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MLT 203 Clinical Chemistry II > Exam 3 TDM/Toxicology > Flashcards

Exam 3 TDM/Toxicology Flashcards

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1
Q

Define therapeutic drug monitoring

A

the analysis, assessment, and evaluation of circulating concentrations of drugs in serum, plasma, or whole blood

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2
Q

Purpose of TDM

A

to ensure that a given drug dosage produces maximal therapeutic benefit and minimal toxic adverse effects

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3
Q

Advantages of TDM

A

o Identifying non-compliant patients
o Maximizing therapeutic effect
o Optimizing a dosing regimen based on drug-drug interactions

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4
Q

Factors that influence drug effect and dosage

A

Age, weight, tolerance, rate of elimination, time of administration, genetic factors, metabolism of other drugs, protein binding, disease states, medication errors/compliance

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5
Q

What does LADME stand for?

A 
Liberation
Absorption
Distribution
Metabolism
Excretion
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6
Q

What is liberation?

A

The release of the drug from its dosage form

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7
Q

What is absorption?

A

Rate at which drug leaves site of administration and the extent to which this happens

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8
Q

What is distribution?

A

the process by which drug diffuses or is transferred from intravascular space to extravascular space (body tissues)
- blood flow, capillary permeability

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9
Q

What is metabolism/biotransformation?

A

o Transformation of the parent drug molecule into one or more metabolites by enzymes

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10
Q

What is MFO?

A

– hepatic mixed function oxidase
 Converts hydrophobic substances into water-soluble substances
 Then transported to bile or released into circulation for elimination

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11
Q

What is elimination/excretion?

A

o Rate of change of drug concentration over times varies continuously with the concentration
o Functional changes in organs can affect rate of elimination (such as hepatic disease/cirrhosis – slows clearance)

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12
Q

Routes of drug administration

A
  • Injections – IV (fastest), intramuscular, subcutaneous, epidermal
  • Inhalation
  • Absorbed through skin (slowest)
  • Rectal
  • Oral
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13
Q

What is cytochrome P450?

A
  • Major enzymes that metabolize drugs

* Gene group family that affects drug metabolism

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14
Q

What is pharmacogenomics?

A

the study of how a person’s unique genetic makeup (genome) influences his or her response to medications.

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15
Q

What is first-pass metabolism?

A
  • Drugs administered through IV enter directly into systemic circulation
  • Drugs administered orally are first exposed to the liver and may be metabolized before reaching the rest of the body
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16
Q

What are some routes of elimination?

A
  • Hepatic metabolism
  • Renal filtration
  • Skin, lungs, mammary glands, salivary glands
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17
Q

What are examples of cardioactive drugs?

A

Digoxin, lidocaine, quinine, procainamide

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18
Q

What is digoxin?

A
  • Used to treat CHF
  • Draw peak levels 2 hours post dose
  • Allows for better cardiac muscle contraction and rhythm
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19
Q

What is lidocaine used for?

A

Used to treat premature ventricular contractions

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20
Q

What is quinidine used for?

A
  • Used to treat cardiac arrhythmias

* Prevents arrhythmias, atrial flutter, fibrillation

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21
Q

What is procainamide used for? How is it measured?

A
  • Used to treat cardiac arrhythmic situations
  • Affects cardiac muscle contraction
  • Often measured with NAPA (N-Acetyl procainamide)
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22
Q

Different types of antibiotics

A

Aminoglycosides, vancomycin

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23
Q

What are aminoglycosides used for?

A
  • Gentamicin, tobramycin, amikacin, kanamycin
    • Used to treat infections with gram-negative bacteria
    • Inhibits protein synthesis of the microorganism
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24
Q

Side effects of aminoglycodies

A

nephrotoxic, ototoxic

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25
Q

What is vancomycin used for?

A
  • Used to treat infections with more-resistant gram-positive bacteria
  • Inhibits cell wall synthesis
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26
Q

First generation anti epileptic drugs

A

phenobarbital, phenytoin (Dilantin), valproic acid (Depakane), carbamazepine (Tegretol)

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27
Q

Second generation. anti epileptic drugs

A

felbamate, gabapentin, oxcarbazepine, topiramate, etc.

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28
Q

Examples of psychotherapeutic drugs

A
  • used to treat manic depression/BD
    • Lithium
    • Tricyclic antidepressants
    • Clozapine – schizophrenia
29
Q

Antiasthmatic drugs

A

o Theophylline and theobromine

30
Q

What are immunosuppressive drugs used for?

A

o Monitoring of this group is important to prevent organ rejection
o Used to treat autoimmune disease

31
Q

Examples of immunosuppressive drugs

A

o Cyclosporine – whole blood

o Tacrolimus – prevents rejection of liver and kidney transplants

32
Q

What are antineoplastic drugs? Example?

A

o Inhibits RNA or DNA synthesis of tumor cells, leading to cell death
o Methotrexate – inhibits DNA synthesis of all cells

33
Q

What are protease inhibitors?

