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FPGEE Exam Flashcards

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  1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of warfarin's S-enantiomer?

    Answer: CYP2C9

    CYP2C9 metabolizes the more pharmacologically active S-warfarin, which is why CYP2C9 polymorphisms and inhibitors significantly affect warfarin dosing.

  2. A patient with CrCl of 25 mL/min requires anticoagulation. Which agent would be MOST appropriate to avoid with severe renal impairment?

    Answer: Dabigatran

    Dabigatran is approximately 80% renally excreted and is contraindicated in severe renal impairment (CrCl <15 mL/min) and requires dose adjustment at lower CrCl values.

  3. Which pharmacokinetic parameter describes the fraction of an administered drug dose that reaches systemic circulation unchanged?

    Answer: Bioavailability

    Bioavailability (F) represents the fraction of the administered dose that reaches the systemic circulation in active form, accounting for absorption and first-pass metabolism.

  4. A patient taking rifampin for tuberculosis starts oral contraceptives. What counseling is MOST important?

    Answer: Use additional barrier contraception because rifampin is a strong CYP inducer

    Rifampin is a potent CYP3A4 inducer that significantly increases the metabolism of oral contraceptive hormones, reducing their efficacy and requiring additional contraception.

  5. Which buffer system is the PRIMARY extracellular buffer in human blood?

    Answer: Bicarbonate-carbonic acid system

    The bicarbonate-carbonic acid buffer system is the primary extracellular buffer, accounting for about 80% of the total blood buffering capacity.

  6. A pharmacist receives a prescription for metformin 1000 mg twice daily. Which lab value is MOST critical to check before dispensing?

    Answer: Serum creatinine/eGFR

    Metformin is contraindicated in patients with eGFR <30 mL/min/1.73m² due to risk of lactic acidosis from drug accumulation in renal impairment.

  7. What is the mechanism of action of proton pump inhibitors (PPIs)?

    Answer: Irreversible inhibition of H+/K+-ATPase enzyme

    PPIs irreversibly inhibit the H+/K+-ATPase (proton pump) on parietal cells, blocking the final step of acid secretion regardless of the stimulus.