100 University-Level Questions on Drug Interactions Instructions This document

contains 100 questions on drug interactions suitable for university-level pharmacy or

medical students. The questions are divided into three types: - Multiple Choice
Questions (MCQs): Select the single best answer from the options provided Matching
Questions: Match items from column A with the corresponding items in column B - Fill-
in-the-Blank Questions: Complete the statement with the appropriate term or phrase An
answer key is provided at the end of the document.

SECTION I: MULTIPLE CHOICE QUESTIONS

(MCQs) Drug Interaction Information Resources 1. Which of the following is considered a
tertiary source for drug interaction information? a) Original research papers b)
Micromedex database c) Case reports d) Clinical trial data Answer: b) Micromedex
database

1. Which resource would be most appropriate for quickly checking a potential drug
interaction in clinical practice? a) Primary literature b) Web-based drug interaction
checker c) Original research papers d) Raw clinical trial data

Drug Interaction Definitions 1. A drug interaction occurs when: a) Two drugs are
prescribed simultaneously b) The effects of one drug are changed by another drug, food,
herb, or chemical c) A patient takes multiple medications at different times d) A
medication is taken with water

2. In a drug interaction between warfarin and aspirin, warfarin would be considered the:
a) Precipitant drug b) Object drug c) Neutral drug d) Catalytic drug 3. The term
"precipitant drug" refers to: a) The drug affected by the interaction b) The drug,
chemical, or food element causing the interaction c) The drug that precipitates in
solution d) The drug that requires precipitation before administration

Classification of Drug Interactions 1. Which type of drug interaction occurs when the
absorption, distribution, or elimination of a drug is affected? a) Pharmacodynamic
interaction b) Pharmacokinetic interaction c) Pharmacogenetic interaction d)
Pharmaceutical interaction 2. A chemical incompatibility between two drugs mixed in an
IV solution is an example of: a) Pharmacokinetic interaction b) Pharmacodynamic
interaction c) Pharmacogenetic interaction d) Pharmaceutical interaction 3. When
genetic polymorphisms alter the pharmacokinetic effect of a drug, this is classified as: a)
Pharmacodynamic interaction b) Pharmacokinetic interaction c) Pharmacogenetic
interaction d) Pharmaceutical interaction 4. Which interaction occurs when the
pharmacodynamic effect of a drug is altered by another substance? a) Pharmacokinetic
interaction b) Pharmacodynamic interaction c) Pharmacogenetic interaction d)
Pharmaceutical interaction 5. Regular insulin converting to Lente insulin when mixed is
an example of: a) Pharmacokinetic interaction b) Pharmacodynamic interaction c)
Pharmacogenetic interaction d) Pharmaceutical interaction

Pharmacokinetic Interactions - Absorption 1. The interaction between calcium and

fluoroquinolones is an example of: a) Adsorption b) Complexation/chelation c) Altered
gastric pH d) Altered intestinal flora 2. Which mechanism explains the interaction
between cholestyramine and digoxin? a) Complexation/chelation b) Adsorption c)
Altered gastric pH d) Competition for Pgp system Answer: b) Web-based drug
interaction checker

3. Laxatives can decrease the bioavailability of controlled-release products by: a)

Increasing GI motility b) Decreasing GI motility c) Altering gastric pH d) Altering intestinal
flora 4. H-2 blockers, antacids, and proton pump inhibitors affect drug absorption
primarily by: a) Increasing GI motility b) Decreasing GI motility c) Altering gastric pH d)
Altering intestinal flora Answer: b) Object drug

1. The reduced bioavailability of ketoconazole when taken with antacids is due to: a)
Increased dissolution at basic pH b) Reduced dissolution at basic pH c) Increased
GI motility d) Competition for absorption sites
2. Antibiotics can reduce the effectiveness of oral contraceptives by: a) Increasing GI
motility b) Decreasing GI motility c) Altering gastric pH d) Altering intestinal flora
3. Verapamil increases the absorption of digoxin by affecting: a) The P-gp system b)
Gastric pH c) GI motility d) Intestinal flora
4. Grapefruit juice reduces the bioavailability of oral fexofenadine by inhibiting: a)
CYP3A4 enzymes b) P-gp system c) OATP protein d) Gastric acid secretion

