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WorksheetsPage 1
Total questions: 98
Worksheet time: 49mins
What is the definition of a drug interaction?
The process of manufacturing drugs in a factory
An occurrence where a drug’s therapeutic effect is influenced by other drugs, herbs, food, beverages, or the environment
Side effects that naturally arise from a drug
A patient’s allergic reaction to dust
Drug interactions can cause the following, except...
Increasing therapeutic effect
Decreasing therapeutic effect
Eliminating all diseases in one second
Causing toxic effects
Based on medical record data, why is the incidence of drug interactions difficult to determine with certainty?
Patients always lie about their food
Hospitals do not have computers
Admission data often does not distinguish between pure adverse drug reactions (ADRs) and drug interactions
Drug interactions are not considered important by clinicians
Which group is most at risk of experiencing drug interactions?
Teenagers who only take vitamin C
Patients with polypharmacy (taking many types of drugs)
Adults who are rarely ill
Children who drink formula milk
What is an example of a patient highly susceptible to drug interactions according to the material?
A patient with a common flu
An HIV-AIDS patient taking protease inhibitors
The interaction that occurs outside the body before a drug is administered (during mixing) is called
Pharmacokinetic interaction
Pharmacodynamic interaction
Pharmaceutical interaction
Social interaction
Issues of "compatibility" and "solubility" are key features of which type of interaction
Pharmacodynamic
Pharmacokinetic
Pharmaceutical
Psychological
What is meant by a pharmacokinetic interaction
The relationship between a drug and its receptor
The influence of food on ADME (Absorption, Distribution, Metabolism, Excretion) processes
A chemical reaction between two infusion bottles
The price of a drug at the pharmacy
Which parameter measures the total exposure of a drug in the blood
C-max
T-max
AUC (Area Under the Curve)
Half-life
Which parameter indicates the time required to reach the peak concentration of a drug
C-max
T-max
AUC (Area Under the Curve)
Half-life
The highest concentration of a drug in blood after administration is called...
T-max
C-max
MEC
MTC
The average gastric fluid volume during fasting is...
10–15 mL
580 mL
1 liter
2 liters
What is the average gastric fluid volume after a meal (post‑prandial)?
45 ± 18 mL
100 mL
580 ± 38 mL
900 mL
What is the effect of solid food on the gastric emptying rate (GER)?
It accelerates emptying
It slows gastric emptying
It has no effect
It eliminates gastric acid
Which type of ingested material leaves the stomach more quickly?
Liquids
Semi‑solid foods
Solid foods
High‑fat meals
What is the stomach pH condition when the stomach is empty (fasting)?
Very alkaline (pH 10)
Neutral (pH 7)
Very acidic (pH 1–3)
Has no pH
What is meant by the process of chelation?
Destruction of drugs by bile
Formation of an insoluble complex between a drug and metal ions (such as Ca2+ )
Acceleration of drug absorption in the intestines
Elimination of drugs through the lungs
Which food example can cause chelation with tetracycline antibiotics?
Red meat
Dairy products (milk, cheese, yogurt)
Green vegetables
Papaya fruit
Which metal ion in milk most commonly causes chelation?
Sodium
Calcium ( Ca2+ )
Potassium
Chloride
What is P-glycoprotein (P-gp)?
A growth hormone.
An efflux transporter that pumps drugs out of cells back into the intestinal lumen.
An enzyme that destroys fat.
A protein that binds oxygen.
If P-gp is inhibited by certain foods, what is the impact on a drug?
Drug absorption decreases.
Drug absorption increases (because nothing is pumping it out).
The drug becomes ineffective.
The drug is immediately excreted in urine.
Where is the primary location of the CYP3A4 enzyme that often interacts with food?
Heart.
Brain.
Small intestinal epithelium and liver.
Bone.
What is the effect of grapefruit juice on the metabolism of certain drugs?
It speeds up metabolism.
It inhibits metabolism (acts as an inhibitor), causing drug levels in the blood to rise.
It has no effect.
It speeds up excretion.
Which active substance in grapefruit juice causes the interaction?
Vitamin C.
