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MELS301 > TDM > Flashcards

TDM Flashcards

1
Q

What does TDM assess

A

Therapeutic compliance - see if the patient is taking the meds
If the drug is actually working
The cause of drug induced toxicity

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2
Q

Pharmacokinetics

A

How the body deals with the drug
Absorption, dosage intervals, excretion and metabolism

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3
Q

Pharmacodynamics

A

How the drug works on the body
Conc of drug at active site
How the drug works

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4
Q

What is a sub therapeutic response

A

Ineffective dosage

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5
Q

What is an adverse response

A

The dosage of the drug is above the therapeutic window causing side effects

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6
Q

What needs to be considered for dosage

A

Other medications, age, health, ethnicity
Absorption/metabolism/excretion of the drug 
Timing between dosages
Drug half life

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7
Q

When do you use TDM for a drug

A

If used chronically
Narrow therapeutic index
Variable pharmacokinetics
Problem with compliance
Severe side effects if failed

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8
Q

When is digoxin given

A

For heart failure like afib

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9
Q

How does digoxin work

A

It inhibits Na/K transporters leading to an increased internal Na and Ca conc to make a greater force of concentration

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10
Q

How is digoxin measured

A

Immunoassays
Like have digoxin like proteins in the body causing interference

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11
Q

Digoxin - blood vs tissues

A

Peaks in 2-3 hours in the blood
Peaks in 6-10 hours in the tissue
Conc in tissue is 15-30 times greater

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12
Q

When is digoxin measured

A

At the trough

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13
Q

Who can tolerate higher doses of digoxin

A

Children
Most excreted unchanged in urine some metabolised

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14
Q

Digoxin toxicity symptoms

A

Nausea
Vomiting
Anorexia
Heart problems - tachycardia, arrhythmia, PVCs, ventricular bigeminy

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15
Q

What to consider for digoxin toxicity

A

Dosage
Last dose time
Test for digoxin like immunoreactive substance assay
Test K and Mg as low levels increase sensitivity

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16
Q

What does lord of paracetamol lead too

A

Hepatic toxicity
Converted to NAPQ1, if this builds up it leads to necrosis
NAPQ1 converted to cysteine conjugates by GSH, this gets quenched with too much paracetamol

17
Q

Do you always treat a paracetamol overdose

A

You want to reduce hepatic toxicity but treatments have effects too so not always needed
Depends on when dose was last taken and how much is left in the blood so if it’s above the red line you must treat if below blue low risk, if green depends if they already have liver dysfunction

18
Q

What conc in blood means paracetamol danger

A

After 4 hours if it is greater than 200mg/L
Or if the half life of the drug is over 2-4 hrs you need treatment and LFTs

19
Q

What is aspirin converted too

A

Salicylic acid

20
Q

How quickly is aspirin distributed to all the tissues

A

Within 30 mins
Excreted unchanged within 36 hours

21
Q

What can aspirin cause

A

Hyperventilation
Respiratory alkalosis

22
Q

Levels of aspirin lethal

A

Above 500 Mg/kg
Less than 150 Mg/kg not toxic

23
Q

Treatment for aspirin overdose

A

Activated charcoal will stop further absorption
Sodium bicarbonate via IV correct the acid-base
Increase excretion (sodium bicarbonate IV and potassium)

24
Q

When do you do osmolarity gaps

A

When you don’t know what the patient has taken

25
Q

Osmolarity equation/gap

A

2(Na +K) + glucose + urea

26
Q

Calculating the anion gap

A

Na - (sodium + bicarbonate)

27
Q

What is ethanol converted into

A

Acelaldehyde to acetic acid

28
Q

How is ethanol tested - samples

A

Breath
Urine and blood

Osmolarity gap, metabolites like ethyl glucuronide and ethyl sultans (urine)

29
Q

Main tests of alcohol

A

Large MCV
Hight GGT other LFTs
Not specific enough but better together

30
Q

What is methanol oxidised too

A

Formaldehyde and then formic acid
More toxic

31
Q

What does formic acid lead too

A

Acidosis
Blindness - optic neuropathy
Death

32
Q

Methanol treatments

A

Fomepizole
Ethanol

33
Q

What does CO poisoning lead too

A

Interferes with oxygen transport
Converted haem iron from Fe2+ to Fe3+

34
Q

How does CO get measured

A

It forms carbohaemohlonin which is measured in the blood

MELS301 (6 decks)

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