quizzes and exams RXRS 200

Metabolic syndrome

Is believed to be on the rise due the increase prevalence of obesity

Is associated with risk factors for type II diabetes, heart disease, and stroke

Is a collection of diseases that all result from insulin resistance

...all of the above

Angioplasty and stenting are surgical interventions for dyslipidemia

false

A new patient named Bob comes into your pharmacy seeking advice. Bob was recently diagnosed with Type II diabetes (T2D) coronary artery disease. You tell Bob that he is only one risk factor away from being diagnosed with metabolic syndrome.
[Select All That Apply] What other risk factor(s) could be combined with Bob's pre-existing conditions (diagnoses of Type II diabetes and coronary artery disease) to qualify a new diagnosis of metabolic syndrome?

Elevated fasting glucose levels

Elevated waist circumference

Elevated triglycerides

What is the most important risk factor for developing atherosclerosis?

Dyslipidemia

Supplements and vitamins have no interactions with pharmaceuticals prescribed to treat Type II diabetes diseases

False

Select All That Apply] Insulin is

A peptide hormone

Produced by beta islet cells in the pancreas

Required for glucose to move into cells

Why do clinicians struggle to convince their hypertension patients to adhere to medication regimens?

Patients usually have no outward signs of disease and do not show signs of improvement after taking their prescribed medications

Which of the following is NOT a therapeutic approach to manage coronary artery disease?

Diuretics to remove excess sodium and water from the body

An increase in systolic blood pressure is expected with age, even in the absence of disease

True

Which of the following is NOT a therapeutic approach to manage insulin resistance diseases?

Blocking removal of glucose from the bloodstream

According to the 3P model in insomnia, receiving a diagnosis such as hepatitis can lead to insomnia. How would this news be categorized in the context of the 3P model?

The diagnosis is a precipitating factor

True or False: Patients who have unipolar depression will be managed with the same approach as someone with bipolar depression

false

Which of the following is true regarding melatonin?

Melatonin can be purchased without a prescription

True or False: Precipitating factors for insomnia include both positive and negative experiences

true

True or False: Dreams can occur in both rapid eye movement and non-rapid eye movement sleep

true

[Select all that Apply] Which of the following is a potential consequence of chronic insomnia?

a. Increased risk of heart disease
b. Decreased work productivity
d. Decreased insulin sensitivity

Which of the following would be a characteristic for the ideal hypnotic?

No tolerance capacity

[Select all that Apply] Which of the following is an appropriate first line treatment for someone who is diagnosed with both major depression and generalized anxiety disorder?

c. Selective serotonin reuptake inhibitors
Serotonin-norepinephrine reuptake inhibitor

What is the appropriate classification for a person who expresses they have twitching during the day as a result of their generalized anxiety disorder?

Physical symptoms

Pharmacokinetic analysis suggests that systemic elimination half-life of sumatriptan is approximately 2.5 hours. Radiolabeled sumatriptan administered orally is largely renally excreted (about 60%) with about 40% found in the feces. Only 3% of the dose can be recovered as unchanged sumatriptan. If a rule of thumb says it takes approximately 5 half-lives (i.e. 2.5hr times 5) to wash out any drug, in the case of IMITREX overdosing subjects should be monitored for at least

12-to-13 hr

Which of the following statements about adjuvants is FALSE?

Adjuvants do not activate cells of the immune system

herd immunity

Protects members of the population who can't receive the vaccine

Botox (Botulinum Toxin) is:

Can be used as a therapeutic for migraine prevention

A drug derived from the toxin of a bacteria

Given parenterally

Typically all drug dosage forms do not contain 100% active (the active is the drug). On average, approxiamtely 20% of a dosage form is the active ingredient. The remaining fraction of a dosage form is called

Excipient (inactive ingredients)

the fact that most small molecule drugs (e.g. tablets, pills, capsules, etc.) can be stored at ambient conditions (normal room temperature and typical fluctuations thereof), while biologics require controlled usually cold or frozen storage away from light and possible air, speaks to a major distinction between these two modalities of drugs called

chemical stability

Pharmacotherapeutics describes the mechanisms of actions of drugs and how they work in the body.

false

Dose response data was collected during the testing of four agents for the treatment of pain relieve. Which drug studied was the most efficacious? Use the graph below.

