PSA Renal and Hepatic Prescribing 2

Question 1

A patient with severe hepatic impairment is prescribed warfarin. What change in anticoagulant response is expected compared to a patient with normal liver function?

Accepted Answer

INR will be higher than expected, requiring lower doses

Answer

INR will be lower than expected, requiring higher doses

Answer

INR response will be identical to normal liver function

Answer

INR will be unpredictably variable with no consistent trend

Question 2

Morphine should be used with extreme caution in renal failure primarily due to accumulation of which active metabolite?

Accepted Answer

Morphine-6-glucuronide (M6G)

Answer

Morphine-3-glucuronide (M3G)

Answer

Normorphine

Answer

6-acetylmorphine

Question 3

Which formula is the standard method recommended for estimating creatinine clearance when adjusting drug doses in renal impairment?

Accepted Answer

Cockcroft-Gault equation

Answer

MDRD equation

Answer

CKD-EPI equation

Answer

Schwartz formula

Question 4

A patient with CrCl 30 mL/min is prescribed digoxin. Compared to a patient with normal renal function, the expected pharmacokinetic change is:

Accepted Answer

Prolonged half-life, requiring dose reduction

Answer

Shorter half-life, requiring more frequent dosing

Answer

Unchanged half-life as digoxin is hepatically metabolized

Answer

Reduced volume of distribution requiring a smaller loading dose

Question 5

Which analgesic should be avoided in renal impairment due to accumulation of its neurotoxic active metabolite, norpethidine?

Accepted Answer

Pethidine (meperidine)

Answer

Fentanyl

Answer

Tramadol

Answer

Hydromorphone

Question 6

NSAIDs cause acute kidney injury in patients with renal impairment primarily through which mechanism?

Accepted Answer

Inhibition of prostaglandin-mediated afferent arteriolar dilation

Answer

Direct tubular epithelial toxicity

Answer

Increased sodium reabsorption at the collecting duct

Answer

Competitive inhibition of creatinine secretion at the proximal tubule

Question 7

A patient with Child-Pugh Class B liver disease is prescribed a drug with a high hepatic extraction ratio administered orally. The most likely pharmacokinetic consequence is:

Accepted Answer

Increased oral bioavailability due to reduced first-pass metabolism

Answer

Reduced oral bioavailability due to compensatory enzyme induction

Answer

No change as hepatic extraction ratio is independent of liver function

Answer

Reduced half-life due to increased renal clearance