SNLE Pharmacology 2

Question 1

What is the 'first-pass effect' in pharmacology?

Accepted Answer

Significant drug metabolism by the liver before reaching systemic circulation after oral administration

Answer

After oral ingestion, drugs absorbed from the gut pass through the portal circulation to the liver where they may be extensively metabolized before reaching systemic circulation. This reduces bioavailability (e.g., nitrates, morphine, propranolol have high first-pass effect and require higher oral doses or alternative routes).

Question 2

A patient is prescribed warfarin. Which food significantly increases bleeding risk?

Accepted Answer

Excessive consumption of cranberry juice

Answer

Cranberry juice contains compounds that inhibit CYP2C9, the enzyme that metabolizes warfarin, leading to increased warfarin levels and INR elevation. This significantly increases bleeding risk. Vitamin K-rich foods (green leafy vegetables) actually reduce warfarin's anticoagulant effect.

Question 3

What is the mechanism of action of beta-blocker medications?

Accepted Answer

Block beta-adrenergic receptors, reducing heart rate, contractility, and blood pressure

Answer

Beta-blockers competitively block beta-1 receptors in the heart (reducing heart rate and contractility) and beta-2 receptors in bronchi and blood vessels. They reduce cardiac oxygen demand and blood pressure. Used for hypertension, angina, heart failure, and dysrhythmias.

Question 4

A patient on gentamicin therapy requires monitoring of which parameters?

Accepted Answer

Renal function (creatinine, BUN) and hearing (ototoxicity)

Answer

Aminoglycosides (gentamicin, tobramycin, amikacin) are nephrotoxic (damage renal tubular cells) and ototoxic (damage cochlear and vestibular hair cells). Peak and trough drug levels, creatinine, BUN, urine output, and audiologic testing are required during therapy.

Question 5

What is the correct action when a patient reports a new rash after receiving a medication?

Accepted Answer

Stop the medication, assess severity, notify the physician, and document the reaction as an allergy

Answer

A new rash after drug administration may represent an allergic reaction ranging from mild to anaphylactic. The drug should be held, severity assessed (mild urticaria vs. angioedema, bronchospasm, hypotension suggesting anaphylaxis), the physician notified, and the reaction documented as an allergy in the medical record.

SNLE Practice Test

SNLE Practice Test

SNLE Pharmacology 2