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CC2 TDM > TDM > Flashcards

TDM Flashcards

1
Q

What is the primary goal of TDM?

A

Ensures that a given drug dosage produces maximal therapeutic effect and minimal toxic adverse effects.

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2
Q

What does TDM involve in terms of analysis?

A

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

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3
Q

For what type of drugs is TDM a quantitative procedure?

A

TDM is a quantitative procedure performed for drugs with a narrow therapeutic index.

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4
Q

Which fraction of the drug can interact with the site of action?

A

Only the free fraction of the drugs can interact with the site of action and result in a biologic response.

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5
Q

T OR F

IS TDM is lifesaving in serious situations?

A

TRUE

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6
Q

Which biological samples are analyzed in TDM?

A

Serum, plasma, or whole blood

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7
Q

Causes of Drug Toxicity

A

Elevated concentration of free drug.
Abnormal response to the drug after administration.
The presence of active drug metabolites.

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8
Q

can travel to the site where it is indicated.

A

Free drug

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9
Q

Factors of TDM

A

 Route of administration
 Rate of absorption
 Protein binding
 Drug administration
 Drug distribution
 Drug elimination

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10
Q

Therapeutic Failure

A

Non-compliance
 Sub therapeutic dose
 Bioavailability
 Malabsorption
 Drug interactions

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11
Q

Types of Assay Required

A
  1. Total drug
  2. Free drug
  3. Metabolites
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12
Q

What are the two main types of drug assays focused on in TDM?

A

Total drug and free drug.

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13
Q

Why are metabolites seldom checked in TDM?

A

TDM primarily focuses on total drug and free drug concentrations, not metabolites.

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14
Q

In which field are metabolites primarily checked, and what is the usual specimen of choice for metabolite analysis?

A

Metabolites are primarily checked in toxicology, with urine being the usual specimen of choice.

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15
Q

Routes of Administration

A
  1. Injections
  2. Inhaled
  3. Absorbed in skin
  4. Rectal (suppository)
  5. Oral (most common)
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16
Q

Injections

A

 Intravenous
 Intramuscular
 Subcutaneous
 Epidermal

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17
Q

What is the bioavailable fraction of an intravenous injection?

A

The bioavailable fraction of an intravenous injection is 1.0 (100% bioavailability).

18
Q

should achieved 0.7
bioavailability fraction

A

Oral (most common)

19
Q

How are drugs usually distributed in the body?

A

Drugs are usually distributed by blood flow and via capillary permeability.

20
Q

Where are drugs generally effective in the body?

A

Drugs are generally effective in the body tissues, not in the blood.

21
Q

Distribution

A

-Usually by blood flow and via capillary
permeability
-Binding to proteins or free fractions
 Lipid solubility of the drug
 pH gradient

22
Q

What happens to drugs during metabolism?

A

Drugs are broken down into metabolites.

23
Q

What are the characteristics of metabolites?

A

Characteristics of metabolites:
Water-soluble
Pharmacologically active or inactive
Easily excreted

24
Q

Where does the first-pass metabolism occur, and what is its effect on drug bioavailability?

A

The first-pass metabolism occurs in the liver, where the drug loses a fraction of its bioavailability before reaching the target.

25
Q

The process by which a drug leaves the site of administration and reaches the target site.

A

absorption

26
Q

What are the mechanisms of absorption?

A

Passive diffusion
Active transport

27
Q

Absorption Depends on

A

Formulation of drug:
Pill (requires dissolution)
Liquid (rapidly absorbed)

Intestine motility
pH levels
Presence of inflammation
Food intake
Age
Pregnancy
Concurrent pathologic conditions

28
Q

What are the primary routes of drug elimination?

A

Hepatic metabolism
Renal filtration
Other routes: Skin, Lungs, Breast, Saliva

29
Q

What factors influence the rate of drug elimination?

A

Type of drug

Patient’s capacity to metabolize and excrete the drug

30
Q

How do functional changes of organs affect drug elimination?

A

Functional changes in organs, such as liver or kidney impairment, can affect the body’s ability to eliminate drugs efficiently.

31
Q

– time required to reduce
blood level drug concentration to half after
equilibrium is obtained

A

Steady state

32
Q

What is the most important factor to consider in specimen collection?

A

Timing

33
Q

What are the different timings for specimen collection?

A

Trough: 30 minutes before the next dose
Peak: 1 hour after administration
Random

34
Q

What type of blood sample is preferred for analysis?

A

Whole blood
–Avoid using EDTA, Citrate, or Oxalate as they add ions that can interfere with analysis

Serum (avoid using gel)
–Measurement of serum concentrations should be done after steady state has been achieved

Plasma (Heparinized samples)

35
Q

Why is urine rarely used in Therapeutic Drug Monitoring (TDM)?

A

Urine is primarily used in toxicology, not in TDM.

36
Q

What is the principle behind the Enzyme Multiplied Immunoassay Technique (EMIT)?

A

The amount of enzyme activity is directly proportional to the amount of drugs present in the sample.

37
Q

What are the characteristics of the Enzyme Link Immunosorbent Assay (ELISA)?

A

Moderate sensitivity
Few assays available
Automated
Rapid turn-around time

38
Q

What is characteristics of the Radio Immunoassay (RIA)?

A

High sensitivity

Long turn-around time

39
Q

What is characteristics of the High Performance Liquid Chromatography (HPLC)?

A

Highest sensitivity, least expensive

Long turn-around time

Measurement depends on the type of column used, the solvent, and detector systems used

40
Q

What is characteristics of the Fluorescence Polarization Immunoassay (FPIA)?

A

Automated
Rapid turn-around time
Moderate sensitivity

CC2 TDM (1 decks)

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