1. Which of the following is TRUE regarding the relationship between drugs and nutrients?
A. Both drugs and nutrients found in food use similar absorption sites in the intestines
B. Every person metabolizes drugs and food consistently and predictably
C. When food or drugs are consumed in normal, healthy quantities, there is no risk of toxicity
D. The adverse effects related to food and drug interactions have been extensively studied
2. Grapefruit juice's interaction with drugs was first discovered during an investigation of which of the following therapeutic agents?
A. Atorvastatin
B. Ketoconazole
C. Erythromycin
D. Felodipine
3. What substance is responsible for the most clinically meaningful drug interaction related to grapefruit?
A. Edible fungi
B. Flavonoids
C. Furanocoumarins
D. Multidrug resistance protein
4. Grapefruit juice acts similarly to which of the following drugs?
A. Amlodipine
B. Pravastatin
C. Itraconazole
D. Carbamazepine
5. What is the mechanism of action underlying an interaction between grapefruit juice and drugs that undergo cytochrome P450 (CYP)3A4 metabolism?
A. The induction of P-gp results in increased presystemic metabolism
B. The inhibition of CYP3A4 results in increased systemic drug bioavailability
C. The activation of OATP results in loss of drug efficacy
D. The increased hepatic metabolism results in hepatic cirrhosis
6. What is the most abundant flavonoid in grapefruit juice?
A. Naringin
B. Quercetin
C. Bergamottin
D. Kaempferol
7. Inhibition of which of the following substances will lead to decreased drug bioavailability?
A. CYP3A4
B. Organic anion transporting polypeptide (OATP)
C. P-glycoprotein
D. 6',7'-dihydroxybergamottin
8. Which of the following citrus fruits contains furanocoumarins in similar concentrations to the grapefruit?
A. Seville oranges
B. Tangerines
C. Valencia oranges
D. Pomegranates
9. Which class of antihypertensive drugs poses the most substantial risk for interactions with grapefruit juice?
A. Beta-blockers
B. Angiotensin II receptor blockers
C. Calcium channel blockers
D. Diuretics
10. Which antiarrhythmic agent has exhibited increased plasma concentrations when taken with grapefruit juice?
A. Dronedarone
B. Digoxin
C. Amlodipine
D. Disopyramide
11. Which of the following lipid-lowering agents does NOT interact significantly with grapefruit juice?
A. Atorvastatin
B. Lovastatin
C. Simvastatin
D. Pravastatin
12. A significant drug interaction has been observed between grapefruit juice and which of the following antiplatelet agents?
A. Warfarin
B. Apixaban
C. Cilostazol
D. Clopidogrel
13. The consumption of grapefruit juice is not recommended with which of the following agents owing to a theoretical risk of severe hypotension?
A. Sildenafil
B. Buspirone
C. Acebutolol
D. Ticragelor
14. Which of the following analgesics can be safely used by patients who wish to consume grapefruit juice?
A. Oxycodone
B. Ketamine
C. Morphine
D. Fentanyl
15. Which of the following adverse events could result from an interaction between an immunosuppressant and grapefruit juice?
A. Nephrotoxicity
B. Rhabdomyolysis
C. Torsades de pointes
D. Purpura
16. Which of the following antiretroviral agents should NOT be ingested with grapefruit juice?
A. Ritonavir
B. Fosamprenavir
C. Nelfinavir
D. Saquinavir
17. Which antihistamine has demonstrated decreased systemic bioavailability after the consumption of grapefruit juice?
A. Cetirizine
B. Desloratadine
C. Diphenhydramine
D. Fexofenadine
18. Which of the following patients are NOT at an increased risk for drug interactions?
A. Patients with cancer
B. Patients with decreased expression of CYP3A4
C. Patients with hepatic cirrhosis
D. Patients receiving enteral nutrition
19. Which of the following is FALSE regarding older adult patients and an increased risk for food-drug interactions:
A. Older adults frequently take multiple chronic medications
B. Individuals experience increased hepatic enzyme activity as they age
C. Older adults have a decreased capacity for drug absorption
D. Older adults consume more grapefruit juice than younger people
20. Which of the following drugs is most likely to exhibit a clinically significant drug interaction with grapefruit juice?
A. A drug that is administered intravenously
B. A drug with high innate bioavailability
C. A drug that is extensively metabolized by CYP3A4
D. A drug with a wide therapeutic index
Evaluation Questions
21. To what extent did the program meet objective #1?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
22. To what extent did the program meet objective #2?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
23. To what extent did the program meet objective #3?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
24. To what extent did the program meet objective #4?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
25. To what extent did the program meet objective #5?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
26. Rate the effectiveness of how well the program related to your educational needs:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
27. Rate how well the active learning strategies (questions, cases, discussions) were appropriate and effective learning tools:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
28. Rate the quality of the faculty:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
29. Rate the effectiveness and the overall usefulness of the material presented:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
30. Rate the appropriateness of the examination for this activity:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
31. Rate the effectiveness of how well the activity related to your practice needs:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
32. Rate the effectiveness of how well the activity will help you improve patient care:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
33. Will the information presented cause you to change your practice?
A. Yes
B. No
34. Are you committed to making these changes?
A. Yes
B. No
35. As a result of this activity, did you learn something new?
A. Yes
B. No
36. What is your practice setting or area of practice?
A. Community Pharmacy/Independent
B. Community Pharmacy/Chain
C. Hospital/Health Systems
D. Long-term Care
E. Managed Care/PBM
F. Oncology/Specialty Pharmacy
G. Research
H. Regulatory/Government
I. Industry/Manufacturing
37. How many years have you been in practice?
A. <5
B. 5 – 10
C. 11 – 20
D. >20
