Dose Op Exam 2 Cs's And Hw's

Front 1

T/F
The glomerula filtration rate (GFR) is the maximum value of renal clearance.

Back 1

False

Front 2

T/F
Fluid is filtered across the glomerulus through passive diffusion.

Back 2

True

Front 3

T/F
Both bound and unbound drug can be filtered.

Back 3

False

Front 4

T/F
Highly ionized substances tend to remain in the urine.

Back 4

True

Front 5

Predict how the following parameters will change when the liver blood flow is increased in a patient when taking a high extraction drug.
(a) the extraction ratio (E)
(b) the clearance (Cl)
(c) oral bioavailability (F)

Back 5

(a) the extraction ratio (E): same
(b) the clearance (Cl): increases
(c) oral bioavailability (F): increases

Front 6

Predict how the following parameters will change when the liver blood flow is increased in a patient when taking a low extraction drug.
(a) the extraction ratio (E)
(b) the clearance (Cl)
(c) oral bioavailability (F)

Back 6

(a) the extraction ratio (E): decreases
(b) the clearance (Cl): same
(c) oral bioavailability (F): same

Front 7

List the assumptions that apply to a one-compartment-body model (IV-bolus administration).

Back 7

- Immediate Distribution
- Elimination is a first-order process
- Linear pharmacokinetics

Front 8

T/F
The clearance of a drug relates the dose with AUC0-tlast (assume IV-bolus administration)

Back 8

False

Front 9

Patient A receives 100 mg of drug A. Patient B 200 mg of drug B. (Assume IV-bolus administration).
T/F
The AUC∞ of patient A must be as double as high as the AUC∞ of patient B.

Back 9

False

Front 10

Patient A receives 100 mg of drug A. Patient B 200 mg of drug B. (Assume IV-bolus administration).
T/F
Both patients must show the same free concentrations at time point zero if the volume of distribution of drug B is as double as high the volume of distribution of A.

Back 10

False

Front 11

Patient A receives 100 mg of drug A. Patient B 200 mg of drug B. (Assume IV-bolus administration and linear pharmacokinetics).
T/F
If patient B received 400 mg of drug B instead of 200 mg, his AUC∞ is likely to be twice as high.

Back 11

True

Front 12

T/F
For a high extraction drug, liver blood flow is important to both hepatic clearance and oral bioavailability.

Back 12

True

Front 13

T/F
For low extraction drug, fu (fraction of unbound drug in plasma) is important to both hepatic clearance and oral bioavailability.

Back 13

False

Front 14

T/F
Basic drugs that are polar in their unionized form, the extent of re-absorption depends on the degree of its ionization.

Back 14

False

Front 15

T/F
Secretion is indicated when renal clearance is larger than GFR*fu.

Back 15

True

Front 16

T/F
It is possible for renal clearance to be close to the kidney blood flow.

Back 16

True

Front 17

T/F
Assuming no plasma protein binding, the renal clearance equals the urine flow when full reabsorption occurs.

Back 17

True

Front 18

T/F
For a one compartment body model, Ke can be calculated as Co/AUC∞

Back 18

True

Front 19

T/F
Clearance and volume of distribution are independent.

Back 19

True

Front 20

T/F
A drug with a high volume of distribution always possesses a high clearance.

Back 20

False

Front 21

T/F
If, for a given drug, QH<<<fu*CLint, the drug is considered to be a high extraction drug.

Back 21

True

Front 22

T/F
Metabolites are always less active than their parent compounds.

Back 22

False

Front 23

T/F
Enzyme induction affects the hepatic clearance of low extraction drug.

Back 23

True

Front 24

If, for a given drug QH>>>Fu+CLint, the drug is considered to be a high extraction drug.

Back 24

False

Front 25

T/F
Enzyme induction always affects the hepatic clearance.

Back 25

False

Front 26

T/F
Plasma protein binding is dependent on liver blood flow.

Back 26

False

Front 27

T/F
Enzyme induction affects the hepatic clearance of low extraction drugs.

Back 27

True

Front 28

T/F
Drugs with a high volume of distribution are always low extraction drugs.

Back 28

False

Front 29

T/F
Increasing urine flow will always increases a drug’s renal clearance.

Back 29

False

Front 30

T/F
For gentamycin (polar in its un-ionized form), the extent of re-absorption depends on the degree of its ionization.

