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PharmA provider considers prescribing tamoxifen for a woman with breast cancer. Upon reviewing
results of genetic testing, the prescriber notes that the patient has variations in the
CYP2Dyallele resulting in a deficiency of the CYP2D6 isoenzymes. What action will this
deficiency warrant in the prescribing of tamoxifen, a CYP2D6 substrate?
A. The tamoxifen will not be prescribed.
B. The individual doses of tamoxifen will be increased.
C. The tamoxifen will be ordered but in lower than normal dosage
D.. The patient's serum tamoxifen level will be routinely monitored - ANSANS: A. Women with a
deficiency of CYP2D6 isoenzymes lack the ability to convert tamoxifen to itsactive form,
endoxifen, and will not benefit from this drug. Another drug should be used totreat this patient's
breast cancer. Increasing the dose, reducing the dose, or monitoring serumdrug levels will not
make this drug more effective in these women.
Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response
to tamoxifen therapy?a. African
b. French
c. Native American
d. Japanese - ANSANS: B. Between 8% and 10% of women of European ancestry have a gene
variant that prevents the effective metabolism of tamoxifen that negatively affects the
medication's therapeutic effect.None of the other options present with a similar risk factor.
Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor
(EGFR) testing for the patient having which condition?
a. Breast cancer
b. Colorectal cancer
C. Bone cancer
d. Brain cancer - ANSANS: B Cetuximab is used mainly for metastatic colorectal cancer. The
medication works only againsttumors that express EGRF; all other tumors are unresponsive.
This makes testing in advanceof treatment required. Cetuximab is not appropriate for any of the
other conditions listed.
When considering the benefit of pharmacogenomies, what information should the prescriber
include when prescribing a new medication?
a. Stress the need to contact the primary health care prescriber immediately if side effects occur
b. Provide definitions and possible examples of related idiosyncratic responses to this
medication.
C. Explain any necessary precautions to take regarding medication administration.
d. Give a detailed explanation regarding the method for discontinuing the medication, should it
become necessary. - ANSANS: B. A patient's unique genetic makeup can lead to drug
responses that are qualitatively and quantitatively different from those of the population at large.
,Adverse effects and therapeutic effects may be increased or reduced. Idiosyncratic responses
to drugs may also occur. Educating the patient on the concept and examples of idiosyncratic
responses should be included in the medication education provided. The other options are
appropriate but not directly related to pharmacogenomics.
A provider has prescribed a female patient a medication that induces P-glycoprotein (PGP). The
provider will be particularly concerned about which aspects of the patient's medicalhistory?
(Select all that apply.)
a. Intestinal problems
b. Kidney function
C. Liver function
d. Pregnancy
e. Seasonal allergies - ANSA,B,C
Drugs that induce PGP can increase drug export from cells of the intestinal epithelium into
theintestinal lumen, thus decreasing absorption of the drug. PGP inducers also increase
drugelimination and decrease brain and fetal drug exposure. Seasonal allergies are not
generally aconcern.
When prescribing medications to infants, it is important for the provider to consider which fact?
(Select all that apply.)
a. Breast-feeding infants are more likely to develop toxicity when the mother is taking
lipid-soluble drugs.
b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.
C. Infants have immature livers, which slows drug metabolism.
d. Infants are more sensitive to medications that act on the central nervous system (CNS)
e. Oral medications are contraindicated in infants. - ANSANS: B, C, D
Immature renal function causes infants to excrete drugs more slowly, and infants are at risk for
toxicity until renal function is well developed. Infants' livers are not completely developed, and
they are less able to metabolize drugs efficiently. Because the blood-brain barrier is not well
developed in infants, caution must be used when administering CNS drugs. Lipid-soluble drugs
may be excreted in breast milk if the mother is taking them. Oral medications may be given
safely to infants as long as they are awake and can swallow the drug.
A provider recommends genetic testing of a patient before prescribing a medication. What
response should the provider give when asked by the patient about the purpose of
genetictesting?
a. "Genetic testing better establishes the drug's therapeutic index."
b. "Such testing will tell us how quickly your body is likely to metabolize, or process, the drug"
C. "The testing helps identify any factors that could affect psychosocial variation in the drug's
response."
d. "It guides the production of a drug that is tailored to your individual genetic makeup." -
ANSANS: B. Pharmacogenomics is the study of the ways genetic variations affect individual
responses todrugs through alterations in genes that code for drug-metabolizing enzymes and
drugreceptors. For some drugs, the FDA requires genetic testing, and for others, this testing
, isrecommended but not required. Genetic testing does not determine a drug's therapeutic
index;this is a measure of a drug's safety based on statistics of the drug's use in the
generalpopulation (see Chapter 5). Any distinct physiologic differences in drug response
amongvarious racial populations are related to genetic differences and do not affect
psychosocialdifferences in drug responses. Genetic testing is recommended to identify how a
patient willrespond to a drug and not to design a drug specific to an individual.
A patient reports mild nausea within an hour after taking the first two doses of a newly approved
medication. Nausea is not listed among the known side effects of this drug. What instructions
will the provider give the patient?
a. "Take the next dose with food and call the office if the nausea reoccurs or if other symptoms
develop.?"
b. "Discontinue the medication and a substitute will be prescribed."
c. "Reporting the situation to the MEDWATCH program will get us a recommendation about
continuing the drug."
d. "I'll write a prescription for an antiemetic to counter this drug's effects." - ANSANS: A. Not all
adverse drug reactions (ADRs) are detected during clinical trials, and prescribers should be
alert to any effects that may result from drug administration. The time of nausea onset suggests
that this is drug-related. Unless contraindicated, taking drugs with food will usually relieve or
decrease nausea. Because there is a possibility that the nausea is not drug-related, it is
important to ask the patient to report the recurrence or worsening of the symptom or the addition
of new symptoms. It is not necessary to hold the drug, becausenausea is not a serious side
effect. The MEDWATCH program should be notified when there is a greater suspicion that the
drug may have caused the nausea, e.g., if the nausea occurs with subsequent doses. Until
there is greater suspicion that the drug caused this patient's nausea and because the patient is
not vomiting, giving an antiemetic is not indicated.
A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of
the same drug. Which statement informs the prescriber's response when explaining this
phenomenon to the patient?
a. Advertising by pharmaceutical companies can enhance patient expectations of one brand
over another, leading to a placebo effect
b. Because the drug preparations are chemically equivalent, the actions of the two brands must
be identical.
C. Inactive ingredients used in composition can result in differing rates of dissolution, which can
alter the drug's onset of action.
d. The bioavailability of a drug is determined by the amount of the drug in each dose. -
ANSANS: C Even if two brands of a drug are chemically equivalent (i.e., they have identical
amounts of the same chemical compound), they can have different effects in the body if they
differ in bioavailability. Tablets made by different manufacturers contain different binders and
fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug.
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