TDM 2 Flashcards
anti-inflammatory agents and painkillers, thus considered to be therapeutic in nature
ANALGESICS
salicylate/ aspirin complication
initial respiratory alkalosis
metabolic acidosis (use of free fatty acids producing ketones)
highest analytic sensitivity for salicylate TDM
GC or liquid chromatography
acetaminophen complication
hepato-cystic necrosis 3 to 4 days after overdose (unable to conjugate acetamidoquinone).
mechanism of acetaminophen complication
glutathione depleted due o conjugation with intermediates
risk factor for acetaminophen toxicity
chronic alcoholic
most common method for acetaminophen detection
FPIA
reference method for acetaminophen quantitation
HPLC
sedatives that have a tranquilizing effect through their depressant effect on the CNS.
BARBITURATES
BARBITURATES complication
cardiac arrest
respiratory depression
derived or chemically related to the substances derived from opium poppy
NARCOTICS
NARCOTICS complications
respiratory depression
coma
respiratory acidosis
myoglobinuria
increase in serum indicators of cardiac damage.
pesticides exist as
organic complexes
organophosphates
carbamates
pesticides complication
inhibit acetylcholinesterase
salivation
lacrimation
involuntary urination and defection
bradycardia
muscular twitching
cramps
slurred speech
behavioral changes
major route for the general population for pesticide
Food contamination
more common route among occupational contexts and accidental routes of exposure for pesticides
inhalation
transdermal absorption
ingestion
lab diagnosis of pesticide poisoning
acetylcholinesterase inhibition in red blood cells
serum pseudocholinesterase
tasteless gas with 200- to 225-fold greater affinity for
hemoglobin than oxygen
carbon monoxide
carbon monoxide complication
suffocation
death
left shift in the oxygen- hemoglobin dissociation (heart and brain)
lab test of carbon monoxide
spot test (5 mL of 40% NAOH + 5 mL of aqueous dilution of WB = pink solution > 20%COHb)
differential spectrophotometry
GC (reference)
4 heavy metals causing poisoning
lead
mercury
arsenic
cadmium
lead poisoning complications
vitamin D deficiency
Anemia (inhibition of heme)
GI irritation
weight loss
kidney damage
convulsions
altered cognition
encephalopathy
death
behavioral changes
hyperactivity
ADD (attention deficit disorder)
decrease in IQ scores
most common method for blood lead quantification
Atomic absorption spectrophotometry
common environmental contaminant – paint ingestion or continuous exposure in the soil
lead
found in antibacterial agents, pesticides and batteries.
mercury
mercury poisoning complications
GI irritation
severe kidney damage
neurologic symptoms
can be ingested without significant effects
elemental mercury
only moderately toxic
cationic mercury
the most toxic mercury
organic mercury
mercury deposits in
hydrophobic compartments (brain, peripheral nerves)
mercury poisoning is commonly detected with the use
atomic absorption
found in pesticides, weed killer and is an ingredient in some paint
arsenic
arsenic poisoning complication
purging gastroenteritis
shredding of the stomach lining
formation of line in the fingernails
death (hemorrhagic gastroenteritis)
lab test for arsenic poisoning
urine atomic absorption spectrophotometry
Metal found in many industrial processes, with its main use being in electroplating and galvanizing.
cadmium
common human sources of cadmium
tobacco products
shellfish and vegetable
cadmium toxicity
binds to proteins and cellular constituents, accumulates in the kidney
cadmium poisoning complications
nausea
vomiting and abdominal pain
respiratory irritation
dizziness, weakness, fever and chills
COPD
renal tubular dysfunction (proteinuria, glucosuria and aminoaciduria)
Vit D deficiency
Itai-itai (severe osteomalacia and osteoporosis from cadmium contaminated rice)
cadmium lab diagnosis
urine/whole blood -AAS
Supertoxic substance that can exist as a gas, solid, or in solution.
cyanide
cyanide is found in
rodenticides
pyrolysis product from burning of some plastics
cyanide toxicity
binds to iron of the heme molecule leading to depletion of cellular ATP
cyanide complications
headache
dizziness
respiratory depression
seizure, coma and death
most common lab diagnosis of cyanide poisoning
Ion-selective electrode
photometric analysis of two-well microdiffusion separation
lab diagnosis for chronic low level cyanide exposure
urinary thiocyanate concentration
reference method for most of the analytes under
substance of abuse
GC-MS
disadvantages of lab techniques for substance of abuse
only detect recent drug use
does not differentiate between single use or chronic abuse
ethanol complication
alcoholic hepatitis
cirrhosis
ethanol metabolism is enacted by ___ converting alcohol to ___, further acted upon by ____.
