NR565 Week 4 Midterm Exam NEWEST 2025
COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+||BRAND NEW VERSION!!
2 medications prescribed together that are highly protein bound, what is clinical outcome? -
CORRECT ANSWER- The two drugs compete for availability of plasma proteins and one or the other
becomes increasingly effective, think extra medication is floating around as it cannot bind to
plasma proteins. Warfarin is highly protein bound.
What areas of healthcare most heavily integrate pharmacogenetics into clinical practice? -
CORRECT ANSWER- Oncology & cystic fibrosis population
Think HER2 with breast cancer and CF have 2 defective CFTR genes
Barrier in understanding racial differences in drug pharmacokinetics with American Indian or
Alaskan Natives? - CORRECT ANSWER- Limited to no research in racial considerations
Purpose of genetic testing with Tamoxifen? - CORRECT ANSWER- Reduce the risk of therapeutic
failure as variation of CYP2D6 will not allow for activation and conversion to endoxifen which is
necessary for treating estrogen sensitive cancers.
what makes clopidogrel unique among other P2Y12 inhibitors? - CORRECT ANSWER- relies on
cytochrome P450 enzyme to convert into active metabolite (CYP2C19) thus requiring this gene
to be present to be an effective drug in clot formation
,Alternatives to clopidogrel - CORRECT ANSWER- Brilinta (ticagrelor) or Effient (Prasugrel) because
they are not dependent on CYP2C19 genotype
Name the 4 medications that REQUIRE pharmacogenetic testing - CORRECT ANSWER- Cetuximab,
trastuzumab, maraviroc, dasatinib
Liver and Kidney functions labs for monitoring? - CORRECT ANSWER- Creatinine, BUN, GFR, AST, ALT,
Bilirubin
Dose of propranolol in migraine reduction - CORRECT ANSWER- 20-80mg 3-4X daily
increases levels of serotonin, prevents beta receptor vasodilation
allow 4-6 weeks to trial treatment
First consideration in selecting most appropriate beta blocker? - CORRECT ANSWER- Cardio
selectivity
Pregnancy Categories B vs D with beta blockers - CORRECT ANSWER- Atenolol - D
betaxolol, acebutolol, metoprolol, nadolol, nebivolol, tiolol, propranolol - C
Where are beta 2 receptors located and what do they do? - CORRECT ANSWER- smooth muscle of
eye, arterioles, venules, bronchioles, liver, pancreas, GI, GU
Stimulate adneylyl cyclase, increase cAMP, activate cardiac G1
Drug of choice for HTN with concomitant BPH - CORRECT ANSWER- Alpha 1 adrenergic antagonist
,Beta blockers that require dosage adjustment in patients with renal impairment - CORRECT
ANSWER- acebutolol, atenolol, nadolol, and nebivolol
Dosing schedule of donepizil - CORRECT ANSWER- 5mg nightly at bedtime, increase at 4-6 week
intervals, max dose is 10 mg daily.
Elicits parasympathetic response - CORRECT ANSWER- Acetylcholine, ACh
Sympathetic nervous system responses elicited by: - CORRECT ANSWER- Epi, Norepi, Dopa
First line treatments for HTN - CORRECT ANSWER- CCB, ACEI, ARB, or thiazide
consider comorbidities
Patients with HTN and comorbidities of essential tremor, migraine, arryhthmia, CAD,
symptomatic HF with reduced EF can be treated with? - CORRECT ANSWER- beta blocker
2 drugs that require tapering when discontinuing in relation to HTN tx - CORRECT ANSWER- beta
blockers and clonidine
G protein-coupled receptors (GPCRs) - CORRECT ANSWER- large family of integral membrane
proteins involved in signal transduction; characterized by their 7 membrane-spanning alpha-
helices; utilize heterotrimeric G protein to transmit signals to effector cells
excitatory neurotransmitters - CORRECT ANSWER- amino acids-glycine, aspartate, glutamate
Most common CYP enzyme and its role - CORRECT ANSWER- CYP3A4, responsible for metabolism of
50% meds. Found in liver & lining of GI tract.
, Meds metabolized by CYP3A4 antimicrobials, calcium channel blockers, antihistamines,
anticonvulsants, azole antifungals, and corticosteroids.
Clinical significance of being an ultra rapid CYP2D6 metabolizer - CORRECT ANSWER- break down
meds rapidly, consider dose, response and toxicity in relation to beta blockers, antidepressants,
antiarrhythmics, and opioids.
PgP inhibition - CORRECT ANSWER- necessary as Pgp is main barrier preventing medications from
being properly delivered
VCORC1 mutation and warfarin - CORRECT ANSWER- can cause warfarin resistance, increases chance
for uncontrolled bleeding requiring a decreased dose
major differences in drug metabolism in Asian populations - CORRECT ANSWER- reduced activity of
CYP450, 2D6, and 2C19.
Lower doses of antiarrhythmics, antidepressants, neuroleptics, acids, bases, neutral drugs
Fast acetylators for psychotropic and cardiac meds like beta blockers, ace inhibitors, calcium
channel blockers, and immunosuppressants
Reasons for poor health outcomes among African Americans? - CORRECT ANSWER- higher death
rate r/t heart disease, stroke, cancer, asthma, flu, pneumonia, diabetes, hiv/aids, homicide d/t
lower level education, higher unemployment rates, lower income levels, more hazardous
occupations, family dynamics, lower immunization rates, less employee sponsored insurance
Pharmacokinetics - CORRECT ANSWER- how drug affects body
absorption, distribution, metabolism, excretion
Phase 1 metabolism - CORRECT ANSWER- Oxidation, reduction, hydrolysis
COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+||BRAND NEW VERSION!!
