Drug Interactions Midterm Revision

1. What are the two broad categories of drug interactions mentioned in

the text?
A. Pharmacokinetic and pharmacodynamic
B. Pharmacodynamic and genetic
C. Pharmacokinetic and genetic variance
D. Pharmacodynamic and environmental factors

2. Which subgroup of pharmacodynamic interactions involves

interference with a biologic or physiologic process?
A. Attenuated pharmacologic effect
B. Direct effect at receptor function
C. Additive pharmacologic effect
D. Interference with a biologic process

3. What is a drug–drug interaction (DDI) defined as?

A. A beneficial alteration in drug response
B. An alteration in drug exposure/response due to co-administration of
another drug
C. A harmful alteration in drug absorption
D. An alteration in drug metabolism

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4. What is a key risk factor for drug interactions in the elderly
population?
A. Male gender
B. Polypharmacy
C. Young age
D. Race variance

5. How do altered levels of metabolizing enzymes in obese and

malnourished patients affect drug interactions?
A. Increase susceptibility to drug interactions
B. Decrease susceptibility to drug interactions
C. Have no impact on drug interactions
D. Cause drug interactions to be less severe

6. What factor contributes to the increased incidence of drug

interactions in critically ill patients?
A. Altered pharmacokinetics
B. Improved nutritional status
C. Decreased medication use
D. Reduced disease state

7. How can cigarette smoking affect drug therapy?

A. Only through pharmacokinetic mechanisms

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B. Only through pharmacodynamic mechanisms
C. By both pharmacokinetic and pharmacodynamic mechanisms
D. By altering drug absorption only

8. What determines an individual's complement of metabolizing

enzymes?
A. Genetic makeup
B. Dietary intake
C. Social habits
D. Age

9. What is the main cause of drug interactions in polypharmacy?

A. Medication non-adherence
B. Higher drug costs
C. Concomitant use of multiple drugs
D. Indicated clinically medications

10. Which population is at an increased risk of drug interactions due to

altered pharmacokinetics and pharmacodynamics?
A. Young adults
B. Children
C. Elderly patients
D. Middle-aged individuals
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11. Which factor can lead to an unaccepted delay or therapeutic failure
for acutely administered drugs like analgesics or hypnotics?
A. Distribution in the body
B. Changes in gastric pH
C. Altered drug transport
D. Protein binding

12. What can alter the kinetics of coadministered drugs by affecting the
dissolution and absorption of antifungal agents like ketoconazole or
itraconazole?
A. Administration/Absorption
B. Changes in gastric pH
C. Altered drug transport
D. Distribution in the body

13. Which type of drugs may accelerate gastric emptying, leading to

decreased absorption of drugs like digoxin or theophylline?
A. Antifungal agents
B. Proton pump inhibitors
C. Prokinetic drugs
D. Antacids

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14. What is more likely to result in significant drug interactions
according to the content?
A. Drugs with a large volume of distribution
B. Drugs with a narrow therapeutic index
C. Drugs with low protein binding
D. Drugs with rapid metabolism

15. Which drug can displace warfarin from protein-binding sites, leading
to increased clearance without a significant change in free drug
concentration?
A. Ketoconazole
B. Phenytoin
C. Metoclopramide
D. Ciprofloxacin

16. What can alter drug absorption by forming complexes that are
poorly absorbed when coadministered with certain antibiotics like
tetracyclines or fluoroquinolones?
A. Antifungal agents
B. Proton pump inhibitors
C. Antacids
D. Prokinetic drugs

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17. Which mechanism of drug interactions involves changes in GI
motility, enzymatic metabolism, and drug transport according to the
content?
A. Altered drug transport
B. Changes in gastric pH
C. Complexation
D. Distribution in the body

18. What can lead to a change in the rate or extent of drug absorption
by altering absorption mechanisms throughout the gastrointestinal
tract?
A. Antacids
B. Drug interactions
C. Proton pump inhibitors
D. Changes in gastric pH

19. Which type of drugs are more likely to have reduced clinical
significance for a reduced rate of absorption when given over the long
term in multiple doses?
A. Drugs with narrow therapeutic index
B. Acutely administered drugs
C. Antifungal agents
D. Drugs with high protein binding

