31.

The primary mechanism whereby grapefruit/grapefruit juice can results in a drug-nutrient interaction (DNl) is (CIRCLE ALL THAT APPLY): Ctassified as a Type tt DNt

-/\

@ *d.

ffi

fa)

cti,,iil

;; o rri" ii, ,r,-

c'Jr)

Cn^r"cterized by inhibition of CYP3A4 in the small intestine Characterized by inhibition of CYP3A4 in the liver

32. Which of the following is/are TRUE of interactions between grapefruit/grapefruit juice and some drugs? (CIRCLE ALL THAT APPLY):

\ Grapefruit/grapefruit juice can be consumed by people taking statin drugs, such as Lipitor, but it - is recommended that it be consumed at least 2 hours after taking the daily drug dose. (l!r/ Eating grapefruit/drinking grapefruit juice can increase risk of toxicity of some drugs. c Eating grapefruit/drinking grapefruit juice can result in low, subtherapeutic levels of some drugs.
The calcium channel blocker Felodipine is an object agent in its interaction with gra pefru it/gra pefruit juice.

33. This patient's chronic alcohol abuse could be expected to influence drug metabolism in what way(s)? (crRcrE ALL THAT APPLY)

'<) j/

Drugs would be metabolized more quickly by the liver / A (!r' higher drug dose may be required for a therapeutic effect c. Drug toxicity could occur at low doses
I +>St

d.

None ofthe above

Case Studv #6:

Lourie is a ?3-veor-old woman with long-standing she has been on and off cg[llsosteroids, specificolly the glucocortigcjlblednisone, for several yeors. She olso hos moderate-severe depression, which hos been difficult to treot. After trying severol other ontidepressonts

systemic@LE)forwhich

unsuccessfully,shehosbeenrecentlyprescribedNardil,awmonoamineoxidose
inhibitor (MAOI) that first come into use in the 7950s. She is 5'2" ond weighs 750 pounds. She became o vegetarian lost yeor when one of her friends told her of oll the heolth benefits. She olso hos storted toking fish oil supplernents. Her lab dota are as follows:
Test
Na+
K+

Reference range 135-145 mEo/L 3.5-5 mEo/L

Laurie's values
136

4.3
29 98 15

HCOr-

Glucose
BUN

Creatinine (Cr)

Albumin Total cholesterol Total bilirubin

RBC

2t-3tmEo/L ms/dl 5-20 ms/dl O.6-L.2 me/dl 3.5-5 e/dl >150 ms/dl 0.1-1me/dl
7O-LLO

0.8
4.4

211
0.6 5.5

3.5-5.9 x 10o/mm'

Hgb

t2-75 sldl
33-43o/o

11t
311
9

Hct
WBC

5-L0 x

10'lmm'

11

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