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Clinical Chemistry 2 - CEUMLS > TDM > Flashcards

TDM Flashcards

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1
Q

Entails analysis, interpretation, and evaluation of drug concentration in serum, plasma, or whole blood samples

A

THERAPEUTIC DRUG MONITORING

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2
Q

Used to establish maximum benefits with minimal toxic effects for drugs whose correlation with dosage, effect or toxicity is not clear

A

THERAPEUTIC DRUG MONITORING

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3
Q

T/F

TDM is a routine laboratory test

A

F
NOT a routine laboratory test: Majority of drugs available in the market have its standard dosage (established)

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4
Q

Assesses drugs with NARROW THERAPEUTIC INDEX

A

THERAPEUTIC DRUG MONITORING

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5
Q

MAIN PURPOSE of TDM

A
  • Ensure the drug dosage will produce maximal therapeutic benefit
  • Identify when the drug is outside the therapeutic range
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6
Q

concentration of drug in the human sample that will produce pharmacologic/therapeutic benefit

A

Therapeutic range

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7
Q

effect if < TR

A

inefficacy

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8
Q

effect if > TR

A

toxicity

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9
Q

therapeutic range of a drug is almost the start of the toxic level (causes adverse effects)

A

Narrow therapeutic index

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10
Q

dose that provides therapeutic benefits (safe & effective) in most healthy population

A

STANDARD DOSAGE

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11
Q

T/F

Standard dose is used in diseased state

A

F

Not utilized in diseased state (diseased patients have alteration in physiologic condition) – can affect the predicted concentration of the standard dose

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12
Q

What must be done during diseased state to fit the individual needs

A

dosage regimen by performing TDM

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13
Q

FACTORS AFFECTING CIRCULATING CONCENTRATION OF DRUG

A

Route of Administration
Absorption
Drug Distribution
Free vs Bound Drug
Drug Metabolism
Drug Elimination

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14
Q

considered to achieve maximum therapeutic benefit of the drug

A

Route of Administration

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15
Q

Most direct and effective route of administration with 100% bioavailability

A

Intravenous (IV)

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16
Q

most common and least invasive route of administration

A

Oral (GI absorption)

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17
Q

Route of Administration done by Inhalation or skin absorption (transdermal patch)

A

Transcutaneous

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18
Q

Route of Administration done by rectal delivery and performed if oral delivery is not possible among infants (not all the time)

A

Suppository

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19
Q

Routes of Drug Administration based on the effectivity in drug delivery or in bioavailability

A

IV
IM
SC
Transcutaneous
Suppository
Oral

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20
Q

fraction of administered dose of drug that reaches the site of action or the circulation

A

Bioavailability

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21
Q

When drugs are absorbed, it can circulate in the blood either as?

A

free drug or protein-bound drug

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22
Q

active drug which exhibits therapeutic benefit

A

free / unbound drug

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23
Q

T/F

Only free drugs exhibit therapeutic benefit

A

F
Some protein-bound drugs may also exhibit therapeutic benefit.

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24
Q

2 fates of circulating drug

A
  1. distributed to the site of action (target of the drug) → shows biologic response
  2. metabolized and eliminated in their metabolite form
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25
Q

Things to consider in Drug Absorption

A

Formulation of Drug
Active transport
Passive Diffusion
Stomach (acidic)
Small intestine (slightly alkaline)

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26
Q

form of drug that is dissolved before absorption? what form has fast absorption?

A

Tablet/capsule

Liquid – fast absorption

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27
Q

Absorption intended for dietary constituents

A

Active transport

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28
Q

Absorption of majority of the drug from the GI tract → bloodstream (no energy required)

A

Passive Diffusion

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29
Q

Requirement for Passive Diffusion of drugs

A

drug must be hydrophobic/non-ionized state

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30
Q

Organ that efficiently absorbs weak acid drug

A

Stomach

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31
Q

Organ that efficiently absorbs weak base drug

A

Small intestine

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32
Q

T/F

Amount of absorbed drug in GI tract (stomach, intestines) is predictable

A

T

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33
Q

T/F

Vomiting patients may have orally administered drugs

A

F
drug must be administered through IM/IV

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34
Q

Ability of drug to leave the circulation depends on their

A

lipid solubility

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35
Q

Relative proportion of the drug in the circulation and tissue/site of action

A

Drug Distribution

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36
Q

type of drugs that can cross cell membrane and lipid compartment

A

Hydrophobic drugs

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37
Q

type of drugs that can cross cell membrane but cannot reach lipid compartment

A

Polar (non-ionized)

