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CC2 LECTURE > THERAPEUTIC DRUG MONITORING > Flashcards

THERAPEUTIC DRUG MONITORING Flashcards

1
Q
  • Involves the analysis and evaluation of circulating concentrations of drugs in blood
A

THERAPEUTIC DRUG MONITORING (TDM)

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2
Q
  • To ensure that a given drug dosage produces maximal therapeutic benefit and minimal toxic adverse effects
A

THERAPEUTIC DRUG MONITORING (TDM)

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3
Q

INDICATIONS OF TDM

  1. Consequences of [?] are serious
  2. Narrow [?]
  3. Good correlation between circulating concentrations and [?]
  4. Change in [?] that may affect circulating drug concentrations
  5. Occurrence of [?]
  6. Monitoring [?]
A

over- and under-dosing

margin of safety

therapeutic or toxic effects

patient’s condition

drug interactions

patient compliance

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4
Q
  • The rate at which the drug is absorbed is dependent upon the route of administration
A

ABSORPTION

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5
Q

require dissolution

A
  • Tablets & capsules
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6
Q

are rapidly absorbed

A

liquids

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7
Q
  • Transport mechanism:
A

passive diffusion

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8
Q
  • Weak acids are absorbed in the [?] ; weak bases in the [?]
A

stomach

intestine

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9
Q

Crucial step in obtaining accurate and meaningful results

A
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10
Q

Single most important factor :

A

timing

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11
Q

Peak concentrations:

A

1 hour after an orally administered dose (1-hr post-dose)

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12
Q

Type of sample/sample matrix:

A

• Serum or plasma – typically used
• Heparin – commoly used anticoagulant

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13
Q

Avoid any degree of [?]– affects conc of elements;
proper phlebotomy techniques, gentle mixing

A

hemolysis

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14
Q

[?] of sample is important

A

Prompt processing

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15
Q

may be collected overtime to asses blood level at different points in the dosing interval

A

Multiple samples

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16
Q

(provides more comprehensive picture in the drug exposure and aids in dosage adjustment)

A

Multiple samples

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17
Q

Maintain [?], including choice of anticoagulant and collection techniques

A

consistency in collection

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18
Q

• Used to treat congestive heart failure and cardiac arrhythmias

A

CARDIOTROPICS

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19
Q

• Act on the conduction system of cardiac muscle

A

CARDIOTROPICS

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20
Q

• Net effect: slow down electrical conduction

A

CARDIOTROPICS

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21
Q
  • for supraventricular and ventricular arrhythmias
A

Quinidine

Procainamide

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22
Q

Cinchonism

A

Quinidine

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23
Q

Quinidine Common formulation:

A

Quinidine sulfate & Quinidine gluconate

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24
Q
  • for supraventricular or ventricular arrhythmias
A

Quinidine

Procainamide

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25
Q

Procainamide Metabolite :

A

n-acetylprocainamide

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26
Q

Reversible lupus-like syndrome w/ elevated ANA titers, urticaria, rash, agranulocytosis and nephrotic syndrome

A

Procainamide

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27
Q
  • local anaesthetic
A

Lidocaine

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28
Q
  • acute control & prevention of ventricular arrhythmias after MI
A

Lidocaine

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29
Q
  • convulsions, coma, respiratory depression, bradycardia, hypotension
A

Lidocaine

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30
Q
  • a short-term prophylactic agent in brain injury
A

Phenytoin (Dilantin)

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31
Q
  • Toxicity is seen at the level of the therapeutic range
A

Phenytoin (Dilantin)

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32
Q

Major toxicity: initiation of seizures

A

Phenytoin (Dilantin)

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33
Q

Other toxic effects: hirsutism, gingival hyperplasia, Vit. D & folate deficiency

A

Phenytoin (Dilantin)

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34
Q
  • Antagonizes effects of epinephrine on the heart, arteries and arterioles of skeletal muscles and on the bronchus
A

Propranolol

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35
Q
  • causes vasodilation
A

Propranolol

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36
Q
  • used for treatment of hypertension and angina pectoris
A