Pharmacokinetic Interactions - Distribution 1. Valproic acid increases phenytoin levels

primarily through: a) Increased absorption b) Plasma protein displacement and enzyme
inhibition c) Decreased renal clearance d) Increased hepatic blood flow 2. Which drug
can displace digoxin from both alpha-1 glycoprotein and albumin tissue-binding sites? a)
Warfarin b) Aspirin c) Quinidine d) Valproic acid

Pharmacokinetic Interactions - Metabolism 1. Smoking decreases the levels of

duloxetine through: a) Enzyme induction b) Enzyme inhibition c) Reduced absorption d)
Increased renal clearance 2. Cimetidine increases atorvastatin levels by: a) Enzyme
induction b) Enzyme inhibition c) Increased absorption d) Decreased renal clearance 3.
Which of the following is an inhibitor of CYP1A2? a) Phenytoin b) Carbamazepine c)
Ciprofloxacin d) Tobacco 4. St. John's Wort is known to induce which CYP enzyme? a)
CYP1A2 only b) CYP2D6 only c) CYP3A4 only d) Multiple CYP enzymes including CYP3A4

5. Which drug is a substrate for CYP2C9? a) Amitriptyline b) Warfarin c) Diazepam d)

Acetaminophen 6. Grapefruit juice is a known inhibitor of: a) CYP1A2 b) CYP2C9 c)
CYP2D6 d) CYP3A family 7. The interaction between MAOIs and tyramine-rich foods can
result in: a) Serotonin syndrome b) Hypertensive crisis c) Respiratory depression d)
Hypoglycemia 8. Serotonin syndrome can occur when SSRIs are co-administered with: a)
Betablockers b) ACE inhibitors c) MAOIs d) Statins

Pharmacokinetic Interactions - Renal Clearance 1. Methylxanthines like caffeine affect

drug clearance by: a) Decreasing GFR and renal blood flow b) Increasing GFR and renal
blood flow c) Blocking active tubular secretion d) Altering urine pH 2. Probenecid
interacts with penicillin by: a) Increasing GFR b) Decreasing GFR c) Blocking active
tubular secretion d) Alkalinizing urine 3. Alkalinization of urine increases the clearance
of: a) Amphetamine b) Salicylates c) Both amphetamine and salicylates d) Neither
amphetamine nor salicylates

Pharmacodynamic Interactions 1. The increased drowsiness when narcotics and

antihistamines are combined is an example of: a) Antagonistic pharmacodynamic
interaction b) Synergistic pharmacodynamic interaction c) Pharmacokinetic interaction
d) Pharmaceutical interaction 2. Naloxone and opioids represent which type of
pharmacodynamic interaction? a) Synergistic effect b) Additive effect c) Antagonistic
effect d) No interaction 3. The increased risk of QTc interval arrhythmias when multiple
QTc-prolonging drugs are given together is an example of: a) Antagonistic effect b)
Synergistic effect c) No interaction d) Pharmaceutical interaction 4. Thiazide diuretics
can increase digoxin toxicity by: a) Increasing digoxin absorption b) Decreasing digoxin
metabolism c) Depleting potassium d) Increasing digoxin excretion

5. Diuretics can cause lithium toxicity by: a) Depleting potassium b) Depleting sodium c)
Increasing lithium metabolism d) Decreasing lithium absorption Answer: b) The drug,
chemical, or food element causing the interaction

1. The antagonism of warfarin's effect by vitamin K is an example of: a)

Pharmacokinetic interaction b) Pharmaceutical interaction c) Pharmacodynamic
interaction d) Pharmacogenetic interaction

Herbal-Drug Interactions 1. St. John's Wort primarily affects drug metabolism by: a)
Inhibiting CYP3A4 b) Inducing CYP3A4 c) No effect on CYP enzymes d) Inhibiting all CYP
enzymes 2. The combination of St. John's Wort and SSRIs can lead to: a) Decreased SSRI
effect b) Serotonin syndrome c) No interaction d) Decreased St. John's Wort effect
Answer: b) Web-based drug interaction checker

1. St. John's Wort can lower the levels of warfarin by: a) Inducing CYP2C9 b) Inhibiting
CYP2C9 c) Increasing warfarin absorption d) Decreasing warfarin excretion