Back 30

False

Front 31

T/F
Creatinine clearance can only be used to estimate the renal clearance of drugs that are similar to creatinine, which does not show plasma albumin binding.

Back 31

False

Front 32

T/F
One compartmental model assumes that drugs take no time to distribute around the body.

Back 32

True

Front 33

T/F
Zero-order elimination has a constant drug elimination rate. If you plot the drug concentration vs. time on an ordinary scale, you should see a straight line. Therefore, zero-order elimination displays linear pharmacokinetics.

Back 33

False

Front 34

T/F
According to the equation CL = ke*Vd, if a patient’s Vd doubles, his CL will also double.

Back 34

False

Front 35

A renal clearance of 550 ml /min may suggest the following (assume GFR is 130 ml/min, renal blood flow is 1100ml/min):
T/F
The drug is eliminated by tubular secretion.

Back 35

True

Front 36

A renal clearance of 550 ml /min may suggest the following (assume GFR is 130 ml/min, renal blood flow is 1100ml/min):
T/F
The drug is extensively reabsorbed in renal tubules.

Back 36

False

Front 37

A renal clearance of 550 ml /min may suggest the following (assume GFR is 130 ml/min, renal blood flow is 1100ml/min):
T/F
Drug interactions in renal tubules are possible.

Back 37

True

Front 38

A renal clearance of 550 ml /min may suggest the following (assume GFR is 130 ml/min, renal blood flow is 1100ml/min):
T/F
Drug renal extraction rate E=50%.

Back 38

True

Front 39

How will the following parameters change for a drug that is a high extraction drug eliminated by hepatic clearance only if the free fraction in plasma is changed form 0.2 to 0.8.
(a) Vd
(b) EH
(c) Cl
(d) Ke

Back 39

(a) Vd - increase
(b) EH - remain the same
(c) Cl - remain the same
(d) Ke - decrease

Front 40

Patient AC is prescribed 400 mg of Drug X twice a day (BID). Due to compliance issues, patient BD is taking 800 mg of the same drug once a day (QD).
T/F
Assuming that both patients are at steady state and have the same clearance, patient BD will have a higher average concentration.

Back 40

False

Cpss=D/(CL*tau) Clearance cancels out and 400mg/12hr=800mg/24hr

Front 41

Patient AC is prescribed 400 mg of Drug X twice a day (BID). Due to compliance issues, patient BD is taking 800 mg of the same drug once a day (QD).
T/F
Patient AC will have a higher Cmax than patient BD.

Back 41

False

Since patient BD is given a higher dose less frequently than patient AC, the fluctuation will be more for patient BD. Cmax will be higher and Cmin will be lower for patient BD than for patient AC.

Front 42

Patient AC is prescribed 400 mg of Drug X twice a day (BID). Due to compliance issues, patient BD is taking 800 mg of the same drug once a day (QD).
T/F
Drug X has an elimination rate constant of 0.2hr-1. The patients will be given the drug for one week. Steady state will be reached in both patients.

Back 42

True

t1/2=0.693/0.2hr-1=3.47 hours time to steady state=3.47 hours*5=17.3 hours Steady state will be reached within one day.

Front 43

T/F
Half-life of any drug is only dependent on the elimination rate constant, neither on clearance, nor on volume of distribution.

Back 43

False

Front 44

T/F
For linear pharmacokinetics, there is no any saturation process involved.

Back 44

True

Front 45

T/F
Total drug amount eliminated via urine is always less than the dose administrated.

Back 45

False

D>=U∞

Front 46

T/F
AUC∞ depends on both dose and volume of distribution.

Back 46

False

AUC∞= D/Cl

Front 47

T/F
In a linear one-compartmental model, initial drug concentration and half-life of drug can determine AUC∞ after IV bolus.

Back 47

True

AUC∞= Co/Ke

Front 48

T/F
Total clearance is always larger than hepatic clearance.

Back 48

False

CLtot = CLren + CLbil + CLmet

Front 49

T/F
The maximum value of renal clearance is that of the glomerula filtration rate.

Back 49

False

Front 50

T/F
The degree of tubular reabsorption might be affected by the pH of the urine.

Back 50

True

Front 51

T/F
Reducing liver blood flow may significantly increase the extraction rate and clearance of a low extraction drug.

Back 51

False

Front 52

A renal clearance of 300 ml /min may suggest the following:
T/F
The drug is eliminated by tubular secretion

Back 52

True

Front 53

A renal clearance of 300 ml /min may suggest the following:
T/F
The drug is extensively reabsorbed in renal tubules.