2 medications prescribed together that are highly protein bound, what is clinical outcome? -
CORRECT ANSWER- The two drugs compete for availability of plasma proteins and one or the other
becomes increasingly effective, think extra medication is floating around as it cannot bind to
plasma proteins. Warfarin is highly protein bound.
What areas of healthcare most heavily integrate pharmacogenetics into clinical practice? -
CORRECT ANSWER- Oncology & cystic fibrosis population
Think HER2 with breast cancer and CF have 2 defective CFTR genes
Barrier in understanding racial differences in drug pharmacokinetics with American Indian or
Alaskan Natives? - CORRECT ANSWER- Limited to no research in racial considerations
Purpose of genetic testing with Tamoxifen? - CORRECT ANSWER- Reduce the risk of therapeutic
failure as variation of CYP2D6 will not allow for activation and conversion to endoxifen which is
necessary for treating estrogen sensitive cancers.
what makes clopidogrel unique among other P2Y12 inhibitors? - CORRECT ANSWER- relies on
cytochrome P450 enzyme to convert into active metabolite (CYP2C19) thus requiring this gene
to be present to be an effective drug in clot formation
,Alternatives to clopidogrel - CORRECT ANSWER- Brilinta (ticagrelor) or Effient (Prasugrel) because
they are not dependent on CYP2C19 genotype
Name the 4 medications that REQUIRE pharmacogenetic testing - CORRECT ANSWER- Cetuximab,
trastuzumab, maraviroc, dasatinib
Liver and Kidney functions labs for monitoring? - CORRECT ANSWER- Creatinine, BUN, GFR, AST, ALT,
Bilirubin
Dose of propranolol in migraine reduction - CORRECT ANSWER- 20-80mg 3-4X daily
increases levels of serotonin, prevents beta receptor vasodilation
allow 4-6 weeks to trial treatment
First consideration in selecting most appropriate beta blocker? - CORRECT ANSWER- Cardio
selectivity
Pregnancy Categories B vs D with beta blockers - CORRECT ANSWER- Atenolol - D
betaxolol, acebutolol, metoprolol, nadolol, nebivolol, tiolol, propranolol - C
Where are beta 2 receptors located and what do they do? - CORRECT ANSWER- smooth muscle of
eye, arterioles, venules, bronchioles, liver, pancreas, GI, GU
Stimulate adneylyl cyclase, increase cAMP, activate cardiac G1
Drug of choice for HTN with concomitant BPH - CORRECT ANSWER- Alpha 1 adrenergic antagonist
,Beta blockers that require dosage adjustment in patients with renal impairment - CORRECT
ANSWER- acebutolol, atenolol, nadolol, and nebivolol
Dosing schedule of donepizil - CORRECT ANSWER- 5mg nightly at bedtime, increase at 4-6 week
intervals, max dose is 10 mg daily.
Elicits parasympathetic response - CORRECT ANSWER- Acetylcholine, ACh
Sympathetic nervous system responses elicited by: - CORRECT ANSWER- Epi, Norepi, Dopa
First line treatments for HTN - CORRECT ANSWER- CCB, ACEI, ARB, or thiazide
consider comorbidities
Patients with HTN and comorbidities of essential tremor, migraine, arryhthmia, CAD,
symptomatic HF with reduced EF can be treated with? - CORRECT ANSWER- beta blocker
2 drugs that require tapering when discontinuing in relation to HTN tx - CORRECT ANSWER- beta
blockers and clonidine
G protein-coupled receptors (GPCRs) - CORRECT ANSWER- large family of integral membrane
proteins involved in signal transduction; characterized by their 7 membrane-spanning alpha-
helices; utilize heterotrimeric G protein to transmit signals to effector cells
excitatory neurotransmitters - CORRECT ANSWER- amino acids-glycine, aspartate, glutamate
Most common CYP enzyme and its role - CORRECT ANSWER- CYP3A4, responsible for metabolism of
50% meds. Found in liver & lining of GI tract.
, Meds metabolized by CYP3A4 antimicrobials, calcium channel blockers, antihistamines,
anticonvulsants, azole antifungals, and corticosteroids.
Clinical significance of being an ultra rapid CYP2D6 metabolizer - CORRECT ANSWER- break down
meds rapidly, consider dose, response and toxicity in relation to beta blockers, antidepressants,
antiarrhythmics, and opioids.
PgP inhibition - CORRECT ANSWER- necessary as Pgp is main barrier preventing medications from
being properly delivered
VCORC1 mutation and warfarin - CORRECT ANSWER- can cause warfarin resistance, increases chance
for uncontrolled bleeding requiring a decreased dose
major differences in drug metabolism in Asian populations - CORRECT ANSWER- reduced activity of
CYP450, 2D6, and 2C19.
Lower doses of antiarrhythmics, antidepressants, neuroleptics, acids, bases, neutral drugs
Fast acetylators for psychotropic and cardiac meds like beta blockers, ace inhibitors, calcium
channel blockers, and immunosuppressants
Reasons for poor health outcomes among African Americans? - CORRECT ANSWER- higher death
rate r/t heart disease, stroke, cancer, asthma, flu, pneumonia, diabetes, hiv/aids, homicide d/t
lower level education, higher unemployment rates, lower income levels, more hazardous
occupations, family dynamics, lower immunization rates, less employee sponsored insurance
Pharmacokinetics - CORRECT ANSWER- how drug affects body
absorption, distribution, metabolism, excretion
Phase 1 metabolism - CORRECT ANSWER- Oxidation, reduction, hydrolysis