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38
Q

type of drugs that can cross cell membrane at a slow rate

A

Polar (ionized)

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39
Q

formula of Volume of Distribution (Vd) index

A

Vd = D/C

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40
Q

what is D in Volume of Distribution (Vd) index formula

A

IV injected dose of drug (mg/g)

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41
Q

what is C in Volume of Distribution (Vd) index formula

A

Conc. of drug in the blood (mg/L or g/L)

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42
Q

Vd of Hydrophobic Drugs

A

↑

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43
Q

Vd of Ionized/Bound Drugs

A

↓

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44
Q

Acidic drug binds to

A

albumin

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45
Q

Basic drug binds to

A

a1-acid glycoprotein

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46
Q

only the free/unbound can interact with its site of action and result in a biologic response

A

Drug dynamics

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47
Q

T/F

Increased free/unbound drugs in the circulation means that there will be increased therapeutic response.

A

F

Increased free/unbound drugs in the circulation does not mean that there will be increased therapeutic response – can lead to TOXICITY

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48
Q

T/F

There is a standard percentage/conc. of the absorbed drug that can be free or protein-bound

A

T

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49
Q

How many protein bound and free absorbed digoxin in circulation

A

25% protein-bound
75% free

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50
Q

T/F

When there is changes in blood protein content, Digoxin for example with 25% protein-bound may increase >25% due to higher chance to bind to protein

A

T

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51
Q

Factors that changes Free vs Bound drugs

A
  • Inflammation
  • Hepatic disease
  • Malignancies
  • Nephrotic syndrome
  • Pregnancy
  • Malignancy
  • Malnutrition
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52
Q

Drug Metabolism

A

First-Pass Metabolism
Pharmacogenomics

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53
Q

All drugs/substances absorbed by GI passes the hepatic portal system (liver) for metabolism before it enters the circulation

A

First-Pass Metabolism

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54
Q

T/F

Efficacy of some drugs depends on the generation of metabolites

A

T

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55
Q

Process of parent drug (administered) generated into its metabolites

A

Biotransformation

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56
Q

Capacity of individual to metabolize drug when there is impaired liver function

A

reduced

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57
Q

Examines variation (influenced by genes) in hepatic metabolism rates between individuals

A

Pharmacogenomics

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58
Q

Drug Elimination

A

Hepatic metabolic processes
Renal filtration

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59
Q

drug elimination wherein liver alters drugs into its metabolites and these metabolites are conjugated to make them water-soluble

A

Hepatic metabolic processes

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60
Q

drug elimination wherein kidneys filters conjugated metabolites into the urine

A

Renal filtration

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61
Q

Specimens for TDM

A

Serum, Plasma, Whole Blood

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62
Q

blood collection tube for serum in TDM

A

plain tube only

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63
Q

blood collection tube for plasma in TDM

A

heparinized tube

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64
Q

use of SST [yellow/gold] in TDM may cause? reason?

A

false ↓
gel separator may absorb some drugs

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65
Q

drugs absorbed by gel separator

A

phenytoin
phenobarbital
lidocaine
quinidine
carbamazepine

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66
Q

These Ca-binding anticoagulants interfere with drug analysis

A

EDTA, citrates, oxalates

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67
Q

Method for TDM

A

HPLC
Immunoassays
GC-MS (gold standard)

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68
Q

single most important factor in TDM

A

Timing of Blood Collection

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69
Q

lowest conc. of drug measured in the blood

A

Trough Concentration

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70
Q

what is the timing of collection to determine trough conc.?

A

collect blood right before administration of next dose

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71
Q

what is the timing of collection to determine peak conc. of orally administered drugs?

A

1hr after administration (except Digoxin)

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72
Q

what is the timing of collection to determine peak conc. of intravenously administered drugs?

