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1. What effect does smoking cannabis or cigarettes have on serum levels of asenapine, olanzapine, and clozapine?
A. Increased serum levels
B. Decreased serum levels
C. No change in serum levels
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Correct answer: B. Decreased serum levels
Explanation: Smoking cannabis or cigarettes regularly leads to induction of the CYP450 1A2 enzyme that metabolizes asenapine, olanzapine, and clozapine (among other medications). So, their serum levels are reduced. This can be very clinically significant, e.g., leadiing to relapse when a patient starts or resumes smoking.
Link: Effects of cannabis or cannabinoids on the cytochrome P450 enzymes
2. This test should be done before starting acamprosate (brand name Campral) for alcohol use disorder.
A. Hepatic function tests
B. Serum creatinine
C. ECG
D. B12 level
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Correct answer: B. Serum creatinine
Explanation: Acamprosate is not metabolized and is excreted unchanged by the kidney. So, its levels are greatly affected by impairment in renal function but not by impairment in hepatic function.
Link: Tips on using acamprosate (Campral®) for alcohol use disorder
3. The decrease in GFR (in mL/min/1.73m2) in Stage 1 of chronic kidney disease is:
A. 60- 89
B. 45 – 59
C. 30 – 44
D. No decrease in GFR
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Correct answer: D. No decrease in GFR
Explanation: In stage 1 of chronic kidney disease, there is evidence of renal damage (e.g., proteinuria), but the GFR is normal.
Link: Stages of kidney disease
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