Question # 1 (Multiple Answer) Factors that could change intrinsic hepatic clearance include:

A) hepatic blood flow
B) induction state of hepatic enzymes
C) hepatic disease

Question # 2 (True/False) In rheumatoid arthritis patients, increased alpha1-acidic glycoprotein may be associated with increased lidocaine protein binding.

A) true
B) false

Question # 3 (Multiple Choice) Hepatic flow-dependent drug elimination refers to:

A) changes in plasma protein concentration
B) rate-limiting step is drug delivery to hepatic elimination sites
C) number of functional hepatocytes
D) carrier saturation
E) drug transfer rates across hepatic cell membrane

Question # 4 (Multiple Answer) Characteristic(s) of a drug whose action is terminate by redistribution include:

A) generally long-acting
B) usually a hydrophilic (not very lipid-soluble) drug
C) eventually concentrates usually in adipose (fat) tissue
D) tends to partition slowly into organs such as the brain, even though the brain receives a significant fraction of the cardiac output

Question # 5 (Multiple Choice) Cytochrome P450 induction (increased, amount of P450 enzyme protein) is often associated with:

A) increased enzyme synthesis rates
B) reduced enzyme degradation rates
C) both
D) neither

Question # 6 (Multiple Choice) Microsomal drug metabolizing enzymes are typically associated with:

A) rough endoplasmic reticulum
B) smooth endoplasmic reticulum

Question # 7 (Multiple Answer) Characteristics of drug-protein binding:

A) often parallels drug lipid solubility
B) drug-plasma albumin binding tends to be relatively nonselective
C) real failure he is associated with the reduction in drug-down fraction because of a reduction in plasma albumin concentration
D) in rheumatoid arthritis patients, increased alpha1-acidic glycoprotein tends to promote increased lidocaine protein binding
E) Surgery may result in increases in alpha1-acidic glycoprotein plasma concentration

Question # 8 (Multiple Choice) Examples of "high-extraction" drugs -- related to hepatic drug clearance:

A) morphine
B) meperidine
C) verapamil
D) diltiazem
E) all the above

Question # 9 (Multiple Choice) Pharmacogenetic effects:

A) prolonged mivacurium-induced neuromuscular blockade due to atypical cholinesterase
B) succinylcholine or volatile anesthetic-induced malignant hyperthermia
C) both
D) neither

Question # 10 (Multiple Answer) Characteristics of drug conjugates (following conjugation reactions)

A) more polar
B) more readily excreted
C) typically more pharmacologically active

Question # 11 (Multiple Choice) Termination of pharmacological action of thiopental occurs mainly by:

A) metabolism
B) excretion
C) redistribution

Question # 12 (Multiple Answer) Concerning influence of age on drug responses:variation in response usually due to:

A) reduced cardiac output
B) reduced hepatic perfusion
C) decreased body fat
D) increased protein binding
E) decreased renal function

Question # 13 (Multiple Choice) Reaction type associated with inactivation of succinylcholine, atracurium, and mivacurium.

A) conjugation
B) hydrolysis
C) oxidation
D) reduction

Question # 14 (Multiple Answer) Phase II and reactions:

A) conjugation
B) hydrolysis
C) oxidation
D) reduction

Question # 15 (Multiple Choice) Factors affecting renal clearance of drugs:

A) the presence of renal disease
B) drug secretion rates
C) number of functional nephrons
D) blood flow
E) all of the above

Question # 16 (Multiple Choice) Concerning drug-plasma protein binding:

A) Drugs are seldom bound to plasma proteins
B) volume of distribution is not influenced by protein binding
C) diazepam is an example of the drug that is minimally protein-bound
D) drug clearance is influenced by the extent of protein binding

Question # 17 (Multiple Choice) Mixed function oxidases system is referred to as mediating:

A) phase I system
B) phase II system

Question # 18 (Multiple Answer) Characteristics of drug-protein binding

A) generally theextent of drug-protein binding parallels drug lipids liability
B) drug-plasma albumin binding is usually highly selective
C) renal failure may decrease drug bound fraction because of reduced plasma albumin
D) sulfonamides may displace unconjugated bilirubin from albumin-binding sites (because neonatal bilirubin encephalopathy)

Question # 19 (Multiple Answer) Factors affecting hepatic drug clearance:

A) drug delivery to liver elimination sites
B) extent of plasma protein-bound drug
C) blood flow
D) carrier saturation
E) glomerular filtration

Question # 20 (Multiple Choice) Factors affecting renal drug secretion rates:

A) carrier saturation
B) drug transfer rates across tubular membranes
C) degree of drug-plasma protein binding
D) rate of drug delivery to secretory sites
E) all the above

Question # 21 (Multiple Choice) Concerning drug-plasma protein binding:

A) A relatively small percentage of drugs are bound to some extent to plasma proteins
B) drug-plasma albumin binding is often highly selective
C) an example of a plasma protein important for drug binding is alpha1-acidic glycoprotein
D) volume of distribution is generally unrelated to protein binding
E) diazepam is an example of a drug that exhibits little plasma protein binding