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Chemistry > Exam 11 (Therapeutic Drug Monitoring, Toxicology, Porphyrins) > Flashcards

Exam 11 (Therapeutic Drug Monitoring, Toxicology, Porphyrins) Flashcards

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1
Q

What is therapeutic drug monitoring?

A

Measurement of drug/metabolite to determine proper dosage

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2
Q

What are some reasons why we would do therapeutic drug monitoring on a patient?

A
  • Serious consequences of over/underdosing
  • Change in patient physiologic status
  • drug interaction is/may be occurring
  • monitor compliance
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3
Q

Therapeutic range

A

Dosage at which patient experiences benefit from the drug without toxic effects

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4
Q

Half-life

A

Time required to eliminate half of a dose from circulation

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5
Q

Pharmacokinetics

A

what the body does to the drug (how does body process drug)

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6
Q

Pharmcodynamics

A

What the drug does to the body (physiological response, side effects, etc)

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7
Q

What is the fastest route of administration? Slowest? Most common?

A

IV fastest
Oral slowest and most common

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8
Q

What does ADME stand for?

A

Adsorption
Distribution
Metabolism
Excretion

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9
Q

First-pass effect and what part of ADME does this apply to?

A

Drug broken down in the liver and excreted in urine, does not make it to circulation, only occurs in some drugs administered orally. (which must then be given IV)
Applies to M - metabolism

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10
Q

First order kinetics

A

Reaction in which metabolism of enzyme is proportional to the concentration of substrate

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11
Q

Zero order kinetics

A

Reaction in which the active sites of the enzymes are fully saturated with substrate. Reaction rate is not affected by drug concentration (ex. Ethanol)

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12
Q

Steady state

A

Where the drug should be measured, drug is in a steady state in the body

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13
Q

Peak

A

Highest concentration of a drug

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14
Q

Random measurement

A

Measurement anywhere other than peak or trough

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15
Q

Trough

A

Lowest point, just before the next dose is administered

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16
Q

Ideally, the trough should be within __________ ________, as well as the peak should not go above this.

A

Therapeutic range

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17
Q

Digoxin (what type of drug, what is it used to treat).

A
  • Cardioactive drug
  • Treats CHF
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18
Q

Lidocaine (what type of drug, what is it used to treat).

A
  • TOPICAL Cardioactive drug
  • Prevents cardiac arrythmias and used as topical local anesthetic
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19
Q

Digi-bind

A

Antibody to digoxin, can interfere with lab analysis (given when digoxin reaches toxic levels, but can falsely elevate digoxin levels)

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20
Q

What is the risk of antibiotics in toxic levels?

A

Kidney damage
Hearing loss

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21
Q

Phenobarbital (what type of drug, what is it used to treat)

A

Antiepileptic drug (barbituate)
Prevents seizures

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22
Q

Phenytoin (Dilantin) (what type of drug, what is it used to treat)

A

Antiepileptic drug
Brain injury/prevent seizures

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23
Q

What can antiepileptic drugs result in if in toxic levels?

A

Seizures, even though they are administered to prevent seizures.

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24
Q

Valproic acid (what type of drug, what is it used to treat, unique facts)

A

Antiepileptic drug (prevents seizures)
Highly protein bound, low bioavailability

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25
Q

Carbamazepine (what type of drug, what is it used to treat, unique facts)

A

Antiepileptic drug (prevents seizures)
Used as a last resort, can have serious toxic effects

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26
Q

Lithium (what type of drug, what is it used to treat)

A

Psychoactive drug
Used to treat bipolar disorder

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27
Q

What hormone can lithium affect in the body?

A

Thyroid hormone/TSH
May cause hypothyroidism

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28
Q

Theophylline (what type of drug, what is it used to treat)

A

Bronchodilators
Used to treat asthma and COPD

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29
Q

Primidone

A

Pro-drug to phenobarbital, body metabolizes it into active drug, can be given to patients who metabolize phenobarbital too quickly

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30
Q

Caffeine (what class of drug, what is it used to treat)

A

Bronchodilators
Used in premature babies to prevent apnea

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31
Q

What are the 3 immunosuppressive drugs? Which is the most potent?

A

Cyclosporine
Tacrolimus (most potent) (allows patient to take smaller doses but must be able to detect very low levels)
Sirolimus

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32
Q

Why are immunosuppressive drugs given?

A

To prevent tissue rejection after graft/transplant

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33
Q

Methotrexate (what type of drug, what is it used to treat)

A

Antineoplastic drugs (inhibit DNA synthesis)
Used to help treat cancer

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34
Q

What is toxicology

A

Study of poisons or xenobiotics

35
Q

ED50

A

dose at which 50% of people experience benefit

36
Q

TD50

A

dose at which 50% of people experience toxicity

37
Q

LD50

A

dose at which 50% of people die (lethal)

38
Q

Ethanol

A

drinking alcohol –> turns to acetic acid

39
Q

Methanol

A

grain/wood alcohol –> turns to formaldehyde and formic acid

40
Q

Isopropanol

A

Rubbing alcohol –> turns to acetone

41
Q

Ethylene glycol

A

Anti-freeze –> turns to oxalic and glycolic acids

42
Q

What can interfere with ethanol analysis levels?