Propranolol

Verapamil

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37
Q
  • for life-threatening ventricular arrhythmias
A

Amiodarone

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38
Q
  • angina, hypertension, supraventricular arrhythmias
A

Verapamil

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39
Q

Treatment of gram (-) bacterial infections

A

AMINOGLYCOSIDES

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40
Q

Toxic effects: nephrotoxicity and ototoxicity

A

AMINOGLYCOSIDES

VANCOMYCIN

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41
Q

Administered IM or IV

A

AMINOGLYCOSIDES

PHENYTOIN

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42
Q

Effective against gram (+) cocci & bacilli

A

VANCOMYCIN

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43
Q

Administered by IV infusion and orally

A

VANCOMYCIN

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44
Q

Toxic side effects occur in the therapeutic range (5 - 10 ug/mL)

A

VANCOMYCIN

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45
Q

Trough levels are monitored

A

VANCOMYCIN

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46
Q

Toxic effects: “red-man syndrome” nephrotoxicity and ototoxicity

A

VANCOMYCIN

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47
Q

Characterized by erythematous flushing of the extremities

A

RED MAN SYNDROME

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48
Q

TYPES OF SEIZURE
1. Focal/Partial Seizure

A

a. Simple Partial

b. Complex partial

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49
Q

TYPES OF SEIZURE
2. Generalized

A

a. Tonic-Clonic (Grand Mal Seizure)

b. Absence Seizure (Petit Mal Seizure)

c. Myoclonic Seizure

d. Atonic Seizure

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50
Q

• originates in one specific area of the brain and will not cause loss of consciousness

A

Simple Partial

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51
Q

• symptoms may vary, but may include altered emotions, sensory changes, or motor symptoms

A

Simple Partial

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52
Q

• originates in one specific area of the brain and will lead to loss of awareness/consciousness

A

Complex partial

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53
Q

changes in behaviour, automatic movements, and confusion

A

Complex partial

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54
Q

• Muscle stiffening

A

(Tonic)

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55
Q

• Rhythmic jerking of the limbs

A

(Clonic)

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56
Q

• Most common seizure

A

Tonic-Clonic (Grand Mal Seizure)

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57
Q

• sudden loss of consciousness

A

Tonic-Clonic (Grand Mal Seizure)

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58
Q

• Brief episode of starring/absence/blanking

A

Absence Seizure (Petit Mal Seizure)

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59
Q

• Often mistaken for daydreaming

A

Absence Seizure (Petit Mal Seizure)

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60
Q

• Typically seen in children

A

Absence Seizure (Petit Mal Seizure)

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61
Q

• Involuntary jerking/twitching of muscles

A

Myoclonic Seizure

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62
Q

• Affects specific muscle groups or the entire body

A

Myoclonic Seizure

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63
Q

• Sudden loss of muscle tone leading to a person collapsing

A

Atonic Seizure

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64
Q

Generalized tonic-clonic seizures and simple partial seizures

A

PHENOBARBITAL

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65
Q

Toxicity :
• Nystagmus
• Ataxia
• Stupor
• Respiratory depression
• Hypotension
• Coma

A

PHENOBARBITAL

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66
Q

• short-term prophylactic agent in brain injury

A

PHENYTOIN

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67
Q

• Major toxicity: initiation of seizures

A

PHENYTOIN

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68
Q

Other toxic effects:
• Hirsutism
• Gingival hyperplasia
• Vit. D & folate deficiency

A

PHENYTOIN

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69
Q

PHENYTOIN Injectable proform:

A

Fosphenytoin

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70
Q

• Used for treatment of petit mal & absence seizure

A

VALPROIC ACID

ETHOSUXIMIDE

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71
Q

• Enhance the activity of Gamma Amino Butyric Acid-mediated inhibitory system

A

VALPROIC ACID

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72
Q

• Hepatic dysfunction: hyperammonemia

A

VALPROIC ACID

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73
Q

• Teratogenic effects

A

VALPROIC ACID

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74
Q

• Toxicity: sedation, gastric disturbances, ataxia

A

VALPROIC ACID

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75
Q

• Generalized tonic clonic, simple partial and complex partial seizures

A

CARBAMAZEPINE

PRIMIDONE

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76
Q

• Tic douloureux (trigeminal neuralgia)

