Lecture: Therapeutic Drug Monitoring Flashcards
Individualized system of administration and management of drug therapy; deals with the measurement of drug concentrations during therapy with pharmaceutical agents
Therapeutic Drug Monitoring
Rate of administration is equal to the rates of metabolism and excretion
Steady-state Drug Level
Drug concentration in the blood can be sub-therapeutic, therapeutic, or toxic
Therapeutic Range
Mathematical interpretation of drug disposition over time to determine proper dosing amounts of therapeutic drug
Pharmacokinetics
Describes absorption, distribution & elimination of drugs
First-Order Kinetics
Describe the rate of change of drug concentration that is independent of the concentration of the drug
Zero-Order Kinetics
Whole blood is collected when determining presence of _ and _
Cyclosporine
Tacrolimus
Lowest level of drug in the blood
Trough Concentration
For initial investigation of therapeutic drug toxicity (exceeds upper therapeutic limit)
Peak Concentration
Antibody specific to a particular drug
Immunoassay
Best specimen for chromatography
Urine
Type of chromatography based on how far drugs travel and separate (stained)
Thin-layer Chromatography
Type of chromatography that depends on type of column used, solvent, detector systems; used to determine tricycline depressants and metabolites
High-Performance Liquid Chromatography
Gold standard in chromatography is used for volatile drugs
Gas Chromatography-Mass Spectrometry
Classification of Drugs
Cardioactive
Antibiotics
Antiepileptics
Psychoactive
Bronchodilator
Immunosuppressive
Antineoplastic
Anti-inflammatory (Analgesics)
Neuroepileptics
Rapid sodium channel blockers are what class of cardioactive drugs?
Class I
Quinidine, procainamide, lidocaine belongs to what class of cardioactive drugs?
Class I
Beta receptor blockers are what class of cardioactive drugs?
Class II
Propranolol belongs to what class of cardioactive drugs?
Class II
K+ channel blockers are what class of cardioactive drugs?
Class III
Amiodarone belongs to what class of cardioactive drugs?
Class III
Calcium channel blockers are what class of cardioactive drugs?
Class IV
Verapamil belongs to what class of cardioactive drugs?
Class IV
Cardiac glycoside for treatment of atrial arrhythmia and CHF; inhibits Na-K-ATPase
Digoxin
Local anesthetic that corrects ventricular arrhythmia
Lidocaine
Another name for lidocaine
Xylocaine
Metabolite of lidocaine
Monoethylglycinexylidide
Naturally occurring drug for arrhythmia
Quinidine
Substitute for quinidine; for arrhythmia
Disopyramide
For ventricular arrhythmia that has toxic effects such as reversible lupus-like syndrome, nephrotic syndrome, urticarial
Procainamide
Other name for Procainamide
Pronestyl
What type of quinidine peaks 2 hours after oral dose?
Quinidine sulfate
What type of quinidine peaks 4 hours after oral dose?
Quinidine gluconate
Metabolite of procainamide
N-acetyl-procainamide
Beta-receptor-blocking drug; suppresses conversion of T4 to T3
Propranolol
Blocks K+ channels in cardiac muscle; contains iodine
Amiodarone
Other name for amiodarone
Cordarone
Treatment for angina, hypertension, supraventricular dysfunction
Verapamil
Antibiotics
Aminoglycosides
Vancomycin
Chloramphenicol
Types of aminoglycosides
Gentamicin, tobramycin, amikacin, kanamycin, neomycin, streptomycin
Disopyramide can induce dry mouth and constipation, these effects are called?
Anticholinergic Effects
Aminoglycoside toxicity can result to?
Hearing loss
Gram-positive cocci and bacilli are susceptible to?
Vancomycin
Vancomycin toxicity can result to?
Red Man Syndrome
Nephrotoxicity
Ototoxicity
Protein synthesis inhibitor; works on gram-negative bacteria
Chloramphenicol
Chloramphenicol toxicity can result to?