Back 53

False

Front 54

A renal clearance of 300 ml /min may suggest the following:
T/F
Drug interactions in renal tubules are likely.

Back 54

True

Front 55

Assuming that the dose and the half-life of Drug A and Drug B are the same, Drug A has twice the AUC than that of Drug B, so the initial plasma concentration for Drug A is _______ (higher/lower/the same as) that of Drug B.

Back 55

higher


↑AUC∞=↑Co / Ke

Front 56

In looking at the clearance of a drug with a metabolite, if the elimination rate of a parent drug is much smaller than the elimination rate of a metabolite (i.e. ke << keM), then the half-life of the metabolite is _______ (larger/smaller/the same as) the half-life of the parent drug.

Back 56

the same as

Front 57

In a one compartment body model, the distribution of an i.v. bolus administered drug occurs ___________ (over a period of time/immediately).

Back 57

immediately

Front 58

For a drug that follows a first-order elimination, one compartment body model, saturation of enzymes or transporters _______ (does/does not) occur.

Back 58

does not

Front 59

T/F
Ionization, protein binding, glomerula filtration rate and urine flow are the factors that significantly affect the renal clearance of a drug. Assume the drug is only cleared by glomerular filtration with the passive renal re-absorption.

Back 59

True

Front 60

T/F
If Drug A is excreted by glomerular filtration as well as by hepatic metabolism and Drug B is cleared only by hepatic clearance, then in a patient with total renal failure, total body clearance of drug A and B will be affected.

Back 60

False

Front 61

T/F
Normal urine flow is 1-2 ml/min. Clren still can be 0 ml/min even though there is no active re-absorption.

Back 61

True

Front 62

T/F
The maximum value of renal clearance is that of the glomerula filtration rate.

Back 62

False

Front 63

T/F
Tubular secretion most often occurs with weak organic acids.

Back 63

True and False accepted

Front 64

A renal clearance of 700 ml /min may suggest the following:
T/F
The drug is eliminated only by glomerular filtration.

Back 64

False

Front 65

A renal clearance of 700 ml /min may suggest the following:
T/F
The drug is eliminated by tubular secretion.

Back 65

True

Front 66

A renal clearance of 700 ml /min may suggest the following:
T/F
Drug interactions in renal tubules are likely.

Back 66

True

Front 67

A renal clearance of 700 ml /min may suggest the following:
T/F
The drug is probably nonionized.

Back 67

False

Front 68

A renal clearance of 700 ml /min may suggest the following:
T/F
The drug is extensively reabsorbed in renal tubules.

Back 68

False

Front 69

T/F
“Linear pharmacokinetics” means that the plasma drug concentration versus time plots will result in a straight line.

Back 69

False

Front 70

T/F
Hydrophobic and ionized drugs are likely to cross most biological membranes.

Back 70

False

Front 71

T/F
A large value for Vd would mean that more drug is outside the plasma.

Back 71

True

Front 72

T/F
The clearance is equal to the elimination rate constant times the volume of distribution.

Back 72

True

Front 73

T/F
If the volume of distribution increases the clearance must increase.

Back 73

False

Front 74

Which of the following factors does NOT influence glomerular filtration:
a) molecular size
b) protein binding
c) lipid solubility
d) renal blood flow

Back 74

c) lipid solubility

Front 75

T/F
The oral bioavailability (F) for a high extraction drug will be close to 1.

Back 75

False

Front 76

T/F
Clearance will increase significantly after induction of the relevant enzyme with a high extraction drug.

Back 76

False

Front 77

T/F
Regarding a high extraction drug, increase in plasma protein binding will decrease the extraction ratio E.

Back 77

False

Front 78

T/F
Regarding a high extraction drug, the hepatocyte membranes do not represent a barrier.

Back 78

True

Front 79

T/F
With a high extraction drug, if the hepatic blood flow is reduced, the clearance will be decreased.

Back 79

True

Front 80

T/F
If Ke decreases for a drug, its AUC(0-inf) will always increase.

Back 80

False

Front 81

T/F
Two drugs, given as an IV bolus injection, follow a one compartment body model. They do not show drug/drug interactions and their elimination rate constant were the same. Therefore their concentration-time profiles will be identical.

Back 81

False

Front 82

T/F
A patient with liver failure (decrease liver blood flow) was given an IV bolus of drug X (high extraction drug). This drug follows a one compartment body model and is heavily metabolized in the liver. Compared with normal people, this patient would have a much smaller starting concentration and much longer half life for this drug.

