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Clin Chem > TDM > Flashcards

TDM Flashcards

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1
Q

What is the free portion of a drug?

A

That which interacts with site of action and produces biological response.

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2
Q

Free portion of a drug best correlates with ________ and therapeutic or toxic effects

A

concentration

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3
Q

Things that can cause the free portion of a drug to be higher than anticipated (potentially causing toxic effects)

A

Conditions that alter binding proteins (inflammation, infection, malnutrition, etc)

Presence of substances that compete for binding sites (other drugs, hormones, etc)

Renal or liver dysfunction (not eliminated as well)

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4
Q

2 ways drugs are cleared from body

A
  1. Hepatic Metabolism

2. Renal filtration

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5
Q

Serum concentration will _______ when rate of absorbance exceeds elimination and distribution of a drug

A

Increase

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6
Q

How many half- lives does it take to reach a steady state of drug in the body?

A

5 & 1/2

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7
Q

How many half-lives does it take for a drug to clear the body?

A

5 & 1/2

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8
Q

T/F Goal of therapeutic drug monitoring is to achieve a trough below therapeutic range and keep peak below toxic range

A

False (partly): Trough should in therapeutic range and peak below toxic range

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9
Q

When is a trough sample drawn?

A

Right before next dose is given

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10
Q

When is a peak sample typically drawn?

A

1 hour after last dose. Can change when drugs are metabolized quicker or slower.

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11
Q

Would a digoxin peak level drawn 1 hour after dose be an accurate representation of the concentration?
Why/why not?

A

No- Digoxin is metabolized slowly. The level of drug in the sample would be low. This should be drawn 6 to 8 hours after a dose.

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12
Q

As a rule, what tube would we use for a TDM blood sample?

A

Red top tube

Generally use non-separator tubes, but that may be changing

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13
Q

What sample types are used for TDM testing?

A

Serum, plasma, whole blood

Urine

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14
Q

What anticoagulant(s) may be used for plasma samples?

A

Heparin

no EDTA or Citrate

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15
Q

What are some Cardioactive drugs that we test for?

A 
Digoxin
Disopyramide
Procainamide
Quinidine
Norpace (quinidine substitute- hard to establish serum concentration and therapeutic values)
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16
Q

What are some TDM antibiotics?

A

Aminoglycosides, Vancomycin, Chloramphenicol

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17
Q

What is digoxin used for?

A

To treat CHF. It increases heart contraction.

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18
Q

Digoxin is eliminated by the _____

A

kidney

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19
Q

Decrease in K+ or Mg++ will ________ the effect of digoxin, whereas hyperthyroid will ______ the effect

A

increase

decrease

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20
Q

This is given to reverse toxic levels of digoxin

A

Digibind

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21
Q

How is procainamide eliminated?

What’s the active metabolite we can monitor?

A

Hepatic and renal function

NAPA (hepatic metabolite)

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22
Q

What are Aminoglycosides used to treat?

A

Infections with gram negative bacteria that are resistant to less toxic antibiotics

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23
Q

What are toxic effects of aminoglycosides (to humans)?

A

Nephrotoxicity and ototoxicity (irreversible effects)

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24
Q

Common examples of aminoglycosides

A

Gentamycin, tobramycin, amikacin, kanamycin

25
Q

What is gentamycin used to treat?

A

Severe septicemia caused by gram neg bacteria

Severe infections of CNS, respiratory tract, urinary tract, GI tract

Neonatal sepsis

Infections of skin, bone, soft tissue

26
Q

How is gentamycin eliminated?

A

Kidneys

27
Q

Gentamycin is a major cause of _______ _____ in humans

A

hearing loss

28
Q

What is tobramycin used for?

A

Used to fight gram neg bacteria resistant to gentamycin

29
Q

Are aminoglycosides given as an out-patient treatment?

A

No. IV or IM only.

30
Q

What is vancomycin used to treat?

A

Infections (endocarditis and sepsis) caused by gram + and some gram - bacteria

note: Used because of MRSA & Corynebacteria

31
Q

what is red man syndrome and what causes it?

