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ASCP Chemistry Exam Prep > (8) TDM & Toxicology > Flashcards

(8) TDM & Toxicology Flashcards

1
Q

What is therapeutic drug monitoring?

A

A process of determining the quantity of a therapeutic drug required to produce a predetermined desirable effect.

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2
Q

Define the following term:

Half-life.

A

Time required for the concentration of a drug to be decreased by half.

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3
Q

Define the following term:

Steady State.

A

Reached when the amount of drug in the dose given is sufficient only to replace the amount of drug eliminated since the last dose.

Can be measured after 5 drug half-lives because then the blood will have reached 97% of the steady state.

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4
Q

Define the following term:

Compartment

A

Specific place in the body where a drug is present (e.g. plasma, tissue).

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5
Q

Define the following term:

First Order Kinetics

A

Rate of metabolism is dependent on the concentration of the substrate.

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6
Q

Define the following term:

Peak Concentration

A

Highest concentration of drug is measured in the blood.
Collection time varies based on the absorption of the drug.

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7
Q

Define the following term:

Therapeutic Range

A

Concentrations between the minimum effective concentration and the minimum toxic concentration.

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8
Q

Define the following term:

Trough Concentration

A

Lowest concentration of a drug measured in the blood.
Collection is usually immediately prior to the administration of the next dose.

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9
Q

Name the five-step process that takes place when a therapeutic agent is administered to a patient.

A
  • Liberation - release of the drug
  • Absorption - drug taken into the body enters the blood
  • Distribution - drug must be translocated to its site of action
  • Metabolism (biotransformation) - occurs mainly in the liver. Unmetabolized drug is a parent compound, products of metabolism are metabolites
  • Excretion - if drug is water-soluble or can be rendered water soluble through metabolism, it is eliminated through the urine
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10
Q

What is the normal therapeutic range and the classification of the following drug:

Theophylline

A

10 - 20 ug/mL
Bronchodilator

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11
Q

What is the normal therapeutic range and the classification of the following drug:

Quinidine

A

2 - 5 ug/mL
Anti-arrhythmic

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12
Q

What is the normal therapeutic range and the classification of the following drug:

Acetaminophen

A

10 - 30 ug/mL
Analgesic

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13
Q

What is the normal therapeutic range and the classification of the following drug:

Phenytoin

A

10 - 20 ug/mL
Anticonvulsants

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14
Q

What is the normal therapeutic range and the classification of the following drug:

Lithium

A

0.5 - 1.5 mEq/L
Psychotropic

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15
Q

What is the normal therapeutic range and the classification of the following drug:

Gentamicin

A

Peak: 5.8 - ug/mL
Trough: 1 - 2 ug/mL

Aminoglycosides

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16
Q

What is the normal therapeutic range and the classification of the following drug:

Digoxin

A

0.8 - 2.0 ng/mL
Anti-arrhythmics

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17
Q

What is the normal therapeutic range and the classification of the following drug:

Phenobarbital

A

15 - 40 ug/mL
Anticonvulsants

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18
Q

What is the normal therapeutic range and the classification of the following drug:

Primidone

A

5 - 12 ug/mL
Anticonvulsants

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19
Q

What is the normal therapeutic range and the classification of the following drug:

Tobramycin

A

Peak: 5 - 8 ug/mL
Trough: 1 - 12 ug/mL

Aminoglycosides

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20
Q

What is the normal therapeutic range and the classification of the following drug:

Procainamide

A

4 - 10 ug/mL
Anti-arrhythmics

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21
Q

What is the normal therapeutic range and the classification of the following drug:

Carbamazepine

A

4 - 12 ug/mL
Anticonvulsants

22
Q

What is the normal therapeutic range and the classification of the following drug:

Valproic Acid

A

50 - 100 ug/mL
Anticonvulsants

23
Q

What plant is digoxin derived from?

A

The foxglove plant (Digitalis lanata or purpurea)

24
Q

What are the toxic effects of digoxin?

A

It effects cellular potassium transport, resulting in bradycardia, followed by arrhythmia, coma, and death.