Back 82

False

Front 83

T/F
A drug was given to patient A by IV bolus. The same dose was given to patient B also by iv bolus. Patient B shows a much higher plasma protein binding for the drug than patient A. If they have the same clearance for this drug, the AUC(0-inf) for both patients will be the same.

Back 83

True

Front 84

For a lipophilic, protein bound, low extraction drug cleared by liver and kidney:
T/F
Increase in plasma protein binding will increase its Vd.

Back 84

False

Front 85

For a lipophilic, protein bound, low extraction drug cleared by liver and kidney:
T/F
Decrease in creatinine clearance will decrease its Clint.

Back 85

False

Front 86

For a lipophilic, protein bound, low extraction drug cleared by liver and kidney:
T/F
Increase in the liver blood flow will increase its Cl.

Back 86

False

Front 87

For a lipophilic, protein bound, low extraction drug cleared by liver and kidney:
T/F
Liver Enzyme inducer will increase its oral bioavailability.

Back 87

False

Front 88

For a lipophilic, protein bound, low extraction drug cleared by liver and kidney:
T/F
Decrease in plasma protein binding will decrease its oral bioavailability.

Back 88

False

Front 89

Forced diuresis is likely to significantly enhance the clearance of
a. a drug which is both polar and slowly removed from the body
b. a drug for which most of the filtered and secreted drug is reabsorbed
c. a drug for which mainly cleared via metabolism
d. a drug for which the ratio of its renal clearance to creatinine clearance is 1.0

Back 89

b. or b. and d.

Front 90

Assume a drug is almost purely cleared via the kidney. What factors (drug
properties) determine its renal clearance.
a. the size of drug
b. the free fraction in the tissue
c. the free fraction in the plasma
d. the pKa of the drug

Back 90

a, c, and d.

Front 91

T/F
The oral bioavailability (F) of a low extraction drug can be changed by CYP-P450 enzyme induction.

Back 91

False

Front 92

T/F
Clearance (CL) and volume of distribution (Vd) can be calculated from Dose and AUC only.

Back 92

False

Front 93

T/F
The oral bioavailiability of a very lipophilic, neutral, high extraction drug (showing linear pharmacokinetics) after oral administration of a tablet is significantly affected by the liver blood flow, the plasma protein binding, and the dissolution rate.

Back 93

True

Front 94

T/F
The bioavailability is the fraction of an oral dose that enters systemic circulation after administration.

Back 94

True

Front 95

T/F
“Linear pharmacokinetics” means that the plasma drug concentration versus time plots will result in a straight line.

Back 95

False

Front 96

T/F
For a linear model the rate of elimination is proportional to the amount of drug remaining to be eliminated.

Back 96

True

Front 97

T/F
one compartment model means that drug in the blood is in rapid equilibration with drug in extravascular tissues

Back 97

True

Front 98

T/F
For a linear model the rate constant for elimination is proportional to the amount of drug remaining to be eliminated

Back 98

False

Front 99

T/F
Bioavailability of a high extraction drug will increase when Fu increases.

Back 99

False

it will decrease
F=QH/(Fu*Clint)

Front 100

T/F
Bioavailability of a high extraction drug will increase when QH increases.

Back 100

True

F=QH/(Fu*Clint)

Front 101

T/F
Bioavailability of a high extraction drug will increase when CLint increases.

Back 101

False

it will decrease
F=QH/(Fu*Clint)

Front 102

T/F
Tubular reabsorption can only be an active transport process.

Back 102

False

Front 103

T/F
Fluid is filtered across the glomerulus through passive diffusion.

Back 103

True

Front 104

T/F
Highly ionized substances tend to remain in the urine.

Back 104

True

Front 105

T/F
Clearance defines the amount of drug eliminated from body per unit time.

Back 105

False

Front 106

T/F
According to the equation: AUC∞=Dose/CL=Dose/Vd+Ke, the change of volume of distribution does affect AUC∞.

Back 106

False

Front 107

T/F
Intrinsic clearance is not dependent on blood flow, and it represents the activities of enzyme system when we talk about liver metabolism.

Back 107

True

Front 108

T/F
Liver blood flow affects high extraction drug much more than low extraction drug when drug major elimination pathway is hepatic elimination.

