Haveles: Applied Pharmacology for the Dental Hygienist, 5th Edition Test Bank Chapter 25: Drug Interactions

MULTIPLE CHOICE 1. Of two drugs involved in a drug interaction, the drug that causes the interaction is referred to as the participant drug, and the drug whose effect is altered is referred to as the target drug. a Both statements are true. . b Both statements are false. . c The first statement is true; the second is false. . d The first statement is false; the second is true. . ANS: D Correct: The drug that causes the interaction is referred to as the precipitant drug. The drug whose effect is altered is referred to as the object drug. REF: pp. 431434 2. Drug interactions involving absorption, distribution, metabolism, or excretion are termed: a Pharmaceutic . b Pharmacokinetic . c Pharmacologic . d Pharmacodynamic . ANS: B Correct: Pharmacokinetics relates to absorption, distribution, metabolism, and excretion of drugs. Incorrect choices: Pharmaceutic relates to dosage forms; pharmacologic and pharmacodynamic relate to drug action. REF: pp. 431434

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3. Drug interactions related to absorption may have two outcomes: 1. The onset of action of the drug can be delayed; or 2. the amount of drug that is absorbed can be altered. a Statements 1 and 2 are true. . b Both statements are false. . c Statement 1 is true; statement 2 is false. . d Statement 1 is false; statement 2 is true. . ANS: A Correct: A drugs onset of action or extent of drug absorbed can be altered by a drug interaction involving absorption. REF: p. 432 4. Drug 1 is 98% bound to plasma proteins. Drug 2, which competes with Drug 1 for its plasma protein binding site, is administered. One percent of Drug 1 is displaced from the proteins by the Drug 2. As a consequence, the free, unbound concentration of Drug 1 increases by: a 1% . b 5% . c 10% . d 50% . ANS: D Correct: Prior to the administration of Drug 2, 98% of Drug 1 is bound to plasma proteins and 2 percent of is free and unbound. After addition of Drug 2, 1% of Drug 1 is displaced from its plasma protein binding site and enters the circulation. This raises the free and unbound level of Drug 1 from 2% to 3%. This translates to a 50% increase in the free drug level. REF: pp. 432433 5. Monoamine oxidase inhibitors (MAOIs) would most likely produce a clinically significant drug interaction with which if the following? a Epinephrine . b Ephedrine

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Test Bank . c Acetylcholine . d Norepinephrine . ANS: B Correct: MAOIs potentiate the actions of indirect, not direct, sympathomimetics. Incorrect choices: Epinephrine, and norepinephrine, are direct sympathomimetics. Acetylcholine, is not a sympathomimetic, but a cholinergic agent. Monoamine oxidase is not a component of the cholinergic neurotransmission system. REF: pp. 433434

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6. Which of the following statements regarding the warfarinaspirin interaction are true? a It is an example of a drug interaction relating to absorption . b Warfarin displaces aspirin from plasma proteins . c The blood levels of warfarin increase . d The blood levels of aspirin increase . e Both statements b and d are true . ANS: C Correct: Aspirin displaces warfarin from plasma proteins, increasing the levels of warfarin in the blood. Incorrect choices: It is an example of a drug interaction relating to distribution. Aspirin is considered the precipitant drug, and warfarin the object drug. The blood levels of warfarin, not aspirin, increase. REF: pp. 436437 7. When taken with methotrexate, aspirin appears to _____ of methotrexate. a Block the excretion . b Increase the excretion . c Block the absorption .