A

30 mins. after administration

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73
Q

highest conc. of drug measured in the blood

A

Peak Concentration

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74
Q

determines if the drug already reached the toxicity level

A

Peak Concentration

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75
Q

exception for determination of peak concentration from oral drugs

A

Digoxin

collect blood 8-10 hr after initial dose

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76
Q

time required for serum conc. of drug to be decreased/reduced by half

A

Half-life

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77
Q

Categories of TDM DRUGS

A
  1. Cardioactive
  2. Antibacterial
  3. Antiepileptic (Anticonvulsant)
  4. Psychoactive
  5. Bronchodilator
  6. Immunosuppressive
  7. Antineoplastic
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78
Q

Types of Cardioactive drugs

A

cardiac glycosides

anti-arrhythmic

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79
Q

T/F

All drugs under each categories must undergo TDM

A

F

*not all drugs under each categories undergo TDM; only selected drugs

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80
Q

EXAMPLES OF CARDIOACTIVE DRUGS

A

DIGOXIN
QUINIDINE
PROCAINAMIDE
DISOPYRAMIDE
LIDOCAINE

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81
Q

brand name of DIGOXIN

A

Lanoxin

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82
Q

Protein-bound DIGOXIN

A

25%

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83
Q

TR of DIGOXIN

A

0.8-2 ng/ml

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84
Q

Peak conc. of DIGOXIN

A

2-3 hr

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85
Q

Half-life of DIGOXIN

A

38 hr

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86
Q

Toxic range of DIGOXIN

A

> 2-3 ng/ml

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87
Q

manifestation of DIGOXIN toxicity

A
  • Nausea
  • Vomiting
  • Visual disturbances
  • Premature ventricular contraction (PVC)
  • Atrioventricular node blockage
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88
Q

DIGOXIN is used as tx for? what is the mechanism?

A

CHF

inhibit Na-K ATPase pump = ↓ IC K+ = ↑ K+ in circulation = ↑ IC Ca2+ → promote cardiac contractility

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89
Q

digoxin metabolite

A

Digoxigenin

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90
Q

Timing of Blood Collection for Digoxin

A

8-10 hr (after administration); correlated with digoxin conc. in tissue

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91
Q

Method for DIGOXIN

A

IA

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92
Q

brand name/s of QUINIDINE

A

Quinidex Extentabs
Cardioquin
Quinora

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93
Q

Protein-bound QUINIDINE

A

70-80%

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94
Q

TR of QUINIDINE

A

2-5 ug/ml

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95
Q

2 common formulation of QUINIDINE

A

Quinidine Sulfate
Quinidine Gluconate

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96
Q

formulation of quinidine with complete and rapid GI absorption

A

Quinidine Sulfate

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97
Q

peak conc. of Quinidine Sulfate

A

2 hr

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97
Q

quinidine that is slow-release formulation and has a slower absorption

A

Quinidine Gluconate

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98
Q

peak conc. of Quinidine Gluconate

A

4-5 hr

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99
Q

half-life of QUINIDINE

A

6-8 hr

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100
Q

manifestation of QUINIDINE toxicity

A
  • Nausea
  • Vomiting
  • Abdominal discomfort
  • Thrombocytopenia
  • Tinnitus
  • CV toxicity (PVC)
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101
Q

occur if blood conc. of Quinidine is 2x the upper limit of TR (10 ug/mL)

A

CV toxicity (PVC)

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102
Q

Naturally occurring drug – extracted from barks of fever tree (Cinchona spp.)

A

QUINIDINE

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103
Q

QUNIDINE is tx for

A

cardiac arrhythmia

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104
Q

methods for QUINIDINE

A

Chromatography, IA

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105
Q

brand name of PROCAINAMIDE

A

Procanbin
Procan SR
Pronestyl

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106
Q

Protein-bound PROCAINAMIDE

A

20%

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107
Q

TR of PROCAINAMIDE

A

4-8 ug/ml

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108
Q

peak conc. of PROCAINAMIDE

A

1 hr

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109
Q

half-life of PROCAINAMIDE

A

4 hr

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110
Q

manifestations of PROCAINAMIDE toxicity

A
  • myocardial depression
  • arrhythmia
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111
Q

PROCAINAMIDE is a tx for

A

cardiac arrhythmia

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112
Q

cardioactive drug metabolized in the liver

A

PROCAINAMIDE

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113
Q

A parent drug; effective form is its metabolite – NAPA

A

PROCAINAMIDE

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114
Q

method for PROCAINAMIDE

A

IA

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115
Q

procainamide metabolite

A

N-acetylprocainamide (NAPA)

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116
Q

inclusions in TOTAL PROCAINAMIDE

A

conc. of parent drug (procainamide) & conc. of metabolite
(NAPA) as these 2 has same effect

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117
Q

brand name of DISOPYRAMIDE

A

Norpace

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118
Q

TR of DISOPYRAMIDE

A

3-7.5 ug/ml

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119
Q

peak conc. of DISOPYRAMIDE

A

1-2 hr

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120
Q

half-life of DISOPYRAMIDE

A

7 hr

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121
Q

toxic ranges of DISOPYRAMIDE?