A

o Antiviral drugs used to treat HIV/AIDS, hepatitis C
o Inhibit viral replication
• Indinavir, ritonavir, lopinavir, nelfinavir

34
Q

Define half-life

A

time needed for the serum drug concentration to decrease by one-half

35
Q

Define steady state

A

time at which the rate of elimination = the rate of administration

36
Q

Methodology used for TDM

A
  • Immunoassays

* Chromatography and mass spectrometry

37
Q

Biomagnification vs bioaccumulation

A

• Biomagnification – across a food chain, toxin concentration can build up over time if it is fat soluble
o DDT, organic forms of mercury/arsenic
• Bioaccumulation – chronic poisoning from the environment or workplace
o Mad hatter syndrome – mercury

38
Q

Describe ethanol toxicity

A
  • Chronic exposure leads to alcohol hepatitis/cirrhosis
  • Increased GGT, AST, HDL
  • Deritis ratio >2.0
39
Q

Describe methanol toxicity. How does it affect AG and osmolality?

A
  • Found in homemade liquor & commercial products
  • Increased AG and serum osmolality
  • Serum osmo increases by about 10mOsm/kg for each 60mg/dL increase in serum ethanol
40
Q

Describe ethylene glycol toxicity

A
  • Causes metabolic acidosis & renal damage
  • Calcium oxalate crystals (envelopes)
  • Sweet taste attracts children/pets
41
Q

Legal levels for alcohol

A

• Legal 80-100 mg/dL (0.08 – 0.10%)

42
Q

Lethal level for alcohol

A

> 400 mg/dL

43
Q

Characteristics of carbon monoxide

A

o Colorless, odorless, tasteless
o Rapidly absorbed into blood
o Produced by incomplete combustion of carbon-containing substances

44
Q

Actions of CO

A

o Binds tightly to HGB and does not allow O2 to attach, forming carboxyhemoglobin
o Decreases O2 delivery to tissues = hypoxia

45
Q

Characteristics of cyanide toxicity. Where is it found?

A

• Found in industrial processes, insecticides, burning plastics
• Toxic by binding to heme iron
o Pesticides – decreased in cholinesterase levels are indicative of exposure to insecticides

46
Q

Symptoms of cyanide toxicity

A

• Causes headaches, dizziness, respiratory depression, leads to seizure/coma/death

47
Q

Where are organophosphates found?

A

insecticides/pesticides

48
Q

Describe aspirin toxicity

A

o Overdose causes severe hepatotoxicity

o Damage not apparent until 3-5 days after ingestion

49
Q

Function of salicylates

A

o Fever reducer/pain reliever
o Decreases thromboxane and prostaglandin formation
 Inhibition of cyclooxygenase which interferes with platelet aggression

50
Q

Toxicity of salicylate

A

o Metabolic acidosis
 Formation of ketones due to fatty acid metabolism
 Hyperventilation

51
Q

Identify parameter of alteration testing

A
  • Temperature <91ºF or >100ºF
  • Ph <4.5 or >11
  • Specific gravity <1.003
  • Creatinine <20mg/dL
  • Presence of bleach, glutaraldehyde, nitrite
52
Q

What are amphetamines?

A

o Stimulant used to treat narcolepsy and ADD

o Ephedrine, pseudoephedrine, “ecstasy”/MDMA

53
Q

OD symptoms for amphetamines

A

hypertension, convulsions, cardiac arrhythmia

54
Q

Chronic use of steroids causes:

A

 Toxic hepatitis
 Atherosclerosis
 Abnormal platelet aggregation
 Heart enlargement

55
Q

Half-life for cannabinoids

A

1 day after single use, 3-5 days after chronic use

56
Q

Function of cocaine

A

CNS stimulator & local anesthetic

57
Q

Primary metabolite of cocaine

A

Benzolecgonine

58
Q

OD symptoms of cocaine

A

 Hypertension, arrhythmia, seizure, MI

o Detect in urine for 3 days post single use, 20 days chronic use

59
Q

Function of opiates

A

Sedative, provides pain relief

60
Q

Types of opiates

A

opium, heroin, morphine, codeine, Dilaudid, Percodan, Demerol, Oxycontin

61
Q

OD symptoms of opiates

A

 Respiratory acidosis
 Myoglobinuria
 Cardiac damage
 Death by cardiopulmonary failure

62
Q

Example of PCP

A

o Ketamine – veterinary analgesic, anesthetic
o Street names
 Vitamin K, special K, super K

63
Q

Types of sedatives

A

o Barbiturates – phenobarbital, secobarbital
o Benzodiazepines – less toxic than barbiturates
 Valium, Ativan
 Rohypnol – sexual assault drug
 Not detected in drug screens

64
Q

OD symptoms of sedatives

A

Slurred speech, lethargy, coma

65
Q

Function of bath salts

A

“Vanilla sky”
o Produce stimulant/hallucinogenic effects
 Euphoria, increased sex drive

66
Q

OD symptoms for bath salts

A

o Can result in life-threatening effects
 Anxiety, paranoia, tachycardia, chest pain, hostile behaviors
 Difficult to screen for in ED, recipe keeps changing

67
Q

What is Krokodil?

A

 Synthetic form of desomorphine
 Similar to heroin highs
 Named for effect it has on skin

68
Q

What is salvia?

A

“Magic mint”

 Produces hallucinogenic effects

69
Q

What are synthetic cannabinoids?

A

 “Spice” or K2
 Produces euphoria
 Difficult to detect

MLT 203 Clinical Chemistry II (3 decks)

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