drug metabolism 
A)  Lead to toxic levels of rifampin and must be monitored closely 
B)  Cause toxic levels of drugs, such as oral contraceptives, when coadministered 
C)  Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure 
D)  Cause nonspecific changes in drug metabolism

Question 9

Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

Accepted Answer

A)  A need to monitor drugs metabolized by 2D6 for toxicity 
B)  Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors 
C)  Decreased conversion of codeine to morphine by CYP 2D6 
D)  The need for lowered dosages of drugs, such as beta blockers 
A)  A need to monitor drugs metabolized by 2D6 for toxicity 
B)  Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors 
C)  Decreased conversion of codeine to morphine by CYP 2D6 
D)  The need for lowered dosages of drugs, such as beta blockers

Question 10

Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

Accepted Answer

A)  Decreased therapeutic levels of quinidine 
B)  Increased therapeutic levels of quinidine 
C)  Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination 
D)  Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination 
A)  Decreased therapeutic levels of quinidine 
B)  Increased therapeutic levels of quinidine 
C)  Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination 
D)  Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

Question 11

Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:

Accepted Answer

A)  Erythromycin 
B)  Digoxin 
C)  Cetuximab 
D)  Rifampin 
A)  Erythromycin 
B)  Digoxin 
C)  Cetuximab 
D)  Rifampin

Question 12

Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.

Accepted Answer

A) True 
 B)False

Exam 8: An Introduction to Pharmacogenomics

A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

Ultra-rapid metabolizers of drugs may have:

Genetic polymorphisms account for differences in metabolism, including:

Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

Patients who have a poor metabolism phenotype will have:

Rifampin is a nonspecific CYP450 inducer that may:

Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:

Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.

The Role of the Nurse Practitioner

Review of Basic Principles of Pharmacology

Rational Drug Selection

Legal and Professional Issues in Prescribing

Adverse Drug Reactions

Factors That Foster Positive Outcomes

Cultural and Ethnic Influences in Pharmacotherapeutics

Nutrition and Nutraceuticals

Herbal Therapy and Nutritional Supplements

Information Technology and Pharmacotherapeutics

Pharmacoeconomics

Over-The-Counter Medications

Drugs Affecting the Autonomic Nervous System

Drugs Affecting the Central Nervous System

Drugs Affecting the Cardiovascular and Renal Systems

Drugs Affecting the Respiratory System

Drugs Affecting the Hematopoietic System

Drugs Affecting the Immune System

Drugs Affecting the Gastrointestinal System

Drugs Affecting the Endocrine System

Drugs Affecting the Reproductive System

Drugs Affecting the Integumentary System

Drugs Used in Treating Infectious Diseases

Drugs Used in Treating Inflammatory Processes

Drugs Used in Treating Eye and Ear Disorders

Anemia

Chronic Stable Angina and Low-Risk Unstable Angina

Anxiety and Depression

Asthma and Chronic Obstructive Pulmonary Disease

Contraception

Dermatologic Conditions

Diabetes Mellitus

Gastroesophageal Reflux and Peptic Ulcer Disease

Headaches

Heart Failure

Human Immunodeficiency Virus Disease and Acquired Immunodeficiency Syndrome

Hormone Replacement Therapy and Osteoporosis

Hyperlipidemia

Hypertension

Hyperthyroidism and Hypothyroidism

Pneumonia

Smoking Cessation

Sexually Transmitted Infections and Vaginitis

Tuberculosis

Upper Respiratory Infections, Otitis Media, and Otitis Externa

Urinary Tract Infections

Women As Patients

Men As Patients

Children As Patients

Geriatric Patients

Pain Management: Acute and Chronic Pain

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