A

> 4.5 ug/ml
10 ug/ml

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122
Q

Toxic range of DISOPYRAMIDE with anticholinergic effect

A

> 4.5 ug/ml

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123
Q

Toxic range of DISOPYRAMIDE with cardiac effects

A

> 10 ug/ml

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124
Q

anticholinergic effects of DISOPYRAMIDE

A

Dry mouth
Constipation

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125
Q

cardiac effects of DISOPYRAMIDE

A

Bradycardia – slower than normal heart rate
AV node blockage

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126
Q

A Quinidine substitute – esp. if adverse effects of quinidine is unacceptable

A

DISOPYRAMIDE

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127
Q

methods for DISOPYRAMIDE

A

Chromatography, IA

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128
Q

cardioactive drug with TR that is also its toxic range? what is the TR and toxic range that is similar?

A

DISOPYRAMIDE

> 4.5 ug/ml (within 3-7.5 ug/ml)

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129
Q

TR of LIDOCAINE

A

1.5-4 ug/ml

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130
Q

Toxic range of LIDOCAINE

A

4-8 ug/ml
>8 ug/ml

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131
Q

manifestation of LIDOCAINE toxicity if 4-8 ug/ml

A

CNS depression

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132
Q

manifestation of LIDOCAINE toxicity if >8 ug/ml

A

seizure, ↓ BP and cardiac output

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133
Q

Corrects ventricular arrhythmia

A

LIDOCAINE

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134
Q

Prevent ventricular fibrillation

A

LIDOCAINE

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135
Q

LIDOCAINE is a tx for

A

AMI

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136
Q

EXAMPLES OF ANTIBACTERIALS

A

AMINOGLYCOSIDES
TEICOPLANIN
VANCOMYCIN
CHLORAMPHENICOL

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137
Q

Protein-bound AMINOGLYCOSIDES

A

10%

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138
Q

TR of AMINOGLYCOSIDES

A

Dependent on
aminoglycosides
used

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139
Q

peak conc. of AMINOGLYCOSIDES

A

1-2 hr

140
Q

half-life of AMINOGLYCOSIDES

A

2-3 hr

141
Q

toxic range of AMINOGLYCOSIDES

A

any conc. above TR of aminoglycosides

142
Q

toxicity of aminoglycosides

A

Nephrotoxicity
Ototoxicity

143
Q

toxicity of aminoglycosides with hearing and balance impairment

A

Ototoxicity

144
Q

toxicity of aminoglycosides with impairment of PCT function

A

Nephrotoxicity

145
Q

REVERSIBLE Nephrotoxicity of Aminoglycosides

A
  • Electrolyte imbalance
  • Proteinuria (Albuminuria)
146
Q

IRREVERSIBLE Nephrotoxicity of Aminoglycosides

A

(chronic toxicity)
* Tissue Necrosis
* Kidney Failure

147
Q

antibacterial drugs that are protein synthesis inhibitors

A

AMINOGLYCOSIDES
CHLORAMPHENICOL

148
Q

aminoglycosides is effective against

A

Gram negative bacteria

149
Q

Examples of aminoglycosides

A

Gentamicin
Tobramycin
Amikacin
Kanamycin

150
Q

Methods for aminoglycosides

A

Chromatography, IA

151
Q

Administration of aminoglycosides

A

IV or IM

152
Q

bioavailability of aminoglycosides

A

100% (administered IV/IM) –> toxicity is much
faster/common

153
Q

Protein-bound TEICOPLANIN

A

90-95%

154
Q

highly protein bound antibacterial drug

A

TEICOPLANIN (90-95%)

155
Q

TR of TEICOPLANIN

A

10-60 mg/L
20-60 mg/L

156
Q

TR of TEICOPLANIN used as tx for endocarditis

A

10-60 mg/L

157
Q

TR of TEICOPLANIN used as tx for staph. infection

A

20-60 mg/L

158
Q

half-life of TEICOPLANIN

A

70-100 hr

159
Q

manifestation of TEICOPLANIN toxicity

A
  • Nausea
  • Vomiting
  • Fever
  • Diarrhea
  • Mild hearing loss
160
Q

TEICOPLANIN is a tx for

A

Methicillin-resistant Staphylococcus aureus (MRSA)

