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***Medical Lab science review- Robert Harr 4th > Clinical Chemistry- Toxicology and Therapeutic Drug Monitoring > Flashcards

Clinical Chemistry- Toxicology and Therapeutic Drug Monitoring Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q
  1. In which of the following cases is qualitative
    analysis of the drug usually adequate?
    A. To determine whether the dose of a drug with a
    low therapeutic index is likely to be toxic
    B. To determine whether a patient is complying
    with the physician’s instructions
    C. To adjust dose if individual differences or disease
    alter expected response
    D. To determine whether the patient has been
    taking amphetamines
A

D. To determine whether the patient has been
taking amphetamines

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2
Q
  1. The term pharmacokinetics refers to the:
    A. Relationship between drug dose and the drug
    blood level
    B. Concentration of drug at its sites of action
    C. Relationship between blood concentration and
    therapeutic response
    D. The relationship between blood and tissue drug
    levels
A

A. Relationship between drug dose and the drug
blood level

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3
Q
  1. The term pharmacodynamics is an expression of
    the relationship between:
    A. Dose and physiological effect
    B. Drug concentration at target sites and
    physiological effect
    C. Time and serum drug concentration
    D. Blood and tissue drug levels
A

B. Drug concentration at target sites and
physiological effect

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4
Q
  1. The study of pharmacogenomics involves which
    type of testing?
    A. Family studies to determine the inheritance of
    drug resistance
    B. Testing drugs with cell cultures to determine the
    minimum toxic dosage
    C. Testing for single nucleotide polymorphisms
    known to affect drug metabolism
    D. Comparison of dose-response curves between
    family members
A

C. Testing for single nucleotide polymorphisms
known to affect drug metabolism

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5
Q
  1. Select the five pharmacological parameters that
    determine serum drug concentration.
    A. Absorption, anabolism, perfusion, bioactivation,
    excretion
    B. Liberation, equilibration, biotransformation,
    reabsorption, elimination
    C. Liberation, absorption, distribution, metabolism,
    excretion
    D. Ingestion, conjugation, integration, metabolism,
    elimination
A

C. Liberation, absorption, distribution, metabolism,
excretion

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6
Q
  1. Which route of administration is associated with
    100% bioavailability?
    A. Sublingual
    B. Intramuscular
    C. Oral
    D. Intravenous
A

D. Intravenous

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7
Q
  1. The phrase “first-pass hepatic metabolism”
    means that:
    A. One hundred percent of a drug is excreted by
    the liver
    B. All drug is inactivated by hepatic enzymes after
    one pass through the liver
    C. Some drug is metabolized from the portal
    circulation, reducing bioavailability
    D. The drug must be metabolized in the liver to an
    active form
A

C. Some drug is metabolized from the portal
circulation, reducing bioavailability

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8
Q
  1. Which formula can be used to estimate dosage
    needed to give a desired steady-state blood level?
    A. Dose per hour = clearance (milligrams per hour)
    × average concentration at steady state ÷ f
    B. Dose per day = fraction absorbed – fraction
    excreted
    C. Dose = fraction absorbed × (1/protein-bound
    fraction)
    D. Dose per day = half-life × log Vd (volume
    distribution)
A

A. Dose per hour = clearance (milligrams per hour)
× average concentration at steady state ÷ f

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9
Q
  1. Which statement is true regarding the volume
    distribution (Vd) of a drug?
    A. Vd is equal to the peak blood concentration
    divided by the dose given
    B. Vd is the theoretical volume in liters into which
    the drug distributes
    C. The higher the Vd, the lower the dose needed to
    reach the desired blood level of drug
    D. The Vd is the principal determinant of the dosing
    interval
A

B. Vd is the theoretical volume in liters into which
the drug distributes

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10
Q
  1. For drugs with first-order elimination, which
    statement about drug clearance is true?
    A. Clearance = elimination rate ÷ serum level
    B. It is most often performed by the liver
    C. It is directly related to half-life
    D. Clearance rate is independent of dose
A

A. Clearance = elimination rate ÷ serum level

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11
Q
  1. Which statement about steady-state drug levels
    is true?
    A. The absorbed drug must be greater than the
    amount excreted
    B. Steady state can be measured after two
    elimination half-lives
    C. Constant intravenous infusion will give the same
    minima and maxima as an oral dose
    D. Oral dosing intervals give peaks and troughs in
    the dose-response curve
A

D. Oral dosing intervals give peaks and troughs in
the dose-response curve

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12
Q
  1. If too small a peak–trough difference is seen for a drug given orally, then:
    A. The dose should be decreased
    B. Time between doses should be decreased
    C. Dose interval should be increased
    D. Dose per day and time between doses should be
    decreased
A

