Deck 15: Assessing Genomic Variation in Drug Response

Question 1

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?

A)Insulin dosages should be given less frequently because the drug will remain bound to receptors longer.
B)Insulin dosages should be decreased because the drug will exert its actions at lower concentrations.
C)Insulin dosages should be given more frequently because the drug will be eliminated at a faster rate.
D)Insulin dosages should be increased because cells will be less sensitive to the presence of active insulin.

Answer 1

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

Question 2

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?

A)Rapid elimination of the drug with no benefit
B)Liver damage or failure
C)Hemolytic anemia
D)Fluid retention

Answer 2

Hemolytic anemia

Question 3

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

A)A prodrug
B)An active metabolite
C)An inactive metabolite
D)A sustained-released drug

Answer 3

A prodrug

Question 4

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 in a blood drug level that is below the minimum effective concentration (MEC)?

A)Drug entry exceeds drug elimination.
B)The risk for toxic side effects is increased.
C)The intended response fails to be produced.
D)The drug's duration of action is longer than expected.

Question 5

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

A)Actions are increased.
B)Actions are decreased.
C)Actions are eliminated.
D)Actions are unchanged.

Question 6

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 to benefit from any active drug that is metabolized by this enzyme?

A)Intended responses increase while side effects decrease.
B)Intended responses decrease while side effects increase.
C)Both intended responses and side effects increase.
D)Both intended responses and side effects decrease.

Question 7

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

A)Stomach
B)Kidney
C)Brain
D)Liver

Question 8

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

A)Drug dissolution in body fluids and drug binding to plasma proteins
B)Rates of drug movement into and through the gastrointestinal tract
C)Drug activation or deactivation and duration of drug actions
D)Drug binding with receptors and drug blocking of receptors

Question 9

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

A)Polymorphisms of genes encoding metabolizing enzymes
B)Age-related loss of alleles within the cells lining the intestinal tract
C)Single gene disorders that reduce the function of the kidneys or the liver
D)Genetic-based behavior problems that promote poor adherence to prescribed drug regimens

Question 10

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 a much smaller than average dose of the drug to keep his international normalized ratio (INR)at 2.0 and his wife takes the average dose even though he is taller and heavier than she is.What is the nurse's best response?

A)"Body size is not important for warfarin but gender differences are because testosterone improves its action."
B)"You are probably anemic,which would reduce your ability to form blood clots,so your doses can be lower."
C)"Many Asian Americans do not break down warfarin as fast as Caucasians,so the drug is more effective at lower dosages."
D)"Caucasians have higher levels of the enzyme that breaks down warfarin,requiring higher dosages for the same effect on INR."

Question 11

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 painful injury,codeine was not effective in managing his pain.What is the nurse's best response or action?

A)Ask the patient how much alcohol he ingests daily.
B)Communicate this information to the admitting physician.
C)Alert the health-care provider that this patient is "drug-seeking."
D)Reassure the patient that he will receive progressively higher dosages of codeine until his pain is controlled.

Question 12

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 enzyme activity?

A)Increasing the patient's fluid intake
B)Co-administering the drug with an antagonist
C)Administering the drug by the intravenous route
D)Crushing the oral form of the drug before administration