161
Q

TEICOPLANIN is effective against

A

Aerobic & anaerobic gram positive cocci and bacilli

162
Q

antibacterial drug not metabolized by the liver

A

TEICOPLANIN

163
Q

Administration of TEICOPLANIN

A

IV or IM

164
Q

brand name of VANCOMYCIN

A

Vancocin HCl

165
Q

protein-bound VANCOMYCIN

A

55%

166
Q

TR of VANCOMYCIN

A

5-10 ug/mL

167
Q

peak conc. of VANCOMYCIN

A

1 hr

168
Q

half-life of VANCOMYCIN

A

4-6 hr

169
Q

antibacterial drug wherein TR is the toxic range? what is the toxic range?

A

VANCOMYCIN

10 ug/mL

170
Q

common toxic effect of vancomycin characterized by erythemic flushing of extremities

A

Red-man syndrome

171
Q

toxic range of vancomycin that exhibits nephrotoxicity

A

> 10 ug/ml

172
Q

toxic range of vancomycin that exhibits ototoxicity

A

> 40 ug/ml

173
Q

vancomycin is tx for

A

Gram positive cocci and bacilli

174
Q

Cell wall inhibitor; kills microbes by destruction or inhibition of cell wall synthesis

A

vancomycin

175
Q

administration of vancomycin

A

IV

176
Q

manifestation of CHLORAMPHENICOL toxicity

A

Blood dyscrasia (aplastic anemia)

177
Q

CHLORAMPHENICOL is a tx for

A

Gram negative bacteria

178
Q

antibacterial drug effective against gram negative bacteria

A

AMINOGLYCOSIDES
CHLORAMPHENICOL

179
Q

antibacterial drug effective against gram positive cocci and bacilli

A

TEICOPLANIN
VANCOMYCIN

180
Q

Examples of PSYCHOACTIVE DRUGS (Anti-psychotic drugs)

A

LITHIUM
TRICYCLIC ANTIDEPRESSANT (TCA)
CLOZAPINE
OLANZAPINE

181
Q

brand name/s of LITHIUM

A

Eskalith
Lithobid

182
Q

Protein-bound lithium

A

Lithium salts, so it doesn’t bind to protein

183
Q

TR of LITHIUM

A

0.5-1.2 mmol/l

184
Q

peak conc. of LITHIUM

A

2-4 hr

185
Q

half-life of LITHIUM

A

10-35 hr

186
Q

toxic ranges of LITHIUM

A

1.5-2 mmol/L
>2 mmol/L

187
Q

manifestation of LITHIUM toxicity if 1.5-2 mmol/L

A

apathy
lethargy
speech difficulties
muscle weakness

188
Q

manifestation of LITHIUM toxicity if >2 mmol/L

A

muscle rigidity
seizures
coma

189
Q

LITHIUM uses this that does not bind to proteins

A

lithium salts

190
Q

Mood-altering drugs

A

LITHIUM

191
Q

LITHIUM is a tx for

A

recurrent depression
bipolar disorder

192
Q

Administration of LITHIUM

A

Oral (completely and rapidly absorbed by GI)

193
Q

protein-bound TCA

A

85-95%

194
Q

2 forms of TCA

A

Amitriptyline
Imipramine

195
Q

TR of Amitriptyline (a TCA)

A

120-150 ng/ml

196
Q

TR of Imipramine (a TCA)

A

150-300 ng/ml

197
Q

peak conc. of TCA

A

2-12 hr

198
Q

manifestation of TCA toxicity when there is slight increase

A

drowsiness
constipation
blurred vision
memory loss

199
Q

manifestation of TCA toxicity at higher levels

A

seizures
cardiac arrhythmia
unconsciousness

200
Q

TCA includes?

A

amitriptyline
imipramine
doxepin

201
Q

TCA is a tx for

A

depression
insomnia
extreme apathy
loss of libido

202
Q

Administration of TCA

A

oral

203
Q

antipsychotic drug that is metabolized into its metabolize forms? what are these?

