Clinical Chemistry (Therapeutic Drug Monitoring and Toxicology)

Question 1

Levels of 8-9% carboxyhemoglobin saturation of whole blood are commonly found in which of the following situations?

A. Fatal carbon monoxide poisoning
B. Acute carbon monoxide poisoning
C. Nonsmoking residents of rural areas
D. Cigarette smokers

Question 2

Which of the following methods would yield reliable quantification of ethanol in the presence of isopropanol?

A. Reaction with permanganate and chromotropic acid
B. Conway diffusion followed by dichromate reaction
C. Alcohol dehydrogenase reaction
D. Gas-liquid chromatography

Question 3

Which of the following tests would be particularly useful in determining isopropanolexposure?

A. Serum osmolality and urine acetone
B. Urine osmolality and serum osmolality
C. Urine acetone and urine osmolality
D. Serum sodium and serum acetone

Question 4

When screening urine for toxic concentrations of certain substances, which of the following will not be identified by the Reinsch test?

A. Bismuth
B. Arsenic
C. Mercury
D. Cyanide

Question 5

Heroin is synthesized from what drug?

A. Diazepam
B. Morphine
C. Ecgonine
D. Chlorpromazine

Question 6

After absorption, codeine is rapidly metabolized to what compound?

A. Phencyclidine
B. Morphine
C. Methadone
D. Propoxyphene

Question 7

THC (A9-tetrahydrocannabinol) is the principal active component of what drug?

A. Benzodiazepine
B. Marijuana
C. Morphine
D. Codeine

Question 8

Identification of the urinary metabolite benzoylecgonine would be useful in determining exposure to which of the following drugs?

A. Codeine
B. Cocaine
C. Amphetamine
D. Propoxyphene

Question 9

Of the following specimens, which would be appropriate for determining exposure to lead?

A. EDTA plasma
B. Serum
C. Whole blood
D. Cerebrospinal fluid

Question 10

Free erythrocyte protoporphyrin (FEP) levels are useful as a screening method for exposure to which of the following metals?

A. Zinc
B. Lead
C. Iron
D. Mercury

Question 11

Anticoagulated whole blood is the preferred specimen in determining exposure to what compound?

A. Methanol
B. Mercury
C. Acetaminophen
D. Carbon monoxide

Question 12

What is the approximate number of half-life periods required for a serum drug concentration to reach 97-99% of the steady state?

A. 1-3
B. 2-4
C. 5-7
D. 7-9

Question 13

For what colorimetric determination is the Trinder reaction widely used?

A. Acetaminophen
B. Propoxyphene
C. Salicylate
D. Barbiturate

Question 14

Acetaminophen is particularly toxic to what organ?

A. Heart
B. Kidney
C. Spleen
D. Liver

Question 15

Which of the following is an example of a long-acting barbiturate?

A. Phenobarbital
B. Amobarbital
C. Secobarbital
D. Pentobarbital

Question 16

Increased trough levels of aminoglycosides in the serum are often associated with toxic effects to which organ?

A. Heart
B. Kidney
C. Pancreas
D. Liver

Question 17

Which of the following is an example of an antiarrhythmic drug that has a metabolite with the same action?

A. Quinidine
B. Digoxin
C. Procainamide
D. Nortriptyline

Question 18

In what form must a drug be in order to elicit a pharmacologic response?

A. Free
B. Bound to albumin
C. Bound to globulins
D. Bound to fatty acids

Question 19

An epileptic patient receiving phenytoin develops acute glomerulonephritis. What change, if any, would be expected in the patient’s circulating drug level?

A. Decrease in free drug
B. Increase in free drug
C. Increase in protein-bound drug
D. No change in circulating drug level

Question 20

Free drug levels can generally be determined by analyzing what body fluid?

A. Whole blood
B. Ultrafiltrate of plasma
C. Urine
D. Protein-free filtrate of plasma

Question 21

Which of the following drugs is used as an
immunosuppressant in organ transplantation, especially in liver transplants?

A. Methotrexate
B. Amiodarone
C. Tacrolimus
D. Paroxetine

Question 22

Which of the following is a commonly encountered xanthine that could potentially interfere with the determination of theophylline?

A. Nicotine
B. Caffeine
C. Amphetamine
D. Procainamide

Question 23

What is the major active metabolite of the anticonvulsant drug primidone?

A. Phenytoin
B. Acetazolamide
C. NAPA
D. Phenobarbital

Question 24

Nortriptyline is the active metabolite of which of the following drugs?

A. Amitriptyline
B. Desipramine
C. Imipramine
D. Doxepin

Question 25

Which of the following is used in the treatment of manic depression?

A. Potassium
B. Lithium
C. Calcium
D. Chloride

Question 26

When is a blood sample for determination of the trough level of a drug appropriately drawn?

A. During the absorption phase of the drug
B. During the distribution phase of the drug
C. Shortly before drug administration
D. Two hours after drug administration

Question 27

In regard to drug distribution patterns, which of the following statements is false?

A. Drug metabolism is slower in newborns than adults.
B. Drug metabolism is more rapid for 6-year-old children than for adults.
C. Renal clearance of drugs is faster in newborns than adults.
D. Drug metabolism often changes during pubescence.

Question 28

Which of the following serum components is able to alter the free drug level in plasma?

A. Creatinine
B. Urea
C. Albumin
D. Calcium

Question 29

Which of the following is an example of a
phenothiazine drug?

A. Cyclosporine
B. Theophylline
C. Phenytoin
D. Chlorpromazine

Question 30

What is the recommended name for diphenylhydantoin?

A. Phenytoin
B. Nalorphine
C. Primidone
D. Carbamazepine

Question 31

Which of the following classes of compounds has a sedative effect and as such is used to treat anxiety?

A. Amphetamines
B. Opiates
C. Cannabinoids
D. Benzodiazepines

Question 32

What is the active metabolite of the antiarrhythmic drug procainamide?

A. Pronestyl
B. Disopyramide
C. PEMA
D. NAPA

Question 33

Which of the following drugs is used as a bronchodilator?

A. Theophylline
B. Phenytoin
C. Amikacin
D. Clozapine