A

elevated LDH and lactate levels

43
Q

What binds to hemoglobin to produce carboxyhemoglobin?

A

Carbon monoxide

44
Q

Children absorb 2-3x as much ______ than adults do.

A

Lead

45
Q

Toxicity of lead

A

Neurological effects

46
Q

What do pesticides inhibit?

A

Acetylcholinesterase

47
Q

Amphetamines/methamphetamines are used to treat?

A

ADHD and narcolepsy

48
Q

Cannabinoids

A

THC/marijuana
well-being and euphoria
Lipophilic (hides in fat cells)

49
Q

Cocaine

A

Stimulant, effective local anesthetic that produces a sense of excitement and euphoria

50
Q

What is the parent drug of cocaine?

A

Benzoylecgonine

51
Q

Opioids and examples

A

Analgesia, sedation, anesthesia
(heroin, percocet, fentanyl, methadone, etc)

52
Q

Opiates

A

Opium
Morphine
Codeine

53
Q

Difference between opioid and opiate

A

opioids are synthetic
opiates are not (HEROIN, MORPHINE, CODEINE)

54
Q

Naloxone

A

Treatment of opioid overdose

55
Q

Phenylcyclidine

A

PCP
stimulant, depressant, anesthetic, and hallucinogenic

56
Q

Sedative hypnotics

A

Barbiturates, benzodiazepines (CNS depressants)

57
Q

Barbiturates

A

Phenobarbital, pentobarbital, secobarbital

58
Q

Benzodiazepines

A

Valium, Xanax, Ativan, Ambien, etc (ANTI-ANXIETY)

59
Q

Designer drugs

A

Bath salts, Synthetic marijuana (K2)

60
Q

What are the 3 clinically significant porphyrins?

A

Uroporphyrin
Coproporphyrin
Protoporphyrin

61
Q

What is the key symptom in an acute attack of porphyria?

A

Abdominal pain

62
Q

What does ZPP indicate exposure to?

A

Lead toxicity

63
Q

What is a competitive inhibitor for entry of calcium into neurons?

A

Magnesium

64
Q

What is the standard therapy for pregnancy-induced hypertension (preeclampsia)?

A

Magnesium

65
Q

What are some metabolic bone diseases?

A

Osteoporosis
Osteomalacia/Ricketts
Renal osteodystrophy
Paget disease
Bone metastases

66
Q

What is the most prevalent metabolic bone disease in developed countries?

A

Osteoporosis

67
Q

Paget disease

A

Localized disease of bone characterized by osteoclastic bone resorption followed by bone replacement in a chaotic fashion

68
Q

What is significant about ionized calcium levels?

A

50% of calcium is ionized (free)
Best indicator of calcium status, must be maintained on ice and handled anaerobically

69
Q

Acceptable specimen types for total calcium measurement

A

Serum and heparinized plasma preferred
Acidified urine

70
Q

How is total calcium measured?

A

Spectrophotometrically (most common)
ISE
AAS

71
Q

What is the difference between the two spectrophotometric methods to measure calcium?

A

O-cresophthalein method - uses 2 reagents

Arsenazo III method - uses only 1 reagent

72
Q

How is ionized calcium measured?

A

ISEs

73
Q

What are the acceptable specimen types for ionized calcium?

A

Heparinized whole blood, heparinized plasma, or serum

74
Q

How is PTH measured?

A

Sandwich immunoassays
- Solid phase capture antibody (against C-terminal region)
- Signal or labeled antibody (against N-terminal region)

75
Q

Acceptable specimens for PTH measurement

A

Serum (gold top) or EDTA plasma

76
Q

What is the principal mediator of humoral hypercalcemia of malignancy?

A

PTHrP

77
Q

Specimen type for PTHrP

A
  • Unstable in room temp/refrigerated serum or plasma
  • Collected in special collection tubes which contain protease inhibitors
  • Maintain on ice, separate and freeze ASAP
78
Q

Which Vitamin D form is measured?

A

25-OH Vitamin D

79
Q

Specimen type for Vit D

A

Serum

80
Q

Preferred specimen type for Phosphorous measurement

A

Serum and heparinized plasma
Hemolyzed UNACCEPTABLE

81
Q

Method of measurement for Phosphorous

A

Phosphate ions react with ammounium molybdate to form a phosphomolybdate complex

82
Q

Specimen type for Magnesium measurement

A

Serum and heparinized plasma, HEMOLYSIS UNACCEPTABLE

83
Q

What are the spectrophotometric methods to measure Magnesium?

A
  • Calmagite and methylthymol blue
  • Formazan dye
  • Chlorophosphonazo III
  • Arsenazo
    (Form colored complex in ALKALINE solution, chelating agents added to decrease calcium interference)

Chemistry (12 decks)

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