Therapeutic Drug Monitoring And Clinical Toxicology Flashcards
What are the drug groups you know?
Cardioactive
Antibiotics
Antiepileptic
Psychotherapeutic
Antiasthmatic
Immunosuppressive
Antineoplastic
Antihypertensive
Name the cardioactive drugs you know
Digoxin
Lidocaine
Quinidine
Procainamide
What drug group does digoxin belong❓
Cardioactive drug
What does digoxin do❓
Cardiac glycoside that allows for better cardiac contraction and rhythm
How does digoxin function❓
Inhibits membrane Na, K ATPase pump
⬇️intracellular K
⬆️Ca
The peak after administration of digoxin occurs….
2 hours post dose
What’s the therapeutic range of digoxin❓
What are its toxic effects❓
How is it excreted❓
O.8-2ng/mL
Premature ventricular contractions
Atrioventricular node blockage
By renal filtration
How is digoxin measured in serum?
Immunoassay
What drug group does lidocaine belong❓
What does it do❓
Cardioactive drug
- Used to correct ventricular arrhythmias
- Used to correct ventricular fibrillation
What’s the therapeutic range of lidocaine❓
What are its toxic effects❓
How is it excreted❓
1.5-4.0 micrograms/mL
CNS depression
Completely eliminated by the liver if orally given as MEGX (monoethylglycinexylidide)
What drug group does quindine belong❓
What does it do❓
How does it work❓
Cardioactive drug
Prevents cardiac arrhythmias, atrial flutter and fibrillation
🚫Na and K channels
What drug group does procainamide belong❓
What does it do❓
How does it work❓
Cardioactive drug
Used to treat cardiac arrhythmias
🚫Na channels
How is procainamide measured in serum?
NAPA (N-acetyl procainamide)
Name the antibiotics you know
Aminoglycosides
Vancomycin
What drug group do aminoglycosides belong❓
What do they do❓
Antibiotics
Used to treat infections with gram-negative bacteria that are resistant to less toxic antibiotics
How do aminoglycosides function❓
Give a few examples
Inhibit protein synthesis of the microorganisms
Gentamycin, tobramycin, amikacin, kanamycin
Aminoglycosides are associated with nephro and ototoxicity
True or false
True
What drug group does vancomycin belong❓
What does it do❓
How does function❓
Antibiotics
Used to treat infections with more-resistant gram-positive cocci and bacilli
Inhibits cell wall synthesis
What are antiepileptic drugs used for❓
Give examples
To treat seizure disorders and epilepsy
First generation: Phenobarbital- Barbiturate primidone Phenytoin- Dilantin Valproic acid- Depakene Carbamazepine- Tegretol
Second generation: Felbamate Gabapentin Levetiracetam Oxcarbazpine Tigabine Topiramate Zonisamide
What are psychotherapeutic drugs used for❓
Give examples
Used to treat manic depression (bipolar disorder)
Lithium
Tricyclic antidepressants
Clozapine
What are antiasthmatic drugs used for❓
Give examples
Used to treat breathing or respiratory disorders of adults or children like asthma
Theophylline
Theobromine
What are immunosuppressive drugs used for❓
Give examples
1.
•Used to treat autoimmune diseases
•Used to prevent organ rejection
- •Cyclosporine
•Tacrolimus (Prograf)
-prevents rejection of liver and kidney transplants
What are antineoplastic drugs used for❓
Give examples
Inhibit RNA or DNA synthesis of tumor cells, leading to death
Methotrexate (🚫 DNA synthesis)
The efficacy of methotrexate is dependent on what❓
A controlled period of inhibition that is detrimental to neoplastic cells
*Leucovorin rescue
What are antihypertensive drugs used for❓
How do they function❓
Give examples
Treatment of high blood presssure
Dilate blood vessels
Na nitroprusside (short term control of hypertension)
What are the techniques used in measuring TDM❓
Immunoassay
Chromatography
Mass spectrometry
What drugs are frequently associated with poisoning❓
Ethanol Paracetamol Salicylates Benzodiazepines Tramadol
What antidote is used in the management of acetaminophen/paracetamol poisoning❓
N-acetylcysteine
What happens in paracetamol poisoning❓
NORMAL: Following the use of acetaminophen ⬇️ n-acetyl-p-benzoquinoneimine (NAPQI) formed through the action of cytochrome p450 ⬇️ Glutathione detoxifies NAPQI
In POISONING: High doses of paracetamol ⬇️ High NAPQI levels ⬇️ Exhaustion of glutathione ⬇️ 🚫detoxification of excess NAPQI ⬇️ NAPQI accumulates ⬇️ hepatotoxicity
What are the clinical features of paracetamol poisoning❓
Nausea and vomiting first 24hrs
Consciousness is maintained
Abdominal pain
Abnormal prothrombin time
Elevated liver enzymes
Bilirubin
Encephalopathy
Liver failure
Renal failure
How is paracetamol poisoning treated❓
Specific antidote N-acetylcystein given IV
Oral methionine assist in glutathione regeneration
Fluid and electrolyte management
Acid base homeostasis
Regular blood level monitoring
What metabolic changes are observed in alcohol poisoning❓
Hypertriglyceridaemia Hypoglycemia Hyperuricaemia Hypogonadism Cushing like syndrome Thiamine deficiency
⬆️RBC volume
⬆️plasma GGT
Blood level >3g/L (65mmol/L) is diagnostic of alcohol poisoning
True or false
True
What are the sources of lead❓
Old paint
Cosmetics
Pipelines
Lead poisoning is symptomatic at what concentration❓
Symptomatic- 5 micromol/L
Upper limit- 2.9 micromol/L
Follow up- 0.5 micromol/L
What are the clinical features of lead poisoning❓
Nausea
Vomiting
Encephalopathy
Convulsions
How would you treat a case of lead poisoning❓
Fluid rehydration
Use of chelating agent like IV sodium calcium edetate
Oral dimercaptosuccinic acid to promote excretion
Acetaminophen/paracetamol poisoning occurs when >= 150mg/kg
True or false
True