A

CARBAMAZEPINE

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77
Q

• Reduction of excitatory synaptic transmission in the spinal trigeminal nucleus

A

CARBAMAZEPINE

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78
Q

CARBAMAZEPINE Metabolites

A

• 10,11-epoxide form
• 10,11-dihydroxy form

79
Q

• Toxicity: drowsiness, ataxia, dizziness, nausea and vomiting

A

CARBAMAZEPINE

80
Q

Rare:
- aplastic anemia,
- thrombocytopenia
- agranulocytosis

A

CARBAMAZEPINE

81
Q

• Generalized tonic clonic, simple partial and complex partial seizures

A

CARBAMAZEPINE

PRIMIDONE

82
Q

PRIMIDONE Metabolites

A

• Phenobarbital
• Phenylethy|malonamide

83
Q

• Petit mal (absence) seizures

A

ETHOSUXIMIDE

84
Q

• Chemically related to imipramine (TCA)

A

ETHOSUXIMIDE

85
Q

• Toxicity: GI : nausea, vomiting, gastric distress

A

ETHOSUXIMIDE

86
Q

COPD : chronic obstructive pulmonary disease

A

ASTHMA

87
Q

ASTHMA
First phase :
Second phase:

A

bronchoconstriction (bronchodilators)

inflammation (steroids)

88
Q

• For moderate or severe asthma attacks

A

THEOPHYLLINE

89
Q

• Bronchodilator, vasodilator

A

THEOPHYLLINE

90
Q

• Stimulates respiration and strengthens the action of cardiac muscles

A

THEOPHYLLINE

91
Q

• known CNS stimulant

A

THEOPHYLLINE

92
Q

• Oral or IV form

A

THEOPHYLLINE

93
Q

THEOPHYLLINE Metabolite:

A

3-methyl-xanthine

94
Q

THEOPHYLLINE Drug interactions (decreased metabolism):

A

• Phenytoin, carbamazepine
• Erythromycin

95
Q

THEOPHYLLINE
• Adult therapeutic range:

A

10-20ug/mL

96
Q

THEOPHYLLINE
• Newborns :

A

5-10ug/mL

97
Q

THEOPHYLLINE

• Toxicity : Nausea, vomiting, headache and anxiety

A

• 15-20 ug/mL

98
Q

THEOPHYLLINE

• Toxicity : Tachycardia, arrhythmias

A

20-40 ug/mL

99
Q

THEOPHYLLINE

• Toxicity : Seizures, cardiac arrest

A

> 40 ug/mL

100
Q

• Tissue damage —arachidonic acid

A

INFLAMMATION

101
Q

2 pathways producing inflammatory mediators:

A
  1. lipo-oxygenase pathway
  2. cyclo-oxygenase pathway
102
Q

leukotrienes

A
  1. lipo-oxygenase pathway
103
Q

• thromboxanes

A
  1. cyclo-oxygenase pathway
104
Q

• prostaglandins

A
  1. cyclo-oxygenase pathway
105
Q

Anti-inflammatory

A

CORTICOSTEROIDS

106
Q

Block the cyclo-oxygenase pathway

A

CORTICOSTEROIDS

107
Q

Fluid retention, weight gain, osteoporosis, gastrointestinal bleeding and mental changes

A

CORTICOSTEROIDS

108
Q

• Anti-inflammatory w/o undesirable side effects

A

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

109
Q

• Acetaminophen/Paracetamol

A

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

110
Q

• Acetylsalicylic acid/ Aspirin

A

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

111
Q

• Naproxen, Ibuprofen, Piroxicam

A

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

112
Q

• Analgesic, antipyretic and anti-inflammatory

A

ASPIRIN

113
Q

• Lower doses: anti-thrombotic (cutting problems)

