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Drug Clearance:  Liver Metabolism, Renal Excretion, Redistribution, Protein Binding

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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

Correct Answers

1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21






































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

BACK







































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

Answer: True

BACK







































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

Answer: (B) rate-limiting step is drug delivery to hepatic elimination sites

BACK







































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

(C) eventually concentrates usually in adipose (fat) tissue

BACK







































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

Answer: (C) both

BACK







































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

Answer: (B) smooth endoplasmic reticulum

BACK







































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

(D) in rheumatoid arthritis patients, increased alpha1-acidic glycoprotein tends to promote increased lidocaine protein binding

BACK







































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

Answer: (E) all the above

BACK







































Question # 9 (Multiple Choice) Pharmacogenetic effects:

Answer: (C) both

BACK







































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

(A) more polar

(B) more readily excreted

BACK







































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

Answer: (C) redistribution

BACK







































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

(E) decreased renal function

BACK







































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

Answer: (B) hydrolysis

BACK







































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

(A) conjugation

(B) hydrolysis

(C) oxidation

(D) reduction

BACK







































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

Answer: (E) all of the above

BACK







































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

Answer: (D) drug clearance is influenced by the extent of protein binding

BACK







































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

Answer: (A) phase I system

BACK







































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

(A) generally theextent of drug-protein binding parallels drug lipids liability

(D) sulfonamides may displace unconjugated bilirubin from albumin-binding sites (because neonatal bilirubin encephalopathy)

BACK







































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

BACK







































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

Answer: (E) all the above

BACK







































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

Answer: (C) an example of a plasma protein important for drug binding is alpha1-acidic glycoprotein

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