Additional MCQs 1. Which of the following is NOT a mechanism of pharmacokinetic drug

interactions affecting absorption? a) Complexation/chelation b) Adsorption c) Receptor
site competition d) Alteration of gastric pH 2. The conversion of regular insulin to Lente
insulin when mixed is due to: a) pH changes b) Protein binding displacement c) Enzyme
induction d) Receptor site competition 3. Which drug pair represents a pharmaceutical
interaction due to charge differences? a) Penicillin and aminoglycoside b) Warfarin and
aspirin c) Digoxin and quinidine d) Phenytoin and valproic acid 4. Chronic ethanol use is
known to induce which CYP enzyme? a) CYP1A2 only b) CYP2D6 only c) CYP2E1 only d)
Multiple CYP enzymes 5. The primary mechanism of interaction between cimetidine and
atorvastatin is: a) Decreased absorption of atorvastatin b) Inhibition of atorvastatin
metabolism c) Displacement from protein binding sites d) Increased renal clearance of
atorvastatin 6. Which statement about drug interactions is FALSE? a) All drug
interactions are clinically significant b) Drug interactions can occur with food and herbs
c) Drug

interactions can be beneficial in some cases d) Drug interactions can affect both
pharmacokinetics and pharmacodynamics 7. The primary information source that
provides the most up-to-date drug interaction information is: a) Tertiary sources like
textbooks b) Primary literature c) Patient package inserts d) Social media 8. St. John's
Wort decreases digoxin levels by: a) Decreasing digoxin absorption b) Increasing digoxin
metabolism c) Increasing catalyzed efflux of digoxin d) Decreasing digoxin distribution 9.
Which of the following receptor sites is NOT affected by St. John's Wort? a) GABA b)
Serotonin c) Dopamine d) Insulin 10. St. John's Wort inhibits: a) Only MAO b) Only
phosphodiesterase c) Both MAO and phosphodiesterase d) Neither MAO nor
phosphodiesterase

SECTION II: MATCHING QUESTIONS

Set 1: Drug Interaction Classifications Match the drug interaction classification with its
correct definition: 1. Pharmacokinetic interaction 2. Pharmacodynamic interaction 3.
Pharmacogenetic interaction 4. Pharmaceutical interaction a. Occurs when the
pharmacodynamic effect of a drug is altered by another substance b. Occurs when the
absorption, distribution, or elimination of a drug is affected c. Occurs when genetic
polymorphisms alter the pharmacokinetic effect of a drug d. Occurs when there is a
chemical or physical incompatibility between drugs

Set 2: Pharmacokinetic Interaction Mechanisms Absorption Match the interaction

mechanism with its correct example: 1. Complexation/chelation 2. Adsorption

3. Altered gastric pH 4. Altered intestinal flora 5. Competition for P-gp system a.

Cholestyramine reducing digoxin bioavailability b. Calcium reducing fluoroquinolone
absorption c. Antibiotics affecting oral contraceptive effectiveness d. H-2 blockers
reducing ketoconazole dissolution e. Verapamil increasing digoxin absorption
Set 3: CYP Enzyme Inhibitors Match the CYP enzyme with its inhibitor: 1. CYP1A2 2.
CYP2C9 3. CYP2C19 4. CYP2D6 5. CYP3A family a. Fluconazole b. Ritonavir c.
Ketoconazole d. Ciprofloxacin e. Erythromycin Answers: 1. [Answer Not Found in Key] 2.
[Answer Not Found in Key] 3. [Answer Not Found in Key] 4. [Answer Not Found in Key] 5.
[Answer Not Found in Key] 6. [Answer Not Found in Key] 7. [Answer Not Found in Key] 8.
[Answer Not Found in Key] 9. [Answer Not Found in Key] 10. -> d. [Option 'd ' Text Not
Found] 11. -> a. Fluconazole b. Ritonavir c. Ketoconazole d. Ciprofloxacin e.
Erythromycin 12. -> c. [Option 'c ' Text Not Found] 13. -> b. [Option 'b ' Text Not Found]
14. -> e. [Option 'e ' Text Not Found]