A

erythemic flushing of extremities

caused by vancomycin

32
Q

When testing for therapeutic levels of anti-epileptic drugs, we measure both _______ and _______ forms of the drug

A

total and free

total for most normal states; free when there is a cause for plasma protein alteration

33
Q

Is peak or trough (or both) the most preferred sample when TDM testing for anti-epileptics?

A

Trough

34
Q

Common first generation anti-epileptics (5)

A 
Phenobarbitol
Phenytoin (Dilantin)
Valproic acid
Carbamazepine
Ethosuximide
35
Q

Common second-gen anti-epileptics (8)

A 
Felbamate
Gabapentin
Lamotrigine
Levetiracetam (keppra)
Oxcarbazepine
Tiagabine
Zonasimide
36
Q

Second generation anti-epileptics are often _____ to first-gen drugs

A

supplemental

37
Q

Common tricyclic antidepressants include:

A 
Imipramine
Amitriptyline
Doxepin
Clozapine
Olanzapine
38
Q

Tricyclic drugs are used to treat:

A

Depression, insomnia, apathy, loss of libido

39
Q

Toxicity of Tricyclic drugs is ____ times upper limit of therapeutic dose and can cause ______, _______, and _____

A

2 times

Seizures, arrhythmia, and loss of consciousness

40
Q

Generally speaking, how do TCAs and SSRIs work?

A

Prolong the effects of neurotransmitters by blocking their receptors

41
Q

What kind of action do TCAs have?

A

non-specific; increase levels of neurotransmitters serotonin and norepi in brain by slowing uptake of them by nerve cells.

42
Q

Do TCAs or SSRIs have more side effects and why?

A

TCAs do. Their action is more non-specific and can block other receptor sites.

43
Q

What do SSRIs inhibit?

A

inhibits serotonin receptors, slowing the reuptake of serotonin

44
Q

List 3 immunosuppressive drugs we monitor

A

Cyclosporine
Tacrolimus
Sirolimus

45
Q

Preferred sample for immunosuppressive drugs

A

whole blood

46
Q

When is TDM started for immunosuppressive drugs?

A

5 to 7 days after initiation. Test trough concentrations.

47
Q

Sirolimus also has ________ activity

A

Anti-fungal

48
Q

Tacrolimus is 100x the potency of _______

A

cyclosporine

49
Q

Cyclosporine toxicity can cause…

A

renal tubular and glomerular dysfunction, HTN

50
Q

Tacrolimus toxicity can cause…

A

similar effects as cyclosporine, with added risk of clot formation

51
Q

Sirolimus toxicity can cause….

A

thrombocytopenia, anemia, leukopenia, infection, hyperlipidemia
(Extremely potent med)

52
Q

Why are anti-neoplastic drugs not aided by TDM?

A

Correlation of toxic & therapeutic concentration hard to establish
Absorbed and incorporated into cells quickly (seconds to minutes)
Dose given more important than concentration

53
Q

How does methotrexate work?

A

Inhibits DNA synthesis in all cells (anti-neoplastic)

54
Q

What are the 2 steps used for analyzing drugs of abuse or drug toxicity in a patient?

A
  1. Screening (good sensitivity, lacks specificity)- can detect class of drugs, positives need confirmation
  2. Confirmation (high sensitivity & specificity)- method used must be different than that for screening. Test usually takes longer.
55
Q

Ingestion of ethylene glycol results in this pH state:

It also leads to _______ ______ deposits in renal tubules (and crystals in urine)

A

acidosis

Oxalic acid

56
Q

What tests are used to measure salicylate concentration?

A

Immunoassays

Trinders

57
Q

How does Trinders test work?

A

salicylates react with ferric nitrate and form colored product- measured spectrophotometrically

58
Q

What are some drugs of abuse that may be tested for?

A 
Amphetamines
Cannabinoids
Cocaine
Opiates
PCP
Sedatives/Hypnotics (barbiturates, Benzos)

Clin Chem (4 decks)

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