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20. What can accelerate gastric emptying, potentially resulting in
decreased absorption of drugs like digoxin or theophylline?
A. Prokinetic drugs
B. Proton pump inhibitors
C. Antifungal agents
D. Antacids

21. Which type of drug metabolism involves combining a phase I

product with an endogenous substance resulting in glucuronidation,
sulfation, acetylation, and methylation?
A. Phase I reactions
B. Phase III reactions
C. Phase II reactions
D. Phase IV reactions

22. What is the main role of cytochrome (CYP) 450 enzymes in drug
metabolism?
A. Increase drug toxicity
B. Terminate biologic activity of the drug
C. Enhance drug absorption
D. Cause drug allergies

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23. Which of the following drugs is known to induce enzymes
responsible for drug metabolism?
A. Rifampin
B. Aspirin
C. Ibuprofen
D. Acetaminophen

24. What effect does inhibition of drug metabolism have on the amount
of drug in the body?
A. Decrease
B. Increase
C. No effect
D. Neutralize

25. Which substance is known to increase the bioavailability of many

drugs by inhibiting drug metabolism?
A. Orange juice
B. Apple juice
C. Grapefruit juice
D. Cranberry juice

26. What type of inhibition occurs when a drug forms a reactive

intermediate with the enzyme leading to permanent inhibition?

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A. Reversible inhibition
B. Irreversible inhibition
C. Temporary inhibition
D. Partial inhibition

27. How are drugs mainly excreted and eliminated from the body?
A. Mainly via the kidneys
B. Via the skin
C. Through the lungs
D. Through the digestive system

28. Which process can affect the excretion of drugs by changing their
elimination rate?
A. Liver detoxification
B. Urinary alkalinization and acidification
C. Lymphatic excretion
D. Sweating

29. When do pharmacodynamic interactions occur?

A. When pharmacokinetics are altered
B. When the response of one drug is modified by another without
pharmacokinetic changes
C. During drug metabolism
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D. During drug absorption

30. How can pharmacodynamic interactions be predicted?

A. By knowing the pharmacologic effects of a drug
B. By altering drug dosages
C. By changing drug administration routes
D. By increasing drug frequency

31. What is a potential consequence of combining St. John’s wort with

other antidepressant drugs?
A. Serotonin syndrome
B. Increased effectiveness of antidepressants
C. Reduced side effects of antidepressants
D. Enhanced sleep quality

32. Why is it important for patients to disclose their use of herbal

medicine to their physician?
A. To prevent drug interactions
B. To receive discounts on medications
C. To avoid herbal medicine side effects
D. To increase the placebo effect

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33. How does St. John’s wort interact with drugs like warfarin and
benzodiazepines?
A. It increases their plasma concentration
B. It has no effect on them
C. It reduces their plasma concentration
D. It enhances their therapeutic effects

34. What is a common belief about herbal medicine and adverse drug
reactions (ADRs)?
A. Herbal medicine is always safe
B. Herbal medicine is ineffective
C. Herbal medicine causes severe ADRs
D. Herbal medicine is unrelated to ADRs

35. In what way can herbal medicine interact with orthodox medicine or
other herbal preparations?
A. By canceling out their effects
B. By increasing their side effects
C. By decreasing their pharmacological action or toxicity
D. By improving their taste

36. What is a significant drawback in the area of drug-herbal

interactions (DHI)?

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A. Lack of patient compliance
B. Overreporting of interactions
C. Underreporting of interactions
D. Excessive regulation of herbal medicines

37. How does St. John’s wort affect the metabolism of protease
inhibitors during HIV treatment?
A. It increases their effectiveness
B. It has no impact
C. It reduces their plasma concentration
D. It enhances their antiviral properties

38. Why should patients maintain a complete medication profile

including over-the-counter medications and dietary supplements?
A. To impress their healthcare providers
B. To receive free samples
C. To avoid medication errors
D. To increase the placebo effect

39. What is the main active compound in St. John’s wort that can lead
to serotonin syndrome when combined with other antidepressant
drugs?
A. Warfarin

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B. Hypericin
C. Cyclosporine
D. Benzodiazepines

40. How can herbal medicine commonly interact with drugs in terms of
pharmacokinetics?
A. By reducing drug metabolism
B. By enhancing drug absorption
C. By increasing drug excretion
D. By improving drug taste