C. Dose interval should be increased

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13
Q
  1. If the peak level is appropriate but the trough level
    too low at steady state, then the dose interval
    should:
    A. Be lengthened without changing the dose
    per day
    B. Be lengthened and dose rate decreased
    C. Not be changed, but dose per day increased
    D. Be shortened, but dose per day not changed
A

D. Be shortened, but dose per day not changed

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14
Q
  1. If the steady-state drug level is too high, the best
    course of action is to:
    A. Decrease the dose
    B. Decrease the dose interval
    C. Decrease the dose and decrease the dose interval
    D. Change the route of administration
A

A. Decrease the dose

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15
Q
  1. When should blood samples for trough drug levels
    be collected?
    A. 30 minutes after peak levels
    B. 45 minutes before the next dose
    C. 1–2 hours after the last dose
    D. Immediately before the next dose is given
A

D. Immediately before the next dose is given

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16
Q
  1. Blood sample collection time for peak drug levels:
    A. Varies with the drug, depending on its rate of
    absorption
    B. Is independent of drug formulation
    C. Is independent of the route of administration
    D. Is 30 minutes after a bolus intravenous injection
    is completed
A

A. Varies with the drug, depending on its rate of
absorption

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17
Q
  1. Which could account for drug toxicity following a
    normally prescribed dose?
    A. Decreased renal clearance caused by kidney disease
    B. Discontinuance or administration of another drug
    C. Altered serum protein binding caused by disease
    D. All of these options
A

D. All of these options

18
Q
  1. Select the elimination model that best describes
    most oral drugs.
    A. One compartment, linear first-order elimination
    B. Michaelis–Menton or concentration-dependent
    elimination
    C. Two compartment with a biphasic elimination
    curve
    D. Logarithmic elimination
A

A. One compartment, linear first-order elimination

19
Q
  1. Drugs rapidly infused intravenously usually follow
    which elimination model?
    A. One compartment, first order
    B. One compartment, logarithmic
    C. Biphasic or two compartment with serum level
    rapidly falling in the first phase
    D. Michaelis–Menton or concentration-dependent
    elimination
A

C. Biphasic or two compartment with serum level
rapidly falling in the first phase

20
Q
  1. Which fact must be considered when evaluating a
    patient who displays signs of drug toxicity?
    A. Drug metabolites (e.g., N-acetylprocainamide)
    may need to be measured as well as parent drug
    B. If the concentration of total drug is within
    therapeutic limits, the concentration of free drug
    cannot be toxic
    C. If the drug has a wide therapeutic index, then it
    will not be toxic
    D. A drug level cannot be toxic if the trough is
    within the published therapeutic range
A

A. Drug metabolites (e.g., N-acetylprocainamide)
may need to be measured as well as parent drug

21
Q
  1. When a therapeutic drug is suspected of causing
    toxicity, which specimen is the most appropriate
    for an initial investigation?
    A. Trough blood sample
    B. Peak blood sample
    C. Urine at the time of symptoms
    D. Gastric fluid at the time of symptoms
A

B. Peak blood sample

22
Q
  1. For a drug that follows first-order pharmacokinetics,
    adjustment of dosage to achieve the desired blood
    level can be made using which formula?
    A. New dose = current dose/concentration at
    steady state × desired concentration
    B. New dose = current dose/desired
    concentration × concentration at steady state
    C. New dose = concentration at steady state/desired concentration × half-life

D. New dose = concentration at steady state/current dose × desired
concentration

A

A. New dose = current dose/concentration at
steady state × desired concentration

23
Q
  1. For which drug group are both peak and trough
    measurements usually required?
    A. Antiarrhythmics
    B. Analgesics
    C. Tricyclic antidepressants
    D. Aminoglycoside antibiotics
A

D. Aminoglycoside antibiotics

24
Q
  1. Which of the following statements about TLC for
    drug screening is true?
    A. Acidic drugs are extracted in an alkaline
    nonpolar solvent
    B. A drug is identified by comparing its Rf value
    and staining to standards
    C. Testing must be performed using a urine sample
    D. Opiates and other alkaloids are extracted at an
    acid pH
A

B. A drug is identified by comparing its Rf value
and staining to standards

25
Q
  1. The EMIT for drugs of abuse uses an:
    A. Antibody conjugated to a drug
    B. Enzyme conjugated to an antibody
    C. Enzyme conjugated to a drug
    D. Antibody bound to a solid phase
A

C. Enzyme conjugated to a drug

26
Q
  1. Which statement about EMIT is true?
    A. Enzyme activity is inversely proportional to drug
    level
    B. Formation of NADH is monitored at 340 nm
    C. ALP is the commonly used conjugate
    D. Assay use is restricted to serum
A

