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

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

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
Carbamazepine (what type of drug, what is it used to treat, unique facts)
Antiepileptic drug (prevents seizures) Used as a last resort, can have serious toxic effects
26
Lithium (what type of drug, what is it used to treat)
Psychoactive drug Used to treat bipolar disorder
27
What hormone can lithium affect in the body?
Thyroid hormone/TSH May cause hypothyroidism
28
Theophylline (what type of drug, what is it used to treat)
Bronchodilators Used to treat asthma and COPD
29
Primidone
Pro-drug to phenobarbital, body metabolizes it into active drug, can be given to patients who metabolize phenobarbital too quickly
30
Caffeine (what class of drug, what is it used to treat)
Bronchodilators Used in premature babies to prevent apnea
31
What are the 3 immunosuppressive drugs? Which is the most potent?
Cyclosporine Tacrolimus (most potent) (allows patient to take smaller doses but must be able to detect very low levels) Sirolimus
32
Why are immunosuppressive drugs given?
To prevent tissue rejection after graft/transplant
33
Methotrexate (what type of drug, what is it used to treat)
Antineoplastic drugs (inhibit DNA synthesis) Used to help treat cancer
34
What is toxicology
Study of poisons or xenobiotics
35
ED50
dose at which 50% of people experience benefit
36
TD50
dose at which 50% of people experience toxicity
37
LD50
dose at which 50% of people die (lethal)
38
Ethanol
drinking alcohol --> turns to acetic acid
39
Methanol
grain/wood alcohol --> turns to formaldehyde and formic acid
40
Isopropanol
Rubbing alcohol --> turns to acetone
41
Ethylene glycol
Anti-freeze --> turns to oxalic and glycolic acids
42
What can interfere with ethanol analysis levels?
elevated LDH and lactate levels
43
What binds to hemoglobin to produce carboxyhemoglobin?
Carbon monoxide
44
Children absorb 2-3x as much ______ than adults do.
Lead
45
Toxicity of lead
Neurological effects
46
What do pesticides inhibit?
Acetylcholinesterase
47
Amphetamines/methamphetamines are used to treat?
ADHD and narcolepsy
48
Cannabinoids
THC/marijuana well-being and euphoria Lipophilic (hides in fat cells)
49
Cocaine
Stimulant, effective local anesthetic that produces a sense of excitement and euphoria
50
What is the parent drug of cocaine?
Benzoylecgonine
51
Opioids and examples
Analgesia, sedation, anesthesia (heroin, percocet, fentanyl, methadone, etc)
52
Opiates
Opium Morphine Codeine
53
Difference between opioid and opiate
opioids are synthetic opiates are not (HEROIN, MORPHINE, CODEINE)
54
Naloxone
Treatment of opioid overdose
55
Phenylcyclidine
PCP stimulant, depressant, anesthetic, and hallucinogenic
56
Sedative hypnotics
Barbiturates, benzodiazepines (CNS depressants)
57
Barbiturates
Phenobarbital, pentobarbital, secobarbital
58
Benzodiazepines
Valium, Xanax, Ativan, Ambien, etc (ANTI-ANXIETY)
59
Designer drugs
Bath salts, Synthetic marijuana (K2)
60
What are the 3 clinically significant porphyrins?
Uroporphyrin Coproporphyrin Protoporphyrin
61
What is the key symptom in an acute attack of porphyria?
Abdominal pain
62
What does ZPP indicate exposure to?
Lead toxicity
63
What is a competitive inhibitor for entry of calcium into neurons?
Magnesium
64
What is the standard therapy for pregnancy-induced hypertension (preeclampsia)?
Magnesium
65
What are some metabolic bone diseases?
Osteoporosis Osteomalacia/Ricketts Renal osteodystrophy Paget disease Bone metastases
66
What is the most prevalent metabolic bone disease in developed countries?
Osteoporosis
67
Paget disease
Localized disease of bone characterized by osteoclastic bone resorption followed by bone replacement in a chaotic fashion
68
What is significant about ionized calcium levels?
50% of calcium is ionized (free) Best indicator of calcium status, must be maintained on ice and handled anaerobically
69
Acceptable specimen types for total calcium measurement
Serum and heparinized plasma preferred Acidified urine
70
How is total calcium measured?
Spectrophotometrically (most common) ISE AAS
71
What is the difference between the two spectrophotometric methods to measure calcium?
O-cresophthalein method - uses 2 reagents Arsenazo III method - uses only 1 reagent
72
How is ionized calcium measured?
ISEs
73
What are the acceptable specimen types for ionized calcium?
Heparinized whole blood, heparinized plasma, or serum
74
How is PTH measured?
Sandwich immunoassays - Solid phase capture antibody (against C-terminal region) - Signal or labeled antibody (against N-terminal region)
75
Acceptable specimens for PTH measurement
Serum (gold top) or EDTA plasma
76
What is the principal mediator of humoral hypercalcemia of malignancy?
PTHrP
77
Specimen type for PTHrP
- 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
Which Vitamin D form is measured?
25-OH Vitamin D
79
Specimen type for Vit D
Serum
80
Preferred specimen type for Phosphorous measurement
Serum and heparinized plasma Hemolyzed UNACCEPTABLE
81
Method of measurement for Phosphorous
Phosphate ions react with ammounium molybdate to form a phosphomolybdate complex
82
Specimen type for Magnesium measurement
Serum and heparinized plasma, HEMOLYSIS UNACCEPTABLE
83
What are the spectrophotometric methods to measure Magnesium?
- 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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