41. What is the potential consequence of co-administering protease

inhibitor and garlic?
A. Decreased metabolism of garlic
B. Rapid metabolism of garlic
C. Increased blood concentration of garlic
D. Enhanced therapeutic effect of garlic

42. How does ginseng generally affect the metabolism of warfarin?

A. Induces warfarin metabolism
B. Inhibits warfarin metabolism
C. Has no effect on warfarin metabolism
D. Increases warfarin concentration
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43. What is a known effect of Ginko biloba on the metabolism of
warfarin and aspirin?
A. No effect on their metabolism
B. Inhibits their metabolism
C. Enhances their metabolism
D. Causes bleeding by inhibiting platelet function

44. What is a potential risk of combining liquorice with diuretics?

A. Toxicity due to corticosteroid inhibition
B. Increased diuretic effect
C. Reduced salt retention
D. Enhanced water excretion

45. Why are drug-food interactions challenging during treatment?

A. Patients are not used to specific foods
B. Predicting patients' next food choice is easy
C. Habitual foods are usually recorded in hospital files
D. Patients may have long-standing habits incompatible with their
medication

46. What can happen when tyramine-containing foods are consumed by

a depressed patient on certain medications?

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A. Hypotension
B. Serotonin syndrome
C. Bronchoconstriction
D. Hyperactivity

47. How can protein-rich foods affect the absorption of medications like
propranolol?
A. Increase bioavailability
B. Decrease bioavailability
C. No impact on bioavailability
D. Speed up metabolism

48. What adverse events can occur when propranolol is taken with a
protein-rich meal?
A. Bradycardia and hypotension
B. Tachycardia
C. Hypertension
D. Respiratory depression

49. What adverse events can occur when propranolol is taken with a
protein-rich meal?
A. Bradycardia and hypotension
B. Tachycardia

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C. Hypertension
D. Respiratory depression

50. What effect can high-protein diets have on the efficacy of

carbidopa/levodopa and theophylline?
A. No effect
B. Increase concentration
C. Decrease concentration
D. Enhance absorption

51. How does fiber intake affect metformin blood levels?

A. Decreases levels
B. Increases levels
C. No effect
D. Enhances absorption

52. What happens when dairy products are taken with ciprofloxacin,
tetracycline, or sodium fluoride?
A. No effect
B. Decrease absorption
C. Increase absorption
D. Enhance metabolism

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53. Which type of meals can enhance the absorption of artemisinin
drugs?
A. High-fat meals
B. High-protein meals
C. High-fiber meals
D. High-carb meals

54. How does chronic alcohol abuse affect the efficacy of phenytoin?
A. Reduces efficacy
B. No effect
C. Increases efficacy
D. Enhances absorption

55. What is the impact of grapefruit juice on the metabolism of certain

drugs?
A. Increases toxicity
B. Decreases concentration
C. No effect
D. Enhances absorption

56. What effect can high vitamin K green fruits/vegetables have on

warfarin efficacy?
A. Increase efficacy

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B. No effect
C. Decrease efficacy
D. Enhance metabolism

57. When should a drug be taken with food according to the content?
A. To enhance absorption
B. To increase side effects
C. To reduce absorption
D. To reduce gastrointestinal side effects

58. Why should some drugs be taken without food?

A. To reduce side effects
B. To increase absorption
C. To enhance metabolism
D. To reduce gastrointestinal side effects

59. What are drug-disease interactions (DDSIs) according to the

content?
A. Situations where a new drug treatment cures the preexisting medical
condition
B. Situations where a new drug treatment has no effect on the
preexisting medical condition

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C. Situations where a new drug treatment worsens the preexisting
medical condition
D. Situations where a new drug treatment prevents the preexisting
medical condition

60. Which of the following is NOT identified as a risk factor strongly

associated with Disease-Drug Side Effects (DDSI)?
A. Old age
B. Children and neonates
C. Male gender
D. Psychiatric comorbidities

61. What type of disease is mentioned as highly affecting medications

and causing disease-drug interactions?
A. Respiratory disease
B. Cardiac disease
C. Skin disease
D. Autoimmune disease