Furanocoumarins.
Glucose.
Lactose.
What is meant by induction of metabolic enzymes?
A decrease in enzyme activity.
An increase in enzyme activity so the drug is eliminated faster (drug levels decrease).
A total cessation of enzyme function.
A change of the enzyme into fat.
Which drug is a strong inducer of metabolism?
Cimetidine.
Ketoconazole.
Rifampin.
Erythromycin.
Which drug is a strong inhibitor of metabolism?
Carbamazepine.
Phenobarbital.
Ketoconazole.
St. John's Wort.
How does food affect the bioavailability (AUC) of paracetamol?
It increases AUC drastically.
It does not greatly change AUC, but lowers the absorption rate (longer T-max).
It eliminates the effect of paracetamol.
It turns paracetamol into a poison.
What is the effect of bean sprouts on paracetamol?
It increases paracetamol levels.
It induces metabolism, thereby reducing paracetamol AUC.
It causes chelation.
It has no effect.
Why should Captopril be taken 1 hour before meals?
So it tastes better.
Because food can significantly reduce its absorption and effectiveness.
To prevent the patient from feeling nauseous.
Because Captopril only works when the stomach is empty.
Patients taking Captopril are advised not to eat bananas excessively due to the risk of...
Hypokalemia.
Hyperkalemia (excess potassium).
Diabetes.
Malnutrition.
What is the reduction in the bioavailability of Lansoprazole when given with food?
10%.
30%.
50%.
70%.
Furosemide functions as a...
Antibiotic.
Diuretic.
Sleeping pill.
Cough medicine.
What happens if Furosemide is taken with food?
Peak concentration (C-max) decreases by about 55%.
Peak concentration increases by 100%.
Its effect lasts longer.
The patient becomes dizzy.
What are MAOIs?
Antacid drugs
Monoamine Oxidase Inhibitors (antidepressants)
Fever-reducing drugs
Muscle vitamins
Which foods contain high Tyramine?
Fresh vegetables
Aged cheese, processed meats, and fermented foods
White rice
Citrus fruits
Interaction of MAOIs with Tyramine can cause...
Severe drowsiness
Hypertensive crisis (blood pressure rises very high)
Diarrhea
Itching
What is the role of Tyramine in the body?
Triggers norepinephrine release
Inhibits blood flow
Raises blood sugar
Repairs nerves
Theophylline is a medication for...
Ulcer
Bronchial asthma (bronchodilator)
External wound
Toothache
Patients using Theophylline should limit the intake of...
Plain water
Caffeine (coffee/tea/cola) due to toxicity risk
Table salt
Carbohydrates
Why is alcohol dangerous when consumed together with Benzodiazepines (such as Diazepam)?
It causes insomnia
It increases the risk of respiratory failure due to excessive central nervous system depression
It neutralizes the drug so it does not work
It causes bloating
The active component in Garlic is...
Gingerol
Allicin
Curcumin
Caffeine
What is the risk of consuming Garlic together with blood thinners (such as Warfarin)?
Blood clots
Increased risk of bleeding (due to anti‑platelet effect)
Bad breath
The drug does not work
Garlic can decrease the level of the following HIV drug...
Insulin
Indinavir (Protease Inhibitor)
Paracetamol
Ginger can strengthen the effect of which type of medication?
Antacid
Anticoagulant (blood thinner)
Antibiotic
Antihistamine
What is the interaction of ginger with antacid medications?
Increases the antacid effect
Decreases the antacid effect
Has no effect
Instantly relieves stomach pain
Turmeric contains an active compound called what?
Allicin
Curcumin
Xanthine
Tyramine
The primary benefit of curcumin is as what?
Just a coloring agent
Anti-inflammatory, natural analgesic, and antiseptic
An instant appetite booster for children
A weight-loss drug
What does IPE stand for?
International Pharmacy Education
Inter Professional Evaluation (evaluation among health professions)
Internal Patient Examination
What is the purpose of the 24‑h dietary recall method?
Counting a patient’s medications
Assessing a patient’s nutritional intake over the past 24 hours to identify potential interactions
Asking the patient to fast for 24 hours
Recording the patient’s body weight
In the identification step, what is the function of a Food List?