Set 4: CYP Enzyme Inducers Match the CYP enzyme with its inducer: 1. CYP1A2 2. CYP2C9
3. CYP2C19 4. CYP2D6 5. CYP3A family a. Rifampin b. St. John's Wort c. Phenytoin d.
Carbamazepine e. Tobacco Answers: 1. [Answer Not Found in Key] 2. [Answer Not Found
in Key] 3. [Answer Not Found in Key] 4. [Answer Not Found in Key] 5. [Answer Not Found
in Key] 6. [Answer Not Found in Key] 7. [Answer Not Found in Key] 8. [Answer Not Found
in Key] 9. [Answer Not Found in Key] 10. [Answer Not Found in Key] 11. [Answer Not
Found in Key] 12. [Answer Not Found in Key] 13. [Answer Not Found in Key] 14. [Answer
Not Found in Key] 15. -> e. [Option 'e ' Text Not Found] 16. -> c. [Option 'c ' Text Not
Found] 17. -> a. Rifampin b. St. John's Wort c. Phenytoin d. Carbamazepine e. Tobacco
18. -> d. [Option 'd ' Text Not Found] 19. -> b. [Option 'b ' Text Not Found]

Set 5: CYP Enzyme Substrates Match the CYP enzyme with its substrate: 1. CYP1A2 2.
CYP2C9 3. CYP2C19 4. CYP2D6 5. CYP2E1

a. Warfarin b. Diazepam c. Haloperidol d. Acetaminophen e. Amitriptyline Answers: 1.

[Answer Not Found in Key] 2. [Answer Not Found in Key] 3. [Answer Not Found in Key] 4.
[Answer Not Found in Key] 5. [Answer Not Found in Key] 6. [Answer Not Found in Key] 7.
[Answer Not Found in Key] 8. [Answer Not Found in Key] 9. [Answer Not Found in Key] 10.
[Answer Not Found in Key] 11. [Answer Not Found in Key] 12. [Answer Not Found in Key]
13. [Answer Not Found in Key] 14. [Answer Not Found in Key] 15. [Answer Not Found in
Key] 16. [Answer Not Found in Key] 17. [Answer Not Found in Key] 18. [Answer Not Found
in Key] 19. [Answer Not Found in Key] 20. -> e. [Option 'e ' Text Not Found] 21. -> a.
Warfarin b. Diazepam c. Haloperidol d. Acetaminophen e. Amitriptyline 22. -> b. [Option
'b ' Text Not Found] 23. -> c. [Option 'c ' Text Not Found] 24. -> d. [Option 'd ' Text Not
Found]

Set 6: Pharmacodynamic Interactions Match the pharmacodynamic interaction type

with its example: 1. Synergistic effect 2. Antagonistic effect 3. Increased sensitivity 4.
Drug-food interaction 5. Drug-herb interaction a. Naloxone reversing opioid effects b.
Thiazide diuretics increasing digoxin toxicity c. Vitamin K reducing warfarin effectiveness
d. Narcotics and antihistamines causing excessive drowsiness e. St. John's Wort causing
serotonin syndrome with SSRIs
Set 7: Renal Clearance Interactions Match the renal clearance mechanism with its
interaction: 1. Glomerular filtration rate 2. Active tubular secretion 3. Tubular
reabsorption 4. Urine pH alkalinization (effect 1) 5. Urine pH alkalinization (effect 2) a.
Probenecid blocking penicillin secretion b. Methylxanthines increasing drug excretion c.
Decreased amphetamine clearance d. Increased salicylate clearance e. Diuretics
affecting lithium levels

SECTION III: FILL-IN-THE-BLANK

QUESTIONS 1. A(n) __ occurs when the effects of one drug are changed by the presence
of another Answer: drug interaction

drug, food, herb, or chemical. 2. The drug, chemical, or food element causing an
interaction is called the __ drug. Answer: precipitant

1. The drug affected by an interaction is called the __ drug. Answer: object

4. __ interactions occur when the absorption, distribution, or elimination of a drug is