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Test Bank d Increase the absorption . ANS: A Correct: Aspirin increases methotrexate levels by a mechanism thought to involve the inhibition of excretion. Incorrect choices: Methotrexate levels rise, which would not occur if it excretion were increased or its absorption increased. Aspirin does not appear to increase the absorption of methotrexate. REF: pp. 436437

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8. The NSAIDs reduce the antihypertensive effect of all of the following except one. Which is the exception? a Propranolol . b Captopril . c Hydrochlorothiazide (HCTZ) . d Digoxin . ANS: D Correct: Digoxin is not an antihypertensive agent. Incorrect choices: NSAIDs counteract the actions of the antihypertensive agents propranolol, captopril, and hydrochlorothiazide. REF: p. 438 9. Sulfonamides and trimethoprim enhance each others antibacterial effect. This is an example of a pharmacodynamic drug interaction. a Both statements are true. . b Both statements are false. . c The first statement is true; the second is false. . d The first statement is false; the second is true. .

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ANS: A Correct: The first statement is true. These two agents act at different steps in the folic acid pathway and enhance each others actions in this way, rather than altering ADME. REF: pp. 438439 10. In the interaction between penicillin and probenecid: a Probenecid lowers the absorption of penicillin. . b Penicillin increases the effect of probenecid. . c Probenecid inhibits the kidney tubular secretion of penicillin. . d Probenecid inhibits the liver metabolism of penicillin. . ANS: C Correct: Probenecid is an inhibitor of organic acid transport into the kidney tubule. This reduces the active secretion of penicillin into the kidney tubule and thus sustains the level of penicillin in the blood. Incorrect choices: Probenecid does not alter the absorption of penicillin. Penicillin does not alter the effect of probenecid. Probenecid does not inhibit the metabolism of penicillin. REF: p. 439 11. Which of the following, when taken with antacids, can result in a decrease in intestinal absorption of the medication? a Codeine . b Meperidine . c Acetaminophen . d Penicillin V . e Tetracycline . ANS: E Correct: Tetracycline forms an insoluble complex with divalent and trivalent cations found in antacids and is not absorbed. Incorrect choices: The absorption of other drugs are not significantly affected by

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Test Bank antacids. REF: p. 439

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12. Which of the following are potent stimulators of liver microsomal enzyme production? a Erythromycin . b Phenobarbital . c Omeprazole . d b and c . ANS: B Correct: Phenobarbital induces microsomal drug metabolizing enzymes, whereas erythromycin and omeprazole inhibit them. REF: p. 440 13. Epinephrine produces a clinically significant drug interaction with tricyclic antidepressants. This interaction results in hypertension followed by reflex bradycardia. a Both statements are true. . b Both statements are false. . c The first statement is true; the second is false. . d The first statement is false; the second is true. . ANS: C Correct: The interaction between epinephrine and tricyclic antidepressants in clinically significant. However, the result is hypertension that is not followed by reflex bradycardia. The latter is characteristic of the interactions of epinephrine with non-specific beta blockers. REF: pp. 439441 TRUE/FALSE 1. The interaction between opioids and alcohol is considered pharmacodynamic.

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ANS: T Correct: Opioids do not increase the blood levels of alcohol, but rather the two agents pharmacologic actions add together to create greater CNS depression. REF: p. 438 2. Bacteriostatic and bacteriocidal antibiotics generally interact to enhance each others actions. ANS: F Correct: The activity of bacteriocidal agents is inhibited by bacteriostatic antiinfective agents. REF: pp. 436, 439 3. Antiinfective agents may increase the anticoagulant action of warfarin by their bacteriostatic and bacteriocidal actions. ANS: T Correct: Certain bacteria found in the colon synthesize vitamin K, which is then absorbed by the host. Because warfarin is a vitamin K antagonist, its anticoagulant activity increases if vitamin K absorption is decreased. REF: pp. 438439 4. Unlike tetracycline, doxycycline can be taken with dairy products or food. ANS: T Correct: Larger doses of divalent or trivalent cations are required to complex doxycycline and inhibit its absorption as compared with tetracycline. REF: p. 439 5. A drug interaction is when two drugs are given together and they result in undesired effects. ANS: F Correct: Drugs do not need to be given together to interact, and the result can be undesirable, desirable, or clinically insignificant. REF: p. 431

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