62. In patients with hepatic impairment, what can drug accumulation

lead to?
A. Reduced elimination
B. Excessive plasma drug concentrations

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C. Decreased side effects
D. Improved liver function

63. Which group of patients is at a high risk of developing Disease-Drug

Side Effects (DDSI) due to central nervous system disorders?
A. Elderly patients
B. Teenagers
C. Middle-aged adults
D. Children

64. What is a common effect of first-generation antipsychotics on

patients?
A. Parkinsonian symptoms
B. Diabetes
C. Hypertension
D. Thyroid disorders

65. Which type of patients are mentioned to be at risk of developing

drug nephrotoxicity due to existing conditions like extracellular volume
depletion and sepsis?
A. Infants and young children
B. Elderly patients
C. Teenagers

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D. Middle-aged adults

66. What is a potential consequence of treatment with dopaminergic

drugs in elderly patients diagnosed with Parkinson's disease?
A. Orthostatic hypotension
B. Reduced risk of fractures
C. Improved cognitive function
D. Decreased hallucinations

67. Which drug type is mentioned to cause urinary incontinence in

patients with dementia or Alzheimer's?
A. Cholinesterase inhibitors
B. Antibiotics
C. Antidepressants
D. Antipsychotics

68. According to the theory of pain and inflammation, what effect does
pain have on the absorption of cardiovascular drugs and analgesics?
A. Increases absorption
B. Reduces absorption
C. No effect on absorption
D. Accelerates metabolism

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69. What can exacerbate peptic ulcers and potentially lead to
gastrointestinal bleeding or perforation?
A. Antibiotics
B. Antacids
C. NSAIDs
D. Steroids

70. Which group of patients should be closely monitored for drug-

disease interactions if prescribed b-blockers or broncho-constrictor
medication?
A. Asthma patients
B. Hypertensive patients
C. Diabetic patients
D. Cancer patients

71. In the context of cardiovascular health, what adverse outcome has

been associated with the use of a-blockers in patients experiencing
syncope?
A. Heart failure
B. Arrhythmia
C. Hypertension
D. Stroke

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72. What is a crucial aspect of preventing drug-disease interactions
according to the content?
A. Genetic testing
B. Regular exercise
C. Efficient monitoring
D. Herbal remedies

73. Which healthcare professionals are highlighted as the most suitable

for managing pharmacotherapy according to the content?
A. Pharmacists
B. Nurses
C. Physicians
D. Dietitians

74. What should guideline developers focus on to enhance the

prevention of drug-disease interactions?
A. Epidemiological knowledge
B. Government regulations
C. Patient satisfaction
D. Pharmaceutical sales

75. What role do comorbidities play in the treatment of patients

according to the content?

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A. No role
B. Moderate role
C. Minor role
D. Important role

76. Why is individualization of patient treatment emphasized in

reducing drug interactions and adverse drug reactions?
A. To complicate treatment
B. To increase costs
C. To improve outcomes
D. To limit access

77. What may cause the pharmacological action of a medicine to

deviate from the expected outcome?
A. Healthcare provider's mood
B. Patient's age
C. Drug-drug interactions
D. Weather conditions

78. What is a key factor in achieving success for the healthcare team
according to the content?
A. Customer satisfaction
B. Profit maximization
C. Employee turnover
D. Market share

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Answers 25. C
1. A 50. C
26. B
2. Invalid Answer Index 51. A
27. A
3. B 52. B
28. B
4. B 53. A
29. B
5. A 54. A
30. A
6. A 55. A
31. A
7. C 56. C
32. A
8. A 57. Invalid Answer Index
33. C
9. C 58. A
34. A
10. C 59. C
35. C
11. B 60. C
36. C
12. B 61. B
37. C
13. C 62. B
38. C
14. B 63. A
39. B
15. B 64. A
40. A
16. C 65. A
41. B
17. A 66. A
42. A
18. B 67. A
43. B
19. B 68. B
44. A
20. A 69. C
45. Invalid Answer Index
21. C 70. A
46. B
22. B 71. A
47. A
23. A 72. C
48. A
24. B 73. A
49. A

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‫‪74. A‬‬

‫‪75. Invalid Answer Index‬‬

‫‪76. C‬‬

‫‪77. C‬‬

‫‪78. A‬‬

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