Hospital meal menu
A list of the patient’s routine foods to evaluate their interactions with medications
Cafeteria food price list
List of the tastiest foods
What is done during the Review and Reinforce stage?
Provide a new prescription
Strengthen patient understanding and monitor therapy progress
Scold patients who eat incorrectly
End the doctor–patient relationship
Which beverage is most recommended for taking medicine?
Orange juice
Warm tea
Plain water
Chocolate milk
Why should medicine not be taken with alcohol?
Because it is expensive
Because alcohol alters absorption and increases the risk of toxicity
Because alcohol spoils the taste of the medicine
What is the best guideline for vitamin intake when EAR is not available?
RDA
AI (Adequate Intake)
UL
Just feelings
What is UL in nutrition guidelines?
Under Limit
Tolerable Upper Intake Level (safe upper intake limit)
Universal Level
Ultra Low
Pharmacodynamic interactions occur at the level of...
Stomach
Kidney
Receptors or the drug’s mechanism of action at the target cell
Medicine bottle
Why do elderly patients more often experience drug–food interactions?
Because they like to eat
Because organ function declines and they often use many medications (polypharmacy)
Because they often forget to eat
Because they do not like drinking plain water
What is an example of an interaction between drugs and acidic beverages?
Increases the solubility of all drugs
Affects the stability of drugs that are sensitive to acid
No interaction
An interaction in which two substances produce the same effect so the result is excessive is called what?
Antagonistic effect
Synergistic/Additive effect
Neutral effect
Side effect
An interaction in which one substance eliminates the effect of another substance is called what?
Synergistic
Antagonistic
Potentiation
Chelation
If a drug has a narrow therapeutic index, drug–food interaction becomes what?
Very dangerous/critical
Not important
Unremarkable
Beneficial
An example of a drug with a narrow therapeutic index is what?
Paracetamol
Vitamin C
Warfarin and Theophylline
Antacid
What is the role of gastric acid in drug absorption?
Only acts as a solvent
Helps dissolve solid drugs into molecules ready for absorption
Kills all drugs that enter
Which drug has increased absorption when taken with food (fatty foods)?
Captopril
Griseofulvin (antifungal)
Tetracycline
Lansoprazole
Why is milk not recommended for patients taking iron (Fe) medication?
Because calcium in milk inhibits iron absorption.
Because milk ruins the taste of iron.
Because iron makes milk spoil.
There is no restriction.
What is the primary goal of managing drug–food interactions?
To sell more supplements.
To ensure therapeutic efficacy and patient safety.
To reduce patients’ meal portions.
To speed up inpatient time without reason.
Celery can affect paracetamol through which pathway?
Renal excretion.
Phase I metabolism (oxidative).
Gastric absorption.
Plasma protein binding.
What does EAR stand for?
Easy Access Resource.
Estimated Average Requirement.
Essential Amino Rate.
What is meant by pharmacology?
The science of making medical devices.
The science of drugs and their effects on living organisms.
The science of healthy dietary patterns.
The science of human surgery.
Drug–food interactions most often occur at the stage of...
Distribution.
Absorption.
Excretion.
Production.
Why are caffeinated beverages not recommended to be taken together with sedatives?
Because caffeine is a stimulant that opposes the sedative effect (antagonist).
Because caffeine makes the medicine tasteless.
Because caffeine only speeds up kidney function.
Because caffeine increases drowsiness.
What should a pharmacist do if there is a potential for a severe interaction?
Do nothing.
Provide education to the patient and discuss with the physician.
Change the medicine without authorization.
Tell the patient to stop eating.
The interaction between dietary fiber and digoxin can cause...
Increased absorption.
Decreased absorption of digoxin due to binding by fiber.
Weight loss.
Where is the primary site of drug absorption in the gastrointestinal tract?
Mouth
Stomach
Small intestine (duodenum/jejunum)
Large intestine
The surface area of the small intestine is very large because of the presence of what structures?