Drug C

How many copies of a gene does a human usually inherit?

2

Which of the following are examples of evidence on the relationship between expected revenues for pharmaceuticals and investments in pharmaceutical innovation? Check all that apply.

There is more research and development for drugs that treat Alzheimer's Disease than tuberculosis

Drug development for conditions that disproportionately affect the elderly (like Alzheimer's Disease) increased after the creation of Medicare Part D

There is more research and development for drugs that treat Alzheimer's Disease than tuberculosis

toxin vaccines

Generate neutralizing antibodies against a toxin vs whole organis

Which family of enzymes is responsible for the metabolism of most drugs?

Cytochrome P-450

Pharmacists are known as the ________expert.

medication

echnosphere® (TI) is a technology used in the FDA approved Inhaled Insulin product, which is the rapid-acting therapy in AFREZZA®. What is an excipient in AFREZZA®? Read the label and identify the correct response.

Fumaryl diketopiperazine (FDKP)

In drug discovery settings absolute oral bioavailability (aBA), mathematically defined as percentage, i.e. when a drug is taken by mouth, divided by total exposure when it is injected directly into the vein, multiplied by 100 (e.g. AUCpo/AUCiv*100; po means per os by mouth in latin, iv means intravenous) is

rarely estimated for orally administered medicines because an intravenous formulation is required in addition to oral, which becomes resource intensive to manage esp. if the ultimate intention is to commercialize an oral dosage form for patient self-administration

The adaptive branch of the immune system is what generates immunological memory to past infections and vaccines

true

Vaccines only induce neutralizing antibody responses

false

One of the oldest examples of biologic drug products, that certainly predates modern biotechnology based pharmaceuticals available currently is

insulin

Why does immunization with vaccinia (Cowpox) virus protect people against smallpox?

Vaccinia and smallpox viruses share surface antigens so neutralizing antibodies can be made by the immune system that protect against infection by both viruses

In a dose response curve, when there is a "LEFT SHIFT" this means there is:

Increase in potency

Because of the fact that biologics are overall more sensitive than small molecule drugs to handling and storage conditions, and display comparative instability, they are also chemically and metabolically labile (soft). For this reason practically all biological medicines are administered

by parenteral (anything other than enteral, e.g. injections, infusions, etc.) routes of drug delivery

[Select all that apply] Elimination of a drug contain these two processes:

Metabolism

Excretion/Elimination

In naming a drug, the precise description of a drug's chemical structure is defined as the drug's:

chemical name

n 1928 Dr. Ian Fleming studied Staph (a type of bacteria), but encountered contamination of plates with airborne mold. He noticed that bacteria were lysed in the area of mold growth. This lead to the identification of a mold product which inhibited the growth of bacteria, i.e. the antibiotic penicillin. This historic case study describes

serendipitous findings leading to new drug discovery.

Review the provided data plot for insulin pharmacokinetcs to select the best answer. The maximal uIU/mL (Cmax) of insulin decreases after 240min as shown in the figure. Which TI dose (this is the inhaled insulin product AFREZZA) has the longest time above Cmax? (note that insulin concentration units are typically measured in uIU/mL, micro insulin units per milliliter of volume of blood)

32 uIU dose

The process of candidate compound design, testing and then depending on the outcome measures, optimization and then retesting, resulting in multiple rounds of experimentation to continue optimizing compound properties to fit within defined window of acceptability with the eventual goal of advanced preclinical or clinical studies refers to the concept of

how drug discovery is NOT linear.

Looking at the data graph and figure explanation, estimate on the duration of time axis approximately, how AFREZZA® TI formulation acts ________ fold faster to lower blood glucose compared to a subcutaneous injection of 15 IU RHI (bold/dark dotted line). The U TI designation referrs to inhaled insulin dose and the IU RHI refers to subcutaneous injection.

5

The abbreviation "CPA" is commonly used in the ambulatory care setting. What does this abbreviation stand for?

Collaborative Practice Agreement

[Select All That Apply] Immunological memory is generate

Through vaccination

By the adaptive immune system

Select all the possible reasons for program failure in drug discovery or development settings.

Commercial feasibility

Target druggability

Clean toxicology profile (e.g. no alerts in cardio, central nervous system, reproductive, etc.)