A

TCA

Imipramine → desipramine
Amitriptyline → nortriptyline

204
Q

Therapeutic effects of this drug is not seen for the first 2-4 weeks after initiation of therapy; hence, effects of TCAs only occur after 4 weeks

A

TCA

205
Q

brand name of CLOZAPINE

A

Clozaril
FazaClo

206
Q

protein-bound CLOZAPINE

A

97%

207
Q

TR of CLOZAPINE

A

350-420 ng/ml

208
Q

peak conc. of CLOZAPINE

A

2 hr

209
Q

half-life of CLOZAPINE

A

8-16 hr

210
Q

manifestation of CLOZAPINE toxicity

A

seizures

211
Q

CLOZAPINE is a tx for

A

Treatment-refractory schizophrenia

212
Q

brand name of OLANZAPINE

A

Zyprexa

213
Q

protein-bound OLANZAPINE

A

93%

214
Q

TR of OLANZAPINE

A

20-50 ng/ml

215
Q

peak conc. of OLANZAPINE

A

5-8 hr

216
Q

half-life of OLANZAPINE

A

21-54 hr

217
Q

Thienobenzodiazepine derivative

A

OLANZAPINE

218
Q

OLANZAPINE is a tx for

A

schizophrenia
acute manic episodes
bipolar disorders (recurrent)

219
Q

Administration of OLANZAPINE

A

Oral
IM (fast-acting formulation)

220
Q

EXAMPLES OF IMMUNOSUPPRESIVE DRUGS

A

CYCLOSPORINE
TACROLIMUS (FK-506)
SIROLIMUS (RAPAMYCIN)
MYCOPHENOLIC ACID (MPA)

221
Q

Cyclic polypeptide with potent immunosuppressive activity

A

CYCLOSPORINE

222
Q

function is to suppress graft-vs-host rejection (heterotopic transplanted organ) → piggyback transplant

A

CYCLOSPORINE

223
Q

specimen of choice for CYCLOSPORINE? reason?

A

whole blood

cyclosporine is sequestered inside the cell, including RBCs

224
Q

BRAND NAME/S of CYCLOSPORINE

A

Gengraf
Neoral
Sandimmune

225
Q

Protein-bound CYCLOSPORINE

A

> 98%

226
Q

TR of CYCLOSPORINE

A

Depends on transplanted organ

227
Q

TR of CYCLOSPORINE if the transplanted organs are – liver, heart, pancreas

A

200-350 ng/m

228
Q

TR of CYCLOSPORINE if the transplanted organ is kidneys

A

100-300 ng/ml

229
Q

peak conc. of CYCLOSPORINE

A

1-6 hr

230
Q

toxic range of CYCLOSPORINE

A

350-400 ng/ml

231
Q

toxicity of CYCLOSPORINE

A

*nephrotoxic

  • Renal tubular dysfunction
  • Glomerular dysfunction
232
Q

heart, liver, pancreas; attaching donor’s organ to the original patient’s organ

A

Piggyback transplant

233
Q

brand name/s of TACROLIMUS

A

Hecoria
Envarsus
Prograf
Astagraf

234
Q

protein-bound TACROLIMUS

A

> 98%

235
Q

TR of TACROLIMUS

A

10-15 ng/ml

236
Q

aka FK-506

A

TACROLIMUS

237
Q

toxicity of TACROLIMUS

A

Nephrotoxicity
Thrombus formation

238
Q

100x more potent than cyclosporine

A

TACROLIMUS

239
Q

function is to suppress transplant rejection, and graft-vs-host disease

A

TACROLIUMUS

240
Q

specimen of choice for TACROLIMUS

A

whole blood

241
Q

SIROLIMUS is aka

A

RAPAMYCIN

242
Q

brand name of SIROLIMUS

A

Rapamune

243
Q

protein-bound SIROLIMUS

A

92% bound to LPP

244
Q

TR of SIROLIMUS if administered w/ cyclosporine

A

4-12 ug/L

245
Q

TR of SIROLIMUS if – if cyclosporine is not used/discontinued

A

12-20 ug/L

246
Q

toxicity of SIROLIMUS

A

Blood dyscrasia (anemia, leukopenia, and thrombocytopenia → aplastic anemia)

Hyperlipidemia

247
Q

Antifungal agent with immunosuppressive activity

A

SIROLIMUS

248
Q

a prophylactic drug to prevent graft rejection before kidney transplant

A

SIROLIMUS

249
Q

Specimen of choice for SIROLIMUS

A

Whole Blood

250
Q

drugs used in conjunction with cyclosporine or tacrolimus

A

SIROLIMUS
MYCOPHENOLIC ACID

251
Q

brand name of MPA

A

Myfortic

252
Q

Protein-bound MPA

A

95%

253
Q

toxicity of MPA

A

Nausea
Vomiting
Diarrhea
Abdominal pain

254
Q

Prodrug of mycophenolate mofetil

A

MPA

255
Q

a Lymphocyte proliferation inhibitor and immunosuppressive drug

A

MPA

256
Q

supplemental therapy with cyclosporine & tacrolimus esp. if the patient is a renal transplant patient