Answer: Pharmacokinetic

affected by another substance. 5. __ interactions occur when the pharmacodynamic

effect of a drug is altered by Answer: Pharmacodynamic

another substance, producing an antagonistic, synergistic, or additive effect. 6. __

interactions occur when genetic polymorphisms alter the pharmacokinetic Answer:
Pharmacogenetic

effect of a drug. 7. __ interactions are caused by chemical or physical incompatibilities

when two or Answer: Pharmaceutical

more drugs are mixed together. 8. The interaction between calcium and
fluoroquinolones is an example of __, which Answer: complexation/chelation

reduces drug absorption. 9. Cholestyramine reduces the bioavailability of digoxin

through the mechanism of . 10. H-2 blockers, antacids, and proton pump inhibitors
affect drug absorption primarily by altering . 11. Antibiotics can reduce the
effectiveness of oral contraceptives by altering __. Answer: intestinal flora

1. Verapamil increases the absorption of digoxin by affecting the __ system. Answer:

P-gp (P-glycoprotein)

2. Grapefruit juice reduces the bioavailability of oral fexofenadine by inhibiting the __

Answer: OATP
protein. 14. Valproic acid increases phenytoin levels through plasma protein __ and
enzyme __. Answer: displacement, inhibition

1. Smoking decreases the levels of duloxetine through enzyme __. Answer: induction

2. Cimetidine increases atorvastatin levels by enzyme __. Answer: inhibition

3. St. John's Wort is known to __ CYP3A4, resulting in decreased levels of drugs

Answer: induce

metabolized by this enzyme. 18. The interaction between MAOIs and tyramine-rich foods
can result in __ crisis. Answer: hypertensive

1. Serotonin syndrome can occur when SSRIs are co-administered with __. Answer:
MAOIs

2. Probenecid interacts with penicillin by blocking __. Answer: active tubular

secretion

3. Alkalinization of urine __ the clearance of salicylates but __ the clearance of

Answer: increases, decreases

amphetamine.

22. The increased drowsiness when narcotics and antihistamines are combined is an
example of a(n) __ pharmacodynamic interaction. 23. Naloxone and opioids represent
a(n) __ pharmacodynamic interaction. Answer: antagonistic

1. Thiazide diuretics can increase digoxin toxicity by depleting __. Answer: potassium

2. The antagonism of warfarin's effect by vitamin K is an example of a(n) __ Answer:

pharmacodynamic

interaction.

Memos
Key Takeaways from Drug Interaction Principles:

• Interaction Types: It is crucial to differentiate between pharmacokinetic (affecting

ADME - Absorption, Distribution, Metabolism, Excretion) and pharmacodynamic
(affecting drug effect at the target site) interactions. Pharmaceutical interactions
(incompatibilities) also occur, typically before administration.
• CYP Enzyme System: The Cytochrome P450 enzyme system plays a central role in
drug metabolism. Understanding common inducers (e.g., St. John's Wort,
 Rifampin, Carbamazepine, Phenytoin, smoking) and inhibitors (e.g., grapefruit
juice, cimetidine, azole antifungals, macrolide antibiotics, protease inhibitors like
Ritonavir) is vital for predicting and managing metabolic interactions.
• Absorption Mechanisms: Drug absorption can be significantly altered by various
mechanisms, including chelation/complexation (e.g., calcium with
fluoroquinolones), adsorption (e.g., cholestyramine with digoxin), changes in
gastric pH (e.g., antacids affecting ketoconazole), altered gut motility, effects on
intestinal flora (e.g., antibiotics impacting oral contraceptives), and transporter
protein interactions (e.g., P-glycoprotein affected by verapamil, OATP by grapefruit
juice).
• Clinically Significant Interactions: Be particularly vigilant for interactions
involving drugs with narrow therapeutic indices (e.g., Warfarin, Digoxin, Lithium,
Phenytoin) and those known to cause serious adverse events (e.g., MAOIs with
tyramine leading to hypertensive crisis, SSRIs with MAOIs causing serotonin
syndrome, QTc-prolonging drugs).
• Information Resources: Utilize reliable drug interaction resources. Tertiary
sources (like Micromedex, Lexicomp) and web-based checkers are useful for quick
clinical checks, while primary literature provides detailed evidence. Always
consider patient-specific factors.
• Herbal Interactions: Herbal products, notably St. John's Wort, can cause
significant drug interactions, primarily through CYP enzyme induction (especially
CYP3A4 and CYP2C9) and pharmacodynamic effects (e.g., risk of serotonin
syndrome with SSRIs).