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Clinical Chemistry > Therapeutic Drug Monitoring > Flashcards

Therapeutic Drug Monitoring Flashcards

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1
Q

MEC

A

minimum effective concentration

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2
Q

MTC

A

minimum toxic concentration

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3
Q

Trough

A

lowest drug level

draw sample prior to next dose given

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4
Q

peak

A

highest drug level, draws at peak of absorption for particular drugs

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5
Q

steady state

A

drug intake & outtake equal so drug level stays in therapeutic range

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6
Q

bioavailability

A

unchanged drug entering the bloodstream

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7
Q

of doses to get to therapeutic range usually

A

at least 5 doses

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8
Q

Drug distribution

A

administration
absorption
distribution
excretion

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9
Q

methods that lead to GI absorption

A

oral, rectal or sublingual routes of administration

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10
Q

GI absorption

A

drugs go through the liver & go through ‘first pass’
drug must go through unionized (hydrophobic), absorb passive diffusion
portion of unchanged drug entering the blood is bioavailable

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11
Q

injected drugs absorption

A

enter the blood stream via IV, intramuscular, intradermal, subcutaneous, respiratory, or percutaneous
do not have to deal with liver’s first pass effect

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12
Q

factors that change drug absorption in GI

A

GI motility
pH
inflamed

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13
Q

carrier proteins of drugs

A

albumin & alpha-1-acid glycoprotein (!!!)

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14
Q

free drug levels affected by:

A 
protein binding
disease state
kidney function
additional drugs being present
hepatic disease
acid-base disturbance
nephrotic syndrome
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15
Q

lipid soluble drug distribution

A

travel through cell membranes & partition in lipid compartments in cells

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16
Q

polar drug distribution

A

travel to water part of cell & stay there

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17
Q

ionized drug distribution

A

diffuse slowly out of blood & into cells

get filtered in kidneys or taken out by liver

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18
Q

major organ for drug metabolism

A

liver via mixed function oxidase system or MFO
converts hydrophobic drug into water soluble substances
go out bile or into blood & out the kidney

19
Q

secondary sites for drug metabolism

A 
lungs
kidneys
skin
brain
GI
20
Q

drug metabolite activity levels

A

bound drug & active metabolite

21
Q

metabolism of lipid soluble drugs

A

non-polar to soluble form using renal excretion via hydroxylation, deamination, sulfoxidation, dealkylation
enzymes: Monooxygenases or mixed function enzymes (MFO) in liver

22
Q

MFO phase I

A

produce reactive intermediates from drug

can accumulate & may not be able to go into phase iI

23
Q

MFO phase II

A

conjugates reactive intermediate to water-soluble products

intermediates are conjugated to glutathione, glycine, phophate or sulfate

24
Q

MFO system influenced

A

process is inducible
drug-drug interactions are competing for MFO system
changes in hepatic health will affect MFO

25
Q

renal clearance

A

parent drug & metabolite are subject to glomerular filtration
if renal function is compromised, then longer half-life

26
Q

acid urine

A

leads to more alkaline drug excretion & vice versa

27
Q

samples

A

usually serum/plasma

urine samples are used when wanting to look at parent drug & metabolites

28
Q

cardiac drugs

A

digoxin/ digitoxin
quinidine
procainamide
disopypramide/norpace

29
Q

digoxin/digitoxin

A

used for CHF
very toxic - tissue levels are 15-30x the serum/plasma level
stays in lipid portion of tissues
stops Na/K ATPase pumps to prevent fluid build up in cells & encourage K to be excreted in the urine

30
Q

quinidine

A

DO NOT MIX W/ DIGOXIN

cardiac drug

31
Q

procainamide

A

active metabolite - NAPA

cardiac drug

32
Q

disopypramide/norpace

A

used as quinidine substitute drug

cardiac drug

33
Q

anti-epileptic drugs

A

all are GI absorbed, liver metabolized & renal excreted

34
Q

older AEDs

A 
highly bound to protein; all toxic 
phenobarbital 
phenytoin/dilantin
valproic acid 
primidone
carbamazepine
35
Q

2nd gen AEDs

A 
felbamate
gabapentin
lamotrigine
tiagabine
topiramate
36
Q

aminoglycosides

A

anti-microbials: gentamycin, kanamycin, tobramycin, neomycin
give by IV
bind to ribosomes & inhibit protein synthesis

37
Q

anti-microbial side effects

A 
affect hearing, balance
anemia, cytopenias
red man syndrome 
nephrotoxic
ototoxic
38
Q

vancomycin

A

affects cell walls of bacteria

G +

39
Q

Tricyclic antidepressants (TCAs)

A

takes 2-4 weeks to see effects; drug metabolized by liver

imipramine, amitriptyline, dozepin

40
Q

Tricyclic antidepressants (TCAs)

A

takes 2-4 weeks to see effects; drug metabolized by liver

imipramine, amitriptyline, dozepin

41
Q

Clozepine

A

used for schizophrenia

42
Q

Olanzapine

A

used for schizophrenia
lose 40% to first pass through liver
given IV

43
Q

immunosuppressive drug specimens

A

all collected in EDTA due to drug affiliation w/ RBCs

44
Q

immunosuppressive drugs

A 
cyclosporine
tacrolimus
sirolimus
mycophenolic acid
all are eliminated through liver

Clinical Chemistry (23 decks)

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