A

MPA

257
Q

brand name/s of METHOTREXATE

A

Otrexup
Rasuvo

258
Q

toxicity of METHOTREXATE

A

Cytotoxicity

259
Q

administered to lessen and ensure nonlethal cytotoxicity produced by methotrexate

A

Leucovorin (Leucovorin rescue)

260
Q

Destroys neoplastic cells by inhibiting DNA synthesis

A

METHOTREXATE

261
Q

DNA synthesis inhibitor

A

METHOTREXATE

262
Q

Can both affect normal and neoplastic cells since they both have DNA (but neoplastic cells are more susceptible)

A

METHOTREXATE

263
Q

METHOTREXATE is a tx for

A

Psoriasis

264
Q

brand name/s of THEOPHYLLINE

A

Theo-Dur
Thea-24
Uniphyl

265
Q

Protein-bound THEOPHYLLINE

A

50-60% (usually bound to ALBUMIN)

266
Q

TR of THEOPHYLLINE

A

10-20 mg/L

267
Q

formulation of THEOPHYLLINE with 1-2 hr peak conc.

A

rapid-release formulation

268
Q

formulation of THEOPHYLLINE with 4-8 hr peak conc.

A

modified-release formulation

269
Q

toxicity of THEOPHYLLINE if >20 ug/ml

A

nausea, vomiting, diarrhea

270
Q

toxicity of THEOPHYLLINE if >30 ug/ml

A

cardiac arrhythmia, seizures

271
Q

THEOPHYLLINE is a tx for

A

asthma
stable COPD

272
Q

a bronchodilator

A

THEOPHYLLINE

273
Q

an anti-neoplastic drug

A

METHOTREXATE

274
Q

Types of seizures

A

Grand mal seizure/Tonic–Clonic
Complex Partial Seizure
Petit mal/ Absent/ Starting Seizure

275
Q

Types of seizure that lasts for >5mins

A

Tonic–Clonic (Grand mal seizure)

276
Q

Types of seizure that arises from one side of brain

A

Complex Partial Seizure

277
Q

Types of seizure that black out for a minute

A

Petit mal/ Absent/ Starting Seizure

278
Q

brand name/s of PHENOBARBITAL

A

Luminal
Solfoton

279
Q

brand name/s of PHENYTOIN

A

Dilantin

280
Q

brand name/s of VALPROIC ACID

A

Depakote
Depakene

281
Q

brand name/s of CARBAMAZEPINE

A

Tegretol

282
Q

brand name/s of ETHOSUXIMIDE

A

Zarontin

283
Q

brand name/s of FELBAMATE

A

Felbatol

284
Q

brand name/s of GABAPENTIN

A

Neurontin

285
Q

brand name/s of LAMOTRIGINE

A

Lamictal

286
Q

brand name/s of OXCARBAZEPINE

A

Trileptal

287
Q

brand name/s of TIAGABINE

A

Gabitril

288
Q

brand name/s of TOPIRAMATE

A

Topamax

289
Q

brand name/s of ZONISAMIDE

A

Zonegran

290
Q

protein-bound PHENOBARBITAL

A

50%

291
Q

protein-bound PHENYTOIN (Diphenylhydantoin)