Back 108

True

Front 109

T/F
Total clearance is dependent on the half-life of the drug

Back 109

False

Front 110

T/F
Volume of distribution and clearance are two major pharmacokinetic parameters, and they are dependent on each other based on equation:
CL=Vd*Ke

Back 110

False

Front 111

T/F
Assuming linear kinetics, clearance would decrease if the dose were decreased by 25%.

Back 111

False

it would stay the same

Front 112

T/F
Assuming linear kinetics, half-life would increase if the dose were decreased by 25%.

Back 112

False

it would stay the same

Front 113

T/F
Assuming linear kinetics, Vd would increase if the dose were decreased by 25%.

Back 113

False

it would stay the same

Front 114

T/F
Assuming linear kinetics, AUC would decrease by 25% if the dose were decreased by 25%.

Back 114

True

Front 115

T/F
If the volume of distribution increases the clearance can remain the same.

Back 115

True

Front 116

T/F
The maximum value of renal clearance can not excess the glomerula filtration rate.

Back 116

False

Front 117

T/F
The renal clearance of a drug (as determined by filtration and reabsorption) always depends on the tissue binding of the drug.

Back 117

False

Front 118

T/F
Drinking a lot of water (urine flow is doubled) will increase significantly the renal clearance of aminoglycocsides.

Back 118

False

Front 119

T/F
For an acidic drug with a pka of 1.0, adjustment of the urine pH within physiological ranges will significantly change the renal clearance.

Back 119

False

Front 120

T/F
To determine the clearance of a drug, one needs to know whether the drug is a one or two compartment drug.

Back 120

False

Front 121

T/F
Since creatinine is endogenous and predominantly eliminated by kidney, its clearance is a good estimation of renal active secretion.

Back 121

False

Front 122

T/F
The larger the volume of distribution, the smaller the AUC of a given drug.

Back 122

False

Front 123

Which of the following is false when defining the term linear pharmacokinetics?
a) no saturation of binding sites (linear protein binding)
b) no saturation of enzymes or transporters
c) CL and Vd are dependent of dose
d) AUC and Ct changed proportionally with drug dose change

Back 123

c) CL and Vd are dependent of dose

(they are independent of Dose)

Front 124

T/F
For any drug, the AUC is affected by its dose and volume of distribution

Back 124

False

Front 125

T/F
As intrinsic clearance describes the liver’s innate ability to clear unbound drug from intracellular water via metabolism or biliary excretion, the higher the liver blood flow, the higher will be a drug’s clearance

Back 125

False

Front 126

T/F
For a high extraction drug that has predominant hepatic metabolism, the liver blood flow is a rate limiting step in its clearance

Back 126

True

Front 127

T/F
For a low extraction drug, the higher the protein binding the higher will be the clearance

Back 127

False

Front 128

T/F
If Drug A is cleared only by hepatic metabolism only, then the clearance of drug A cannot be greater than liver blood flow

Back 128

True

Front 129

T/F
For a low extraction drug, the lower the protein binding the higher will be the clearance

Back 129

True

Front 130

T/F
A one compartment model means that drug in the blood is in rapid equilibration with drug in extravascular tissues

Back 130

True

Front 131

T/F
For a linear model, the rate constant for elimination is not proportional to the amount of drug remaining to be eliminated

Back 131

True

Front 132

T/F
Clearance and volume of distribution are independent each other, but both of them are dependent of dose.

Back 132

True

Front 133

T/F
A drug with a linear protein binding has linear pharmacokinetics.

Back 133

False

can have nonlinear elimination

Front 134

T/F
In a linear one-compartmental model, lower dose and lower volume of distribution result in a lower initial drug concentration after a single IV bolus.

Back 134

False

C(0)=Dose/Vd

Front 135

T/F
In a linear one-compartmental model, any two concentration points in concentration-time profile can determine drug half-life after a single IV bolus.

Back 135

True

Front 136

T/F
Total clearance is always greater or equal to renal clearance.

Back 136

True

CLtot = CLren + CLbil + CLmet

Front 137

T/F
Since creatinine is endogenous and predominantly eliminated by kidney, its clearance is a good estimation of renal active secretion.

Back 137

False

Front 138

T/F
Creatine clearance can only be used to estimate the renal clearance of drugs that are similar to creatine, which does not show plasma albumin binding.

Back 138

False

Front 139

T/F
“Linear pharmacokinetics” means that the plasma drug concentration versus time plots will result in a straight line.

Back 139

False