25
Q

Why do we test Procainamide/NAPA drug levels on a patient?

A

NAPA has anti-arrhythmic activity similar to procainamide; often measured together.

26
Q

Define the following term:

Acute Toxicity

A

Single short-term exposure to the toxic effects of a substance in a dose sufficient to cause a toxic effect.

An example would be an overdose of sleeping pills taken in bulk.

27
Q

Define the following term:

Chronic Toxicity

A

Involves repeated exposure to a substance causing toxic effects over an extended period of time. A single dose does not have a toxic effect but an accumulation of substance has effect.

An example would be slow poisoning.

28
Q

Contrast TD50 and LD50 of a toxic substance.

A

TD is the dose predicted to produce a toxic response in 50% of the population, causing a pathogenic response but not death.

LD is the dose predicted to produce death in 50% of the population.

29
Q

Describe the toxic effect of the following:

Acetaminophen

A
  • Severe hepatoxicity due to minimal renal filtration
  • Free radical formation leading to cell death
  • Toxic effects seen 3 - 5 days following overdose
  • Cleared rapidly from serum, so overdose may be hard to detect
  • Initial symptoms are vague
30
Q

Describe the toxic effect of the following:

Salicylate

A
  • Metabolic acidosis due to acid ingestion
  • Respiratory alkalosis due to hyperventilation
31
Q

What is the principle of the salicylate testing procedure?

A

Salicylate acid + Fe2+ ⇢ Violet color complex

(not very specific, but low false negatives)

32
Q

What is the trough level of salicylates?

A

<100 mg/mL

33
Q

What is the toxic levels of salicylates?

A

>100 ug/mL

34
Q

Discuss the “spot test” for carbon monoxide poisoning.

A

Carboxyhemoglobin is bright cherry read, giving the EDTA specimen a characteristic color. A 1:20 dilution of whole blood is created. 5 mL of the diluted specimen is added to 5 mL of 40% NaOH. Persistence of a pink solution is indicative of a carboxyhemoglobin level of 20% or greater.

35
Q

What is the pharmacological classification of the following drugs:

Cocaine

A

Stimulant

36
Q

What is the pharmacological classification of the following drugs:

Heroin

A

Narcotic

37
Q

What is the pharmacological classification of the following drugs:

Methadone

A

Narcotic

38
Q

What is the pharmacological classification of the following drugs:

Diazepam

A

Depressant

39
Q

What is the pharmacological classification of the following drugs:

Amphetamine

A

Stimulant

40
Q

What is the pharmacological classification of the following drugs:

Codeine

A

Narcotic

41
Q

What is the pharmacological classification of the following drugs:

Meperidine

A

Narcotic

42
Q

What is the pharmacological classification of the following drugs:

Methamphetamine

A

Stimulant

43
Q

What is the pharmacological classification of the following drugs:

Morphine

A

Narcotic

44
Q

What is the pharmacological classification of the following drugs:

Ethanol

A

Depressant

45
Q

List the principle urinary metabolites of the following drug:

Cocaine

A

Ergoninemethyl ester, benzoylecgonine, ecgomine

46
Q

List the principle urinary metabolites of the following drug:

Heroin

A

6-acetylmorphine, morphine, morphine glucoronide

47
Q

List the principle urinary metabolites of the following drug:

Methadone

A

2-ethlidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine, 2-ethyl, 5-methyl-3, 3-diphenylpyrroline, methadol, normethadol, conjugates

48
Q

List the principle urinary metabolites of the following drug:

Diazepam

A

Nordiazepam, oxazepam, 3-hydroxydiazepam, glucuronide conjugates.

49
Q

List the principle urinary metabolites of the following drug:

Amphetamine

A

Benzoic acid, p-hydroxyamphetamine, p-hydroxynorephedrine, phenylacetone.

50
Q

List the principle urinary metabolites of the following drug:

Codeine

A

Morphine, norcodeine, conjugates

51
Q

List the principle urinary metabolites of the following drug:

Meperidine

A

Normeperidine, meperidin (Demerol)

ASCP Chemistry Exam Prep (10 decks)

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