Blood dyscrasia (Aplastic anemia)
Cytoplasmic vacuolation
Antiepileptics
Phenobarbital
Phenytoin
Valproic Acid
Carbamazepine
Ethosuximide
Gabapentin
Topiramate, Lamotrigine
Long-acting barbiturate; controls the grand mal tonic-clonic seizure & focal seizure
Phenobarbital
Phenobarbital toxicity can result to?
Nystagmus, stupor, ataxia, respiratory depression
For tonic-clonic, simple-partial seizure; short-term prophylactic agent; not for petit mal and atomic seizures
Phenytoin
Phenytoin decreases _ and _ influx
Calcium
Sodium
Phenytoin toxicity can result to?
Teratogenic (cleft lip and palate)
Used for petit mal, atomic seizure, grand mal
Valproic Acid
Other name for valproic acid
Depakene
Valproic Acid toxicity can result to?
Pancreatitis
Tricyclic compound related to imipramine; used for grand mal seizures
Carbamazepine
Other name for Carbamazepine
Tegretol
Drug of choice for petit mal seizures
Ethosuximide
Other name for Ethosuximide
Zarontin
Carbamazepine toxicity can result to?
Hematologic dyscrasias, ataxia
Ethosuximide toxicity can result to?
GI disturbances, ataxia, SLE, aplastic anemia, pancytopenia
Chemically similar to a neurotransmitter gamma aminobutyric acid; for partial seizures
Gabapentin
Other name for Gabapentin
Neurontin
Gabapentin is chemically similar to?
Gamma aminobutyric acid (GABA)
Adjunct drugs for partial seizure
Topiramate, Lamotrigine, Felbamate
Other name for Lamotrigine
Lamictal
Blocks dopamine and serotonin; for Schizophrenia; difficult to monitor
Neuroepileptics
Neuroepileptics
Phenothiazines
Butyrophenones
Risperdal
Olanzapine
Quetiapine
Aripiprazole
Example of Butyrophenones
Haloperidol
Example of Phenothiazines
Chlorpromazine
Psychoactive drugs
Lithium
Tricylic Antidepressants
Fluoxetine
Drug of choice for Chronic cluster headache; inhibits iodine uptake; for manic-depressive illness
Lithium
Used for depression and insomnia
Tricylic Antidepressants
Major metabolite of TCAs
Desipramine
Examples of TCAs
Imipramine, amitriptyline, doxepin, nortriptyline, trazadone
Blocks re-uptake of serotonin; for Obsessive-compulsive disorders
Fluoxetine
Other name for fluoxetine
Prozac
Relaxes the bronchial smooth muscles; asthma, COPD
Theophylline
Immunosuppressive Drugs
Cyclosporine
Tacrolimus
Rapamycin
Mycophenolate Mofetil
Leflunomide
Blocks production of IL-2; prevents allogenic organ transplant
rejection and GVHD
Cyclosporine
Macrolide antibiotic; 100X more powerful than cyclosporine
Tacrolimus
Other name for Tacrolimus
Prograf
This immunosuppressive drug has these side effects - lipid abnormalities, thrombocytopenia
Rapamycin
Other name for Rapamycin
Sirolimus
Used for renal allograft rejection
Mycophenolate Mofetil
Inhibits lymphocyte proliferation; treatment for Rheumatoid arthritis
Leflunomide
Anti-neoplastic and immunosuppressive agent; inhibits DNA synthesis
Methorexate
Antidote for Methorexate
Leucovorin
Used for leukemias and lymphomas before BM transplantation
Busulfan
Busulfan toxicity can result to?
Hepatic occlusive diseases
Direct stimulator of respiratory system and inhibitor of Kreb’s cycle
Salicylate
Other name for Salicylate
Aspirin
Anti-Platelet property of Salicylate
Cyclooxygenase inhibitor
Common cause of fatal drug poisoning
Acute aspirin intoxication
Salicylate toxicity can result to?
Reye’s Syndrome
Method used for determining salicylate?
Trinder’s assay
Inhibits prostaglandin metabolism
Acetaminophen
Other name for Acetaminophen
Tylenol
Lower toxicity than salicylates and acetaminophen
Ibuprofen
Anti-inflammatory Drugs are also known as?
Analgesics