Chapter·PharmacologyDrug interactions and adverse effects

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1

A 72-year-old man presents to the emergency department with a 1 hour history of bruising and bleeding. He says that he fell and scraped his knee on the ground. Since then, he has been unable to stop the bleeding and has developed extensive bruising around the area. He has a history of gastroesophageal reflux disease, hypertension, and atrial fibrillation for which he is taking an oral medication. He says that he recently started taking omeprazole for reflux. Which of the following processes is most likely inhibited in this patient?

ASulfation

BOxidation

CFiltration

DAcetylation

EGlucuronidation

2

A 75-year-old female patient comes to the emergency department with altered mental status. She is brought in by her daughter with whom the patient lives. The patient’s daughter said they were watching TV when her mother became unresponsive. On exam the patient withdraws to pain but does not open her eyes or speak. An emergent head CT is done and shows an intracranial bleed. The patient is moved to the ICU and intubated. Further history is obtained from the daughter. The patient has a past medical history of diabetes and a previous stroke. Her medications are metformin and warfarin. The patient is compliant with all of her medications. The daughter says that the patient changed her diet about 1 month ago in response to a diet she saw on a talk show. Which of the following foods is most likely to cause the pathology seen in this patient?

AGrapefruit juice

BSt. John’s wort

CGreen tea

DChili peppers

ESpinach

3

A 58-year-old man comes to the physician because of severe muscle aches and fatigue for 3 days. Last week he was diagnosed with atypical pneumonia and treated with clarithromycin. He has hyperlipidemia for which he takes lovastatin. Physical examination shows generalized tenderness of the proximal muscles in the upper and lower extremities. Serum studies show an elevated creatine kinase concentration. This patient's current symptoms are most likely caused by inhibition of which of the following hepatic enzymes?

ACYP2E1

BCYP3A4

CCYP2C9

DCYP1A2

ECYP2C19

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