Question 1

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

Accepted Answer

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 
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 A

Question 2

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?

Accepted Answer

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. 
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. B

Question 3

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

Accepted Answer

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

Question 4

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?

Accepted Answer

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. 
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.

Question 5

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?

Accepted Answer

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 
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

Question 6

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?

Accepted Answer

A) This child should receive only a small fraction of the standard dose. 
B) This child should receive the drug intravenously rather than orally. 
C) This child should receive higher doses than the standard dose. 
D) This child should receive the standard dose. 
A) This child should receive only a small fraction of the standard dose. 
B) This child should receive the drug intravenously rather than orally. 
C) This child should receive higher doses than the standard dose. 
D) This child should receive the standard dose.

Question 7

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)?

Accepted Answer

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. 
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 8

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?

Accepted Answer

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

Question 9

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

Accepted Answer

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 
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 10

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

Accepted Answer

A) Heart rate is unchanged. 
B) Heart rate decreases. 
C) Heart rate increases. 
D) Heart rate is irregular. 
A) Heart rate is unchanged. 
B) Heart rate decreases. 
C) Heart rate increases. 
D) Heart rate is irregular.

Question 11

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?

Accepted Answer

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

Question 12

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

Accepted Answer

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

Question 13

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

Accepted Answer

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

Question 14

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?

Accepted Answer

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." 
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 15

Which of the following is a goal of pharmacogenetics?

Accepted Answer

A) Producing "blockbuster drugs" that will work equally well for everyone 
B) Bringing down the cost of pharmaceutical manufacturing 
C) Developing drugs that will treat very rare diseases 
D) Reducing adverse reactions 
A) Producing "blockbuster drugs" that will work equally well for everyone 
B) Bringing down the cost of pharmaceutical manufacturing 
C) Developing drugs that will treat very rare diseases 
D) Reducing adverse reactions

Question 16

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?

Accepted Answer

A) No therapeutic response 
B) Increased adverse reactions and possible toxicity 
C) Therapeutic response as expected in the general population 
D) Drug inactivation occurs more rapidly, and the therapeutic response is limited. 
A) No therapeutic response 
B) Increased adverse reactions and possible toxicity 
C) Therapeutic response as expected in the general population 
D) Drug inactivation occurs more rapidly, and the therapeutic response is limited.

Question 17

Which statement about agonist and antagonist drugs is true?

Accepted Answer

A) Both drugs types must interact with receptors to produce their intended responses. 
B) The primary target tissues for these types of drugs are invading bacteria and viruses. 
C) Antagonists drugs produce only intended responses, and agonist drugs produce both intended responses and side effects. 
D) These types of drugs are less likely to cause allergic responses than drugs that are neither agonists nor antagonists. 
A) Both drugs types must interact with receptors to produce their intended responses. 
B) The primary target tissues for these types of drugs are invading bacteria and viruses. 
C) Antagonists drugs produce only intended responses, and agonist drugs produce both intended responses and side effects. 
D) These types of drugs are less likely to cause allergic responses than drugs that are neither agonists nor antagonists.

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

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?

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

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?

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?

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?

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)?

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?

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

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

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?

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

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

Which of the following is a goal of pharmacogenetics?

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?

Which statement about agonist and antagonist drugs is true?

DNA Structure and Function

Protein Synthesis

Genetic Influence on Cell Division, Differentiation, and Gametogenesis

Patterns of Inheritance

Epigenetic Influences on Gene Expression

Autosomal Inheritance and Disorders

Sex Chromosome and Mitochondrial Inheritance and Disorders

Family History and Pedigree Construction

Congenital Anomalies, Basic Dysmorphology, and Genetic Assessment

Enzyme and Collagen Disorders

Common Childhood-Onset Genetic Disorders

Common Adult-Onset Disorders

Cardiovascular Disorders

The Genetics of Cancer

Genetic Contributions to Psychiatric and Behavioral Disorders

Genetic and Genomic Testing

Health Professionals and Genomic Care

Financial, Ethical, Legal, and Social Considerations

Genetic and Genomic Variation

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Exam 17: Assessing Genomic Variation in Drug Response

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

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?

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

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?

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?

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?

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)?

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?

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

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

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?

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

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

Which of the following is a goal of pharmacogenetics?

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?

Which statement about agonist and antagonist drugs is true?

DNA Structure and Function

Protein Synthesis

Genetic Influence on Cell Division, Differentiation, and Gametogenesis

Patterns of Inheritance

Epigenetic Influences on Gene Expression

Autosomal Inheritance and Disorders

Sex Chromosome and Mitochondrial Inheritance and Disorders

Family History and Pedigree Construction

Congenital Anomalies, Basic Dysmorphology, and Genetic Assessment

Enzyme and Collagen Disorders

Common Childhood-Onset Genetic Disorders

Common Adult-Onset Disorders

Cardiovascular Disorders

The Genetics of Cancer

Genetic Contributions to Psychiatric and Behavioral Disorders

Genetic and Genomic Testing

Health Professionals and Genomic Care

Financial, Ethical, Legal, and Social Considerations

Genetic and Genomic Variation

Filters