A

ASPIRIN

114
Q

• Chronic toxicity: tinnitus, muffled hearing

A

ASPIRIN

115
Q

• Acute toxicity : acidosis

A

ASPIRIN

116
Q

• Reye’s syndrome: hepatotoxicity

A

ASPIRIN

117
Q

• Analgesic and anti-pyretic

A

ACETAMINOPHEN

118
Q

• ACETAMINOPHEN Metabolites :

A

glucoronide and sulfate conjugates

119
Q

• Acute toxicity: nausea, vomiting and abdominal pain

A

ACETAMINOPHEN

120
Q

• Chronic toxicity: anemia, renal damage, GI disturbances

A

ACETAMINOPHEN

121
Q

• Autoimmune diseases

A

IMMUNOSUPPRESSIVES

122
Q

• Tissue transplant recipient

A

IMMUNOSUPPRESSIVES

123
Q

• Drug of choice for maintenance of kidney, liver, heart and heart- lung allografts

A

CICLOSPORIN

124
Q

• Adverse effect : nephrotoxicity

A

CICLOSPORIN

125
Q

• Other effects: neurologic, dermatologic, hepatotoxic

A

CICLOSPORIN

126
Q

• Currently used in transplant surgery to prevent organ rejection

A

TACROLIMUS

127
Q

• Similar toxicity profile to ciclosporin

A

TACROLIMUS

128
Q

• Available as citrate and CO3 salts

A

LITHIUM

129
Q

• Anti-manic agents

A

LITHIUM

130
Q

• Prophylaxis and treatment of bipolar disorder

A

LITHIUM

131
Q

• Toxicity: from single toxic dose or prolonged use

A

LITHIUM

132
Q

• Renal toxicity and hypothyroidism

A

LITHIUM

133
Q

• Block reuptake of adrenergic and dopaminergic neurotransmitters

A

TRICYCLIC ANTIDEPRESSANTS

134
Q

• Amitriptyline, imipramine, nortriptyline, despramine, doxepin

A

TRICYCLIC ANTIDEPRESSANTS

135
Q

• Toxicity: excess CNS stimulation

A

TRICYCLIC ANTIDEPRESSANTS

136
Q

• Inhibits dihydrofolate reductase

A

3.METHOTREXATE

137
Q

(enzyme cofactor important for DNA synthesis)

A

dihydrofolate reductase

138
Q

Uses :

  • Psoriasis
  • Refractory rheumatoid arthritis
  • Malignant neoplastic diseases
A

METHOTREXATE

139
Q

• Toxicity: hematologic effects, GI effects

A

METHOTREXATE

140
Q

• Treat leukemias and lymphomas prior to BM transplantation

A

BUSULFAN

141
Q

• Toxicity: hepatic veno-occlusive disease

A

BUSULFAN

142
Q

Block Na channels during depolarization

A

Rapid sodium channel blockers

143
Q

Used to treat atrial and ventricular arrhythmias

A

Rapid sodium channel blockers

144
Q

• Mechanism: Antagonize the effect of catecholamine (epinephrine and norepinephrine) on beta receptors

A

Beta adrenergic blockers

145
Q

• Net effect: Decreases the HR and reduce myocardial contractility

A

Beta adrenergic blockers

146
Q

• Used in management of various arrhythmias (atrial fibrillation and atrial flatter)

A

Beta adrenergic blockers

147
Q

• Given to patients with heart failure and hypertension

A

Beta adrenergic blockers

148
Q

• Leads to delayed depolarization

A

Potassium channel blockers

149
Q

• Used to treat atrial and ventricular arrhythmias

A

Sodium channel blockers

Potassium channel blockers

150
Q

• Inhibits Ca influx during depolarization

A

Calcium channel blockers

151
Q

• Used to treat supraventricular arrhythmias (atrial fibrillation
and atrial flatter)