Drugs that are derived from biotechnology are considered

as biologics if they have a large molecular weight and complex structure, such as a protein

IMITREX for injection (supplied in glass vials), as opposed to nasal spray or tablets, is designed to provide rapid intervention during migraine attacks in a

hospital or clinic setting

Which is NOT a valid statement on prevailing di$erences between small molecule drugs (SMDs) and biological
medicines (BMs).

precise analytical methods exist for both SMDs and BMs to easily characterize them on an atomic or
molecular identity resolution level

The process of finding a new drug can be characterized by:

High costs (~ $1 BB)

High rates of attrition at each stage of the pipeline

Long cycle times (~15 years)

After a patient is diagnosed with late-stage cancer, their oncologist wishes to maintain the patient only on morphine to
relieve the pain and no future plans for other modes of treatment. What would be an appropriate classification for the role
of morphine in this patient's care?

pallative

500mg of Drug X was given at 8:00AM to a patient via intravenous bolus. At 8:00PM, there was 250mg of drug in the body.
What is the half-life of this drug?

12hr

Based on the total dose given (observing the box-label on various shown IMITREX® migraine treatment presentations),

rank order from most efficient formulation & route to least efficient.

injection=STAT dose > nasal spray > tablets

The first phase of drug metabolism is done primarily by the liver

true

When a patient takes an inducer of CYP 450 enzymes, drug elimination will decrease.

false

Which of the following terms describe the application of pharmacokinetic principles to individualize
pharmacotherapy?

d. Therapeutic drug monitoring

Biologics such as monoclonal antibodies are much larger in size than molecules like aspirin

true

For PRO Drugs, activation creates active metabolite which has pharmacologic effect

true

Which of the following is NOT a pharmacokinetic process?

receptor binding

Which of the following options is not included or considered by the term pharmacokinetics (not included in PK)? (what the body does to the drug or how the drug gets in, gets around - circulates, and gets out of the body)

Clinical response to a drug ie; toxicity or adverse events & efficacy (e.g. lowering blood glucose after injection of insulin)

What is the name of the law that allows pharmacists to administer immunizations without a prescription from a prescriber?

SB 493

which of the following formulas defines bioavailability?

Amount of drug absorbed ÷ drug dose

What would be the result if someone is an ultra-rapid metabolizer for an ACTIVE drug?

Less drug response at typical doses

When a drug has multiple receptor target sites that can cause a variety of side effects, the drug is considered:

Non-specific

If one considers isolating penicillin from Penicillium chrysogenum, the mold (fungus) which naturally produces this well-known, structurally simple small-molecule antibiotic drug, as opposed to synthesizing it in a organic chemistry lab, which instance of di$erences between small-molecule vs. biologic drugs correctly classi#es penicillin as a small molecule and NOT a biologic?

in this hypothetical scenario penicillin is actually produced by non-genetically modified, non-GMO, fungus, as opposed to recombinant technology which interjects enzymatic machinery cloned from fungi into another host expression system for production

Due to provisions in the Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) will negotiate prices for some drugs, first taking effect in 2026.

true

Which of the following route of drug delivery will bypass first-pass metabolism in the liver?

Intravenous infusion

Evaluate the structure of the active ingrdient in IMITREX, called sumatriptan, in the figure. What is the difference in drug substance (DS), another way of saying active ingredient, chemical form between nasal spray and all others (refers to the ?

free base of sumatriptan vs. succinate salt form of sumatriptan

Serendipity, screening, chemical modification and rationale drug design are all techniques and strategies that have been successfully used in Drug Discovery campaigns.

TRUE

Thinking about the "A" in the acronym ADME, but more importantly what must occur before the "A" has the opportunity to begin, the functional formulation role sumatriptan succinate can play in 50mg IMITREX tablets is in ensuring complete

(hint* what is a typical physical feasure of salt when mixed with water

dissolution of the solid dose.

To become a pharmacist who can dispense medications at a location like Walgreens, what training must they now obtain?

pharmD

deally, volcanologists want to design a vaccine that

is safe and/or has limited side effects

Has limited or no cold chain requirements

Generates sterilizing immunity

Select all which may be valid reasons for failure in drug discovery and development.

False positives

Poor selectivity against subtypes of target prtein

Target validation

When looking at the structure and function of G-protein coupled receptors:

G-proteins coupled receptors will have 7 transmembrane domains