final metabolite ___ is excreted in urine
alcohol dehydrogenase
acetaldehyde
aldehyde dehydrogenase
acetic acid
reference method for ethanol determination
GC
0.01 – 0.05 g/ 100 ml stage
Subclinical
Subclinical manifestation of alcohol
normal
0.04 – 0.12 g/100 ml
euphoria
euphoria manifestation
Sociability
talkativeness
increased self-confidence
decreased inhibition
Diminution of attention, judgment and control
sensory-motor impairment
Slowed information processing
0.09 – 0.25 g/ 100 ml stage
excitement
excitement stage manifestation
- decreased sensory response
- emotional instability
- sensory-motor incoordination
- increased reaction time
- reduced visual acuity
- loss of critical judgment
- impairment of perception, memory and comprehension
- drowsiness
- impaired balance
0.18 – 0.30 g/ 100 mL
Confusion
confusion stage manifestations
▪ Disorientation, mental composition, dizziness
▪ Exaggerated emotional state
▪ Disturbance of vision
▪ Increased pain threshold
0.27 – 0.40 g/ 100 mL
Stupor
stupor manifestations
General inertia approaching loss of motor function
▪ Greatly decreased response to stimuli
▪ Notable muscular incoordination, inability to stand or walk
▪ Vomiting, incontinence of urine and feces
▪ Impaired consciousness, sleep or stupor
0.35 – 0.50 g/ 100 mL
Coma
coma stage
Complete unconsciousness
▪ Anesthesia, depressed or abolished reflexes
▪ Subnormal temperature
▪ Impaired circulation and respiration
▪ Possibly death
0.45
Death from respiratory arrest
widely used in paints, solvents, antifreeze and solid
canned fuels.
methanol
metabolites of methanol
formaldehyde and formic acid
methanol complication
metabolic acidosis
pancreatic necrosis
visual impairment
CNS stimulants that block dopamine receptors
in the brain
Amphetamines
Amphetamines use
narcolepsy and ADD treatment
amphetamine/ MDMA/ ecstasy complications
violent behavior,
seizures
hyperthermia
liver toxicity
renal failure
CNS stimulant that is metabolized by cholinesterase.
cocaine
cocaine complications
hypertension
myocardial infarction
seizure
cardiotoxicity
sudden death.
metabolite of cocaine found in urine after 3 days
benzoylecgonine
Produce psychologic effects and are stored in
fat cells.
cannabinoid compounds
cannabinoid compounds complication
rare and not severe
Phencyclidine
abused anesthetic
stimulant
hallucinogen
depressant
phencyclidine complications
violent tendencies
seizures
respiratory depression
death.
Opiates use
analgesic
sedation
anesthesia
opiates treatment
naloxone
lab diagnosis of opiates
immunoassay –> initial
GC-MS confirmatory
types of cardioactive drugs
Digoxin
Antiarrhythmic drugs
chemical agents that maintains normal heart function
Cardioactive drugs
major cardiac glycoside and alters the force of
contraction through its effect on the ATPase pump in heart muscle.
digoxin
Blood specimens for digoxin should be collected when
8 hours after dose
digoxin complications
nausea
rapid heart rate
visual impairment
prescribed to treat irregular heartbeat that produces inappropriate ventricular contraction or tachycardia.
Antiarrhythmic drugs
5 antiarrhythmic drugs
lidocaine
procainamide
disopyramide
quinidine
propanolol
two active metabolites of lidocaine
monoethylglycinexylidide
glycinexylide
Procainamide produces
N-acetylprocainamide
adverse reactions of disopyramide
anticholinergic effects
used as an alternative to quinidine if the
side effects of the said drug become intolerable
disopyramide
produces several active metabolites
Quinidine
increases digoxin when taken with digoxin
quinidine
monitoring of quinidine
only involves trough level
generally prescribed for hypertension, certain arrythmias, migraine and other conditions related to
sympathetic stimulation.
propanolol
propanolol toxicity
excessive inhibition of sympathetic nervous system
bradycardia
hypotension
cardiac failure
alters transmission of nerve impulses within the brain to minimize the seizures of epilepsy
Anticonvulsants
relax bronchial smooth muscle for the relief
or prevention of asthma.
Bronchodilators
most common bronchodilator
Theophylline
Theophylline metabolites
caffeine
3 types of psychotropic or antipsychotic drugs
lithium
antidepressants
fluoxetine
used to treat manic-depressive illness.
lithium
lithium is eliminated as
unchanged drug
used to treat depression
tricyclic antidepressants
TAD peak serum concentrations are reached in the range of
2-12 hours
TAD complications
drowsiness
constipation
blurred vision
memory loss.
seizure
cardiac arrythmia
unconsciousness
blocks serotonin uptake by nerve terminals in the CNS and by platelets
Fluoxetine
medications to treat cancer
Antineoplastic drugs
rapidly metabolized or incorporated into
cellular macromolecular structures within seconds to minutes of their administration.
Antineoplastic drugs
antibiotics with serious side effects requiring moniyoring
amikacin
gentamycin
tobramycin
vancomycin
chloramphenicol
amikacin toxic effects
nephrotoxicity
ototoxicity
gentamicin toxic effects
nephrotoxicity
ototoxicity
vertigo
respiratory paralysis
tobramycin toxic effects
nephrotoxicity
ototoxicity
vertigo
respiratory paralysis
vancomycin close monitoring is recommended for patients with
reduced renal function
propensity for bacterial infection
Chloramphenicol toxicity
toxic to bone marrow
aplastic anemia
blood dyscrasias
cardiovascular collapse
aspirin use
analgesic
antipyretic,
anti-inflammatory drug.
lab diagnosis of salicylates
GC LC (highest sensitivity, specificity)
immunoassays
chromogenic assay (trinder salicylate + ferric nitrate)
acetaminophen use
analgesic
