FINALS TDM/ cardiotropics

Question 1

Involves the analysis and evaluation of circulating concentrations of drugs in blood

Answer 1

TDM/ Therapeutic Drug Monitoring

Question 2

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

Answer 2

TDM/ Therapeutic Drug Monitoring

Question 3

Indications of TDM

Answer 3

1.Consequences of over- and under-dosing are serious
2. Narrow margin of safety
3. Good correlation between circulating concentrations and therapeutic or toxic effects
4. Change in patient’s condition that may affect circulating drug concentrations
5. Occurrence of drug interactions
6. Monitoring patient compliance

Question 4

The rate at which the drug is absorbed is dependent upon the route of administration

Tablets & capsules require dissolution; liquids are rapidly absorbed

Transport mechanism: passive diffusion

Weak acids are absorbed in the stomach; weak bases in the intestine

Answer 4

Absorption

Question 5

FACTORS AFFECTING ABSORPTION

Answer 5

CPIP

Changes in intestinal movement
pH
Inflammation
Presence of food or other drugs

Question 6

Single most important factor

Answer 6

Timing

Question 7

Peak concentrations

Answer 7

1 hour after an orally administered dose

Question 8

SAMPLE COLLECTION

Answer 8

Serum or heparinized plasma

Question 9

Used to treat congestive heart failure and cardiac arrhythmias

Act on the conduction system of cardiac muscle

Net effect : slow down electrical conduction

Answer 9

CARDIOTROPICS

Question 10

Rapid sodium channel blockers

Answer 10

Class I

Question 11

Quinidine

Answer 11

Class I

Question 12

Procainamide

Answer 12

Class I

Question 13

Lidocaine

Answer 13

Class I

Question 14

Phenytoin

Answer 14

Class I

Question 15

Beta adrenergic blockers

Propranolol

Answer 15

Class II

Question 16

Potassium channel blockers

Amiodarone

Answer 16

Class III

Question 17

Calcium channel blockers

Verapamil

Answer 17

Class IV

Question 18

Digoxin and Digitoxin

Answer 18

DIGITAL GLYCOSIDES

Question 19

Inhibits membrane Na+-K+-ATPase
Decreases K+ and Mg+ and increases Ca+
Rapid onset of action : 1-2 h after oral administration

Answer 19

Digoxin

Question 20

Slower onset of action (1-4 hours oral)
Active metabolite : digoxin

Answer 20

Digitoxin

Question 21

Local anesthetic

Acute control and prevention of ventricular arrhythmias after myocardial infarction

Toxicity : convulsions, coma, respiratory depression, bradycardia, hypotension

Answer 21

Lidocaine

Question 22

For supraventricular and ventricular arrhythmias

Common formulation: quinidine SO4 & quinidine gluconate

Toxicity : cinchonism: vertigo, tinnitus, headache, visual disturbances and disorientation

Answer 22

Quinidine

Question 23

Supraventricular or ventricular arrhythmias

Metabolite : n-acetylprocainamide

Toxicity : reversible lupus-like syndrome w/ elevated ANA titers, urticaria, rash, agranulocytosis and nephrotic syndrome

Answer 23

Procainamide

Question 24

Antagonizes effects of epinephrine on the heart, arteries and arterioles of skeletal muscles and on the bronchus

Vasodilator: angina pectoris, hypertension

Answer 24

Propanolol

Question 25

For life threatening ventricular arrhythmias

Answer 25

Amiodarone

Question 26

For angina, hypertension and supraventricular arrhythmias

Answer 26

Verapamil