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Pharmacotherapy Review & Drug Interactions Flashcards

7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Pharmacotherapy Review & Drug Interactions flashcards as text

  1. Which drug is a substrate of CYP2D6 and may accumulate to toxic levels in 'poor metabolizers' of this enzyme?

    Answer: Codeine

    Codeine is converted to its active analgesic form (morphine) by CYP2D6; poor metabolizers accumulate codeine with little analgesia, while ultra-rapid metabolizers risk morphine toxicity.

  2. A patient taking simvastatin 80 mg is prescribed amlodipine. What adjustment is recommended?

    Answer: Reduce simvastatin to no more than 20 mg/day due to CYP3A4 inhibition

    Amlodipine is a weak CYP3A4 inhibitor; simvastatin 80 mg is already restricted due to myopathy risk, and the FDA recommends limiting simvastatin to 20 mg/day when co-administered with amlodipine.

  3. What is the mechanism of action of direct oral anticoagulants (DOACs) such as rivaroxaban?

    Answer: Directly inhibit activated Factor Xa, preventing thrombin generation

    Rivaroxaban is a direct Factor Xa inhibitor that blocks the conversion of prothrombin to thrombin without requiring antithrombin as a cofactor.

  4. Which medication requires therapeutic drug monitoring due to its narrow therapeutic index and non-linear (Michaelis-Menten) pharmacokinetics?

    Answer: Phenytoin

    Phenytoin exhibits saturable (zero-order at therapeutic concentrations) Michaelis-Menten kinetics, causing small dose increases to produce disproportionately large plasma level elevations.

  5. A diabetic patient on glipizide starts a fluoroquinolone antibiotic. What glucose-related adverse effect is possible?

    Answer: Both hypoglycemia and hyperglycemia, depending on the specific fluoroquinolone

    Fluoroquinolones can cause both hypoglycemia (by stimulating insulin secretion, especially gatifloxacin/moxifloxacin) and hyperglycemia by interfering with pancreatic beta-cell function.

  6. Angiotensin-converting enzyme (ACE) inhibitors are contraindicated in pregnancy primarily because they cause:

    Answer: Fetal renal tubular dysgenesis and oligohydramnios

    ACE inhibitors impair fetal renal development in the second and third trimesters, leading to fetal renal tubular dysgenesis, oligohydramnios, and potentially fetal death.

  7. Which drug interaction results from cholestyramine's mechanism of action as a bile acid sequestrant?

    Answer: Decreased GI absorption of many drugs taken concomitantly

    Cholestyramine binds drugs in the GI tract, reducing their absorption; this applies to thyroid hormones, warfarin, digoxin, and many other drugs, requiring 1-4 hours of separation.