Chapter 17 Assessing Genomic Variationin Drug Response

Chapter 17: Assessing Genomic Variation in Drug Response ____ 1. Which of the following is a goal of pharmacogenetics? D. Reducing adverse reactions ____ 2. Which processes of drug response are most subject to genetic variation? C. Drug activation or deactivation and duration of drug actions ____ 3. Which statement about agonist and antagonist drugs is true? A. Both drugs types must interact with receptors to produce their intended responses. ____ 4. What is the expected heart-rate response when a patient is taking a drug that is an adrenaline ____ 5. How do genetic/genomic issues influence individual variation in the response to a specific drug? A. Polymorphisms of genes encoding metabolizing enzymes ____ 6. Which organ has the greatest concentration of cytochrome P (CYP) 450 enzymes? D. Liver ____ 7. How are the actions of naturally occurring estrogen changed when a patient is taking a drug that is ____ 8. Which type of parent compound must undergo first-phase metabolism to produce the intended ____ antagonist? B. Heart rate decreases. an estrogen agonist? A. Actions are increased. response after it enters the body? A. A prodrug 9. 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)? C. The intended response fails to be produced. ____ 10. 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? B. Insulin dosages should be decreased because the drug will exert its actions at lower concentrations. ____ 11. 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? C. Administering the drug by the intravenous route ____ 12. 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? B. Communicate this information to the admitting physician. ____ 13. 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? D. Both intended responses and side effects decrease. ____ 14. 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? C. Hemolytic anemia ____ 15. 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, whereas his wife takes the average dose, even though he is taller and heavier than she is. What is the nurse’s best response? C. “Many Asian Americans do not break down warfarin as fast as Caucasians, so the drug is more effective at lower dosages.” ____ 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 most likely result if you give this active drug at the standard dose? B. Increased adverse reactions and possible toxicity ____ 17. 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 enzyme needed for this drug's metabolism. How would you expect this to affect dosing of the drug 6-mercaptopurine? A This child should receive only a small fraction of the standard dose.