A

Calcium channel blockers

152
Q

• Given to patients with angina and hypertension

A

Calcium channel blockers

153
Q

• Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp

A

AMINOGLYCOSIDES

154
Q

• Commonly used w/ other antibiotics for synergistic effects

A

AMINOGLYCOSIDES

155
Q

• Oral is not common due to poor absorption in the IT

A

AMINOGLYCOSIDES

156
Q

• Can cause kidney damage esp if high conc persists in the renal tubules

A

AMINOGLYCOSIDES

157
Q

• Ototoxicity: damage to the inner ear leading to hearing
loss or balance issues

A

AMINOGLYCOSIDES

158
Q

• Methicillin Resistant Staphylococcus aureus (MRSA), Streptococcus pneumoniae, Enterococcus spp

A

VANCOMYCIN

159
Q

• Not effective against gram (-) bacteria

A

VANCOMYCIN

160
Q

– available but mainly used to treat GI infection caused by Clostridium difficile

A

• Oral vancomycin

161
Q

• Blood sample is collected just before the next dose

A

VANCOMYCIN

162
Q

• Common adverse reaction to rapid IV infusion of
vancomycin

A

RED MAN SYNDROME

163
Q

• Characterized by flushing, red rash, hypotension

A

RED MAN SYNDROME

164
Q

• Prevention: slow down infusion process

A

RED MAN SYNDROME

165
Q

• Anti-convulsant

A

PHENOBARBITAL

166
Q

: involuntary rhythmic eye movement

A

• Nystagmus

167
Q

: lack of coordination of muscle movements

A

• Ataxia

168
Q

: state of mere consciousness or insensibility

A

• Stupor

169
Q

: low blood pressure

A

• Hypotension

170
Q

: state of deep unconsciousness

A

• Coma

171
Q

• Anti-epileptic medication to treat various seizure disorders

A

PHENYTOIN

172
Q

• Pro-convulsant effect

A

PHENYTOIN

173
Q

: abnormal growth of hair in females

A

• Hirsutism

174
Q

: overgrowth of gum tissues (remedy: good oral hygiene)

A

• Gingival hyperplasia

175
Q

: long-term use; can interfere w/ absorption metabolism

A

• Vit. D & folate deficiency

176
Q

(water-soluble; IV or IM administration; converted to phenytoin in the body; often used when more controlled and rapid movement of phenytoin is needed)

A

Fosphenytoin

177
Q

: known neurotransmitter that sends chemical signals to CNS; involved in the regulation of communication of the brain cells

A

Gamma Amino Butyric Acid

178
Q

• Works to decrease nerve impulses that can cause nerve seizure and pain

A

CARBAMAZEPINE

179
Q

: severe stabbing pain to one side of the face

A

Tic douloureux (trigeminal neuralgia)

180
Q

Syndrome of variable airflow obstruction

A

COPD : chronic obstructive pulmonary disease

181
Q

Characterized by bronchial inflammation with prominent eosinophil infiltration and bronchial hyper responsiveness

A

ANTIASTHMATICS

182
Q

Common clinical symptoms: cough chest tightness, wheezing

A

ASTHMA

183
Q

one of the most well-known antiasthmatics

A

THEOPHYLLINE

184
Q

: involved in asthmatic and allergic reactions; acts to sustain inflammatory reactions

A

leukotrienes

185
Q
  • made at sites of tissue damage/infection involved w/ healing injury
A

Thromboxanes

Prostaglandins

186
Q

used to provide relief for inflamed areas

A

CORTICOSTEROIDS

187
Q

lessens swelling, redness, itching, and allergic reactions

A

CORTICOSTEROIDS

188
Q

given to patients w/ severe allergies, skin problems, asthma, arthritis

A

CORTICOSTEROIDS

189
Q

popular pain reliever

A

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

190
Q

bipolar disorder, mood swings, depression, mania

A

MANIC DEPRESSION DRUGS

191
Q

most well-known MANIC DEPRESSION DRUGS

A

LITHIUM

192
Q

controls processes such as inflammation, blood flow, or formation of blood clots

A

Thromboxanes

Prostaglandins

193
Q

seizures, coma, hypotension, respiratory depression

A

TRICYCLIC ANTIDEPRESSANTS

194
Q

vertigo, tinnitus, headache, visual disturbances and disorientation

A

Quinidine

CC2 LECTURE (33 decks)

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