Smooth muscle
Villi and microvilli
Gastric acid
Bile
What is first-pass metabolism?
The drug goes directly to the heart
The drug is metabolized in the intestine or liver before reaching systemic circulation
The drug exits via urine the first time
The drug is absorbed through the skin
How does age affect drug metabolism?
No effect
Infants and the elderly generally have lower metabolic capacity
With increasing age, metabolism becomes faster
Only children can metabolize drugs
What is bioavailability?
The rate a drug degrades in the stomach
The percentage of drug that reaches systemic circulation in active form
The price of the drug available at the pharmacy
Which is a pharmacokinetic interaction at the distribution stage?
Competition for plasma protein binding between a drug and food components.
Change in urine pH.
Chelation formation in the intestine.
Enzyme inhibition in the liver.
What is the role of bile in drug absorption?
Helps dissolve lipophilic (fat‑soluble) drugs.
Neutralizes stomach acid.
Breaks drug molecules into gas.
Prevents drugs from entering the liver.
Why can smoking affect drug interactions?
Cigarette smoke contains chemicals that can induce hepatic enzymes (CYP1A2).
Smoking makes people hungry.
Smoking lowers blood pressure.
It has no effect.
The interaction between warfarin and vitamin K (in green vegetables) is...
Synergistic.
Antagonistic (vitamin K counteracts warfarin’s anticoagulant effect).
Chelation.
Pharmaceutical.
Patients taking warfarin should manage their intake of green vegetables so that it is...
Always increasing day by day.
Consistent (stable) each day to maintain drug efficacy.
Eliminated completely.
What is a prodrug?
A very expensive drug.
A drug that is inactive when taken and becomes active after metabolism in the body.
A drug used only by professionals.
A processed herbal drug.
How does dehydration affect drug excretion?
It speeds up excretion.
It decreases excretion, increasing the risk of toxicity.
It eliminates side effects.
It increases appetite.
A weakly acidic drug is more readily absorbed in an environment that is...
Basic (alkaline).
Acidic (such as the stomach).
Neutral.
Oily.
What is the purpose of the Monitoring stage in medication administration?
To see whether the patient pays for the medicine.
To ensure the patient achieves therapeutic targets and does not experience harmful effects.
To count the number of patients in the clinic.
To record the patient’s family name.
Genetic factors can influence drug interactions because...
Everyone has different eating hobbies.
There are enzyme polymorphisms (differences in metabolic capacity between individuals).
Interaction between calcium and the antibiotic ciprofloxacin results in…
Ciprofloxacin becomes more potent.
Decreased absorption of ciprofloxacin (chelation).
Urine turns white.
Teeth become stronger.
Why do vegetables in the Brassicaceae family (such as cabbage and broccoli) affect drugs?
They contain substances that can induce metabolic enzymes.
They contain natural poisons.
They are difficult to chew.
They contain a lot of water.
What is a drug’s half-life t1/2 ?
The time it takes to finish one bottle of medicine.
The time required for the drug concentration in blood to fall to half of its initial level.
The drug’s expiration time.
The rest period after taking a drug.
A drug–food interaction that causes “dumping syndrome” occurs because…
Gastric emptying is too rapid.
The drug refuses to leave the stomach.
The stomach becomes extremely hungry.
The drug turns into gas.
Why can apple or orange juice affect some medications (such as fexofenadine)?
It inhibits intestinal absorption transporters (OATP).
It only increases blood sugar levels.
Because the taste is sweet.
Because it contains fiber.
What is biliary excretion?
Drug elimination through urine.
Drug elimination through bile into feces.
Drug elimination through sweat.
Drug elimination through tears.
Drug interactions at the kidney often involve what?
Changes in urine pH or competition within renal tubules.
Direct destruction of the kidney.
Formation of kidney stones from all drugs.
Changes in skin color.
Why should drug–food counseling be provided personally?
Each patient has unique eating patterns and health conditions.
To make the pharmacist appear busy.
Because all patients have different names.
Only because of government regulations.
Fat‑soluble vitamins ( A , D , E , K ) need what for maximal absorption?
Very large amounts of water.
The presence of fat in food.