B. Formation of NADH is monitored at 340 nm

27
Q
  1. Which statement regarding cloned enzyme donor
    immunoassay (CEDIA) is true?
    A. The enzyme used is glucose-6-phosphate
    dehydrogenase
    B. The enzyme donor and acceptor molecules are
    fragments of β-galactosidase
    C. Drug concentration is inversely related to
    fluorescence
    D. The antibody is covalently linked to the enzyme
    donor
A

B. The enzyme donor and acceptor molecules are
fragments of β-galactosidase

28
Q
  1. Which statement is true regarding particle-enhanced
    turbidimetric inhibition immunoassay methods for
    therapeutic drugs?
    A. Drug concentration is proportional to light
    scatter
    B. Magnetic separation is needed to remove
    unbound conjugate
    C. When particle-bound drug binds to antibody,
    light scattering is increased
    D. Two antibodies to the drug are needed
A

C. When particle-bound drug binds to antibody,
light scattering is increased

29
Q
  1. Quantitation of a drug by gas chromatography–mass
    spectroscopy (GC-MS) is usually performed in
    which mode?
    A. Total ion chromatography
    B. Selective ion monitoring
    C. Ion subtraction
    D. Selective reaction monitoring
A

B. Selective ion monitoring

30
Q
  1. SITUATION: A urine sample is received in the
    laboratory with the appropriate custody control
    form, and a request for drug of abuse screening.
    Which test result would be cause for rejecting
    the sample?
    A. Temperature after collection 95°F
    B. pH 5.0
    C. Specific gravity 1.005
    D. Creatinine 5 mg/dL
A

D. Creatinine 5 mg/dL

31
Q
  1. Which substance has the longest detection time?
    A. Amphetamines
    B. Cocaine
    C. Benzodiazepines
    D. Marijuana
A

D. Marijuana

32
Q
  1. Which statement about the measurement of
    carboxyhemoglobin is true?
    A. Treatment with alkaline dithionite is used to
    convert carboxyhemoglobin to oxyhemoglobin
    B. Oxyhemoglobin has no absorbance at
    540 nm, but carboxyhemoglobin does
    C. Bichromatic analysis is required in order to
    eliminate interference by oxyhemoglobin
    D. Carboxyhemoglobin can be measured by
    potentiometry
A

C. Bichromatic analysis is required in order to
eliminate interference by oxyhemoglobin

33
Q
  1. Which of the following statements about blood
    alcohol measurement is correct?
    A. Symptoms of intoxication usually begin when
    the level exceeds 0.05% w/v
    B. The skin puncture site should be disinfected
    with isopropanol
    C. The reference method is based upon enzymatic
    oxidation of ethanol by alcohol dehydrogenase
    D. Gas chromatography methods require extraction
    of ethanol from serum
A

A. Symptoms of intoxication usually begin when
the level exceeds 0.05% w/v

34
Q
  1. Which specimen is the sample of choice for lead
    screening?
    A. Whole blood
    B. Hair
    C. Serum
    D. Urine
A

A. Whole blood

35
Q
  1. Which of the following enzymes can be used to
    measure plasma or serum salicylate?
    A. Peroxidase
    B. Salicylate esterase
    C. Salicylate hydroxylase
    D. p-Aminosalicylate oxidase
A

C. Salicylate hydroxylase

36
Q
  1. Which of the following tests is least essential to the
    operation of an emergency department at a general
    hospital?
    A. Carboxyhemoglobin
    B. Osmolality
    C. Salicylate
    D. Lead
A

D. Lead

37
Q
  1. Which of the following trace elements is
    considered an essential micronutrient?
    A. Thallium
    B. Aluminum
    C. Mercury
    D. Selenium
A

D. Selenium

38
Q
  1. When measuring trace metals in blood other
    than lead, what type of tube should be used?
    A. Navy blue top
    B. Green top
    C. Purple top
    D. Red top
A

A. Navy blue top

39
Q
  1. Which whole-blood level is suggestive of excessive
    exposure to lead in children but not adults?
    A. 4 μg/dL
    B. 14 μg/dL
    C. 28 μg/dL
    D. 32 μg/dL
A

B. 14 μg/dL

40
Q
  1. What are the likely laboratory findings in a person
    suspected of having Wilson’s disease?
    A. Blood copper and ceruloplasmin low, urinary
    copper excretion high
    B. Blood and urine copper concentration high,
    ceruloplasmin low
    C. Blood and urine copper concentration high,
    ceruloplasmin high
    D. Blood and urine copper concentration low,
    ceruloplasmin low
A

A. Blood copper and ceruloplasmin low, urinary
copper excretion high

***Medical Lab science review- Robert Harr 4th (63 decks)

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