Therapeutic Drug Monitoring Flashcards
Which is true? A.an equilibrium exists between free and protein-bound drug B.acidic drugs are bound to globulin C.basic drugs are bound to albumin D.NOTA
A
Baliktad ang B at C
Which is false?
A.k-value is negative because it is decreasing
B.Indepedent of clearance mechanism, decreases in serum concentration of drugs often occur as zero-order process
B
first order dapat
Which among these chromatographic methods needs large sample volume but permits separation of parent drug from metabolites & co-administered drugs?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry
C
Which among these chromatographic methods needs allows direct analysis of biological specimen with minimal sample preparation?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry
D
Which among these chromatographic methods is adapted to simultaneous quantification of drugs and metabolites?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry
B
have parasympathetic-like effects on AV node cells; serum conc 8-10 hrs after oral dose correlates with tissue conc A.phenytoin B.anti-epileptic drug C.aminoglycosides D.cardiotropics
D - used to treat arrhythmia, congestive heart failure
[Cardiotropics]
identify the ff:
A.general therapeutic range
B.general toxic level
A.0.5-2 ng/mL
B. >2 ng/mL
[Cardiotropics] identify the ff: A.half-life range. B.is this prolonged with dec renal fxn? C.is it more bioavailable at elixir? or at liquid-filled capsule?
A.35-40 hours
B.yes
C.liquid filled capsule (90-100%). elixir or tablet is 60-85%
false about aminoglycosides
A.nephrotoxic effects are irreversible & ototoxic effects are reversible
B.toxic conc: above therapeutic range
C.measured via chromatography and immunoassay
A - baliktad kasi
false about anti-epileptic drugs
A.in a normal physiologic state, total drug conc is suffcient
B.most preferred specimen is whole blood
C.free drug meas may only be necessary in alteration of patient plasma protein
D.effective conc: acceptable/no side effects
B - serum dapat
Which is true? A.aminoglycosides are antibiotics B.phenobarbitals are cardiotropics C.phenytoin is an amino acid D.NOTA
A!
Phenobarbital: which is false? A.absorption of oral dose is slow but complete B.only trough levels are evaluated C.50% protein-bound D.fast-acting barbituate for seizures
D - slow acting! hence: A is true
False about phenytoin?
A.GIT absorption is sometimes incomplete
B.primidone is an inactive form that rapidly converts to Pb
C.major toxicity: seizure initiation
D.binds to protein a lot more than phenobarbital
B - is true for phenobarbital :)
note: 87-97% ang protein binding ng phenytoin. 50% @ phenobarbital
A.T/F all forms of phenytoin are detected in most immunoassays
B.Valproic acid is used for monotherapy of ___
C.GIT absorption of valproic acid: describe
A.F - Fosphenytoin isn’t
B.petit mal & absence seizures
C.rapid and complete
False about valproic acid
A.less protein bound than phenobarbital
B.nausea,lethargy,weight gain: common adverse reactions
C.hepatic dysfuction may occur even @ serum therapeutic conc
A - more bound!
note: 93% ang protein binding ng valproic acid. 50% @ phenobarbital
A.toxic level of valproic acid, please identify
B.most serious idiosyncratic drug effect of carbamazepine
C.when carbamazepine plasma conc > 15 ug/mL, what kind of anemia could be present?
A. > 120 ug/mL
B.leukopenia
C.aplastic anemia
False about tricyclic antidepressants A.orally admin B.varying degree of absorption C.85-95% protein-bound D.therapeutic effects are seen in 1-3 days
D – therapeutic effects are not seen for 2-4 weeks after therapy initiation
A.Why should tricyclic antidepressants @ plasma be evaluated when steady state has been achieved?
B.most preferable method for TCA screening
C.T/F TCA is eliminated by hepatic metabolism
A.high variability in half-life & absorption
B.immunoassays using polyclonal antibodies
C.T
[cyclosporine]
A.primary clinical use
B.specimen of choice for
A. suppression of host vs graft reaction of heterotopic transplanted organs
B. whole blood
A.How can overuse of cyclosporine lead to hypertension?
B.T/F For cyclosporine,relationship between oral dose & blood conc is poor.
A. renal tubular & glomerular dysfunction
B. T
[cyclosporine] used to measure its drug conc A.immunoassay B.chromatographic method C.electrophoresis
A!
B – separation, quantification of parent drug fr metabolites
antineoplastic drugs]
Which is false?
A.admin route for most is intravenous
B.therapeutic range conc: all w/o toxic effects
C.correlation between plasma conc and therapeutic benefit are hard to establish
B
[methrotrexate]
A. this drug + ____ = antineoplastic power duo
B. What does this do @ DNA in cells?
C. T/F Efficacy dep on controlled period of inhibition
A.leucovorin rescue
B.inhibit DNA synthesis
C. T
Which is/are false?
A.TDM must be done for most drugs.
B.Serum: most commonly used specimen for TDM
C.Binding of drug leads to altered cell functions
D.Drugs never compete for binding sites
A = limited number of drugs only D = nope, they do esp similar structures!
accdg to Tietz, what are the 3 purposes of TDM
assess therapeutic compliance
assess efficacy
elucidate cause of drug-induced toxicity
differentiate pharmacodynamics from pharmacokinetics
pharmacodynamics: relate drug conc at the sie of action to magnitude of effect
pharmacokinetics: relates dose, dosing interval and admin route to drug conc @ blood
A.What is kinetic homogeneity
B.Why is important?
A.assumes that changes in drug conc @ blood vs time are proportional to changes in local conc @ tissue
B.basis on which all therapeutic conc & toxic conc are established
A.What is steady state
B.T/F The larger the difference bet min effect.con & min. toxic conc, the more TDM is needed
A.point at which body conc of drug is in equil with dose rate admin & rate of elim
B.F – smaller dapat
A.What is bioavailability?
B.What is first-pass effect?
A.fraction of drug absorbed @ systemic circ
B.Drugs orally admin: first exposed @ liver, metabolized before reaching the rest of the body… while IV drugs directly systemic circ
Which is false?
A.absorption rate constant of a drug is usually less than elimination rate constant
B.displacement of a drug from plasma protein-binding sites never causes clinical toxicity
C.Liver is the principal organ for drug metab
B – if free drug conc is increased, clinical toxicity is possible
enumerate 4 most impt determinants of drug dist
- binding of drug to circulating blood comp
- binding to fixed receptors
- passing of drug through membrane barriers
- Does it dissolve in lipids?
enumerate disease states that alter free drug conc
- increase in non-protein nitrogen compounds in uremia
- acid-base and electrolyte imbalances
- decrease in albumin
Why do….
A.hydrophobic drugs have large volume of distribution index?
B.ionized substances/plasma-bound ones have small volume of dist index?
A.partitioning of hydrophilic compartments
B.sequestration @ vasculature
volume of dist index = A. (IV injected dose) + (plasma conc) B. (IV injected dose) - (plasma conc) C. (IV injected dose) * (plasma conc) D. (IV injected dose) / (plasma conc)
D
A.What do phase I / phase II rxns in the liver do?
B.4 ways on how drugs are eliminated fr body
A.convert the lipophilic drugs to more water-soluble forms
B.biliary, intestinal, pulmonary, renal