A

87-97%

292
Q

protein-bound VALPROIC ACID

A

93%

293
Q

protein-bound CARBAMAZEPINE

A

70-80%

294
Q

protein-bound ETHOSUXIMIDE

A

<5%

295
Q

protein-bound FELBAMATE

A

30%

296
Q

protein-bound GABAPENTIN

A

Do not bind to protein

297
Q

protein-bound LAMOTRIGINE

A

55%

298
Q

protein-bound OXCARBAZEPINE

A

40%

299
Q

protein-bound TIAGABINE

A

96%

300
Q

protein-bound TOPIRAMATE

A

15%

301
Q

protein-bound ZONISAMIDE

A

60%

302
Q

toxicity of PHENOBARBITAL

A

Drowsiness
Fatigue
Depression
Reduced mental capacity

303
Q

Slow-acting barbiturate

A

PHENOBARBITAL

304
Q

tx for all types of seizures except petit mal

A

PHENOBARBITAL

305
Q

administration of PHENOBARBITAL

A

oral; slow GI absorption but complete

306
Q

inactive proform of phenobarbital

A

Primidone

307
Q

Primidone is a tx for

A

Grand mal seizure

308
Q

Readily absorbed by GI; undergo first-pass metabolism to form PHENOBARBITAL

A

Primidone

309
Q

toxicity of PHENYTOIN

A

Seizures
Ataxia – difficulty in balanced walking
Coma
Vit D deficiency
Seizures

310
Q

PHENYTOIN is a tx for

A

tonic-clonic seizure

311
Q

proform of phenytoin; IM drug

A

Fosphenytoin

312
Q

rapidly absorbed within 75 mins after administration → already metabolized

A

Fosphenytoin

313
Q

Conditions when protein-binding is ↓

A

Anemia
Hypoalbuminemia
Coadministration of same binding properties as phenytoin

314
Q

toxic value of VALPROIC ACID

A

> 120 ug/mL

315
Q

most common toxicity of VALPROIC ACID

A
  • Nausea
  • Lethargy
  • Weight gain
316
Q

more serious toxicity of VALPROIC ACID (>200 ug/mL)

A

Pancreatitis
Hyperammonemia
Hallucinations

317
Q

VALPROIC ACID is a tx for

A

petit mal seizure

318
Q

Inhibit metabolism of other anti-epileptic drugs

A

VALPROIC ACID

319
Q

CARBAMAZEPINE toxicity

A

Ataxia
Leukopenia
Seizures
Aplastic anemia

320
Q

CARBAMAZEPINE toxicity if >15 ng/mL

A

Aplastic anemia

321
Q

usually has RARE TOXICITY, often tolerable, self-limiting

A

ETHOSUXIMIDE

322
Q

CARBAMAZEPINE is a tx for

A

seizure and facial pain

323
Q

ETHOSUXIMIDE is a tx for

A

petit mal seizure

324
Q

PRIMIDONE toxicity

A

Anemia
Ataxia
Nausea

325
Q

PRIMIDONE is a tx for

A

tonic-clonic and complex partial seizure

326
Q

FELBAMATE toxicity

A

Fatal aplastic anemia
Hepatic failure

327
Q

FELBAMATE is a tx for

A

Mixed-seizure disorders (children)
Lennox-Gastaut syndrome
Refractory epilepsy (adults)

328
Q

administration of FELBAMATE

A

Oral (most common; almost complete absorption of felbamate in GI tract)

329
Q

GABAPENTIN toxicity

A

*mild
* Fatigue
* Ataxia
* Dizziness
* Weight gain

330
Q

GABAPENTIN is a tx for

A

AED for patients with
o Liver disease
o Acute Intermittent Porphyria (w/ partial onset seizures)

331
Q

GABAPENTIN administration

A

Oral (60% bioavailability)

332
Q

T/F

Gabapentin is metabolized by the liver

A

F

333
Q

LAMOTRIGINE toxicity

A

Usually evident if given with valproic acid as it can inhibit metabolism of other AED
* dizziness
* GI disturbances
* rashes

334
Q

LAMOTRIGINE is a tx for

A

partial or generalized tissues

335
Q

OXCARBAZEPINE toxicity

A

Similar with carbamazepine

336
Q

OXCARBAZEPINE is a tx for

A

partial seizures
tonic-clonic seizures

337
Q

OXCARBAZEPINE Administration

A

oral (immediately into licarbazepine)

338
Q

metabolite of OXCARBAZEPINE

A

Licarbazepine

339
Q

TIAGABINE toxicity

A

confusion
stuttering
mild sedation
PARESTHESIA

340
Q

TIAGABINE is a tx for

A

partial seizures

341
Q

has toxicity of change of taste with particular foods (diet coke and beet)

A

TOPIRAMATE

342
Q

TOPIRAMATE toxicity

A

change of taste with particular foods (diet coke and beer)
“pins and needles” sensation in extremities

343
Q

TOPIRAMATE administration

A

Oral (almost completely absorbed; almost 100% bioavailability)

344
Q

ZONISAMIDE toxicity

A

breathing difficulty
low BP
slow heart rate
loss of consciousness

345
Q

an anticonvulsant

A

ZONISAMIDE

346
Q

ZONISAMIDE is a tx for

A

partial and generalized seizure

347
Q

administration of ZONISAMIDE

A

Oral

Clinical Chemistry 2 - CEUMLS (9 decks)

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