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Clinical Pathology > Therapeutic Drug Monitoring And Clinical Toxicology > Flashcards

Therapeutic Drug Monitoring And Clinical Toxicology Flashcards

1
Q

What are the drug groups you know?

A

Cardioactive

Antibiotics

Antiepileptic

Psychotherapeutic

Antiasthmatic

Immunosuppressive

Antineoplastic

Antihypertensive

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2
Q

Name the cardioactive drugs you know

A

Digoxin

Lidocaine

Quinidine

Procainamide

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3
Q

What drug group does digoxin belong❓

A

Cardioactive drug

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4
Q

What does digoxin do❓

A

Cardiac glycoside that allows for better cardiac contraction and rhythm

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5
Q

How does digoxin function❓

A

Inhibits membrane Na, K ATPase pump

⬇️intracellular K
⬆️Ca

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6
Q

The peak after administration of digoxin occurs….

A

2 hours post dose

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7
Q

What’s the therapeutic range of digoxin❓

What are its toxic effects❓

How is it excreted❓

A

O.8-2ng/mL

Premature ventricular contractions
Atrioventricular node blockage

By renal filtration

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8
Q

How is digoxin measured in serum?

A

Immunoassay

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9
Q

What drug group does lidocaine belong❓

What does it do❓

A

Cardioactive drug

  • Used to correct ventricular arrhythmias
  • Used to correct ventricular fibrillation
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10
Q

What’s the therapeutic range of lidocaine❓

What are its toxic effects❓

How is it excreted❓

A

1.5-4.0 micrograms/mL

CNS depression

Completely eliminated by the liver if orally given as MEGX (monoethylglycinexylidide)

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11
Q

What drug group does quindine belong❓

What does it do❓

How does it work❓

A

Cardioactive drug

Prevents cardiac arrhythmias, atrial flutter and fibrillation

🚫Na and K channels

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12
Q

What drug group does procainamide belong❓

What does it do❓

How does it work❓

A

Cardioactive drug

Used to treat cardiac arrhythmias

🚫Na channels

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13
Q

How is procainamide measured in serum?

A

NAPA (N-acetyl procainamide)

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14
Q

Name the antibiotics you know

A

Aminoglycosides

Vancomycin

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15
Q

What drug group do aminoglycosides belong❓

What do they do❓

A

Antibiotics

Used to treat infections with gram-negative bacteria that are resistant to less toxic antibiotics

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16
Q

How do aminoglycosides function❓

Give a few examples

A

Inhibit protein synthesis of the microorganisms

Gentamycin, tobramycin, amikacin, kanamycin

17
Q

Aminoglycosides are associated with nephro and ototoxicity

True or false

A

True

18
Q

What drug group does vancomycin belong❓

What does it do❓

How does function❓

A

Antibiotics

Used to treat infections with more-resistant gram-positive cocci and bacilli

Inhibits cell wall synthesis

19
Q

What are antiepileptic drugs used for❓

Give examples

A

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
20
Q

What are psychotherapeutic drugs used for❓

Give examples

A

Used to treat manic depression (bipolar disorder)

Lithium
Tricyclic antidepressants
Clozapine

21
Q

What are antiasthmatic drugs used for❓

Give examples

A

Used to treat breathing or respiratory disorders of adults or children like asthma

Theophylline
Theobromine

22
Q

What are immunosuppressive drugs used for❓

Give examples

A

1.
•Used to treat autoimmune diseases
•Used to prevent organ rejection

  1. •Cyclosporine
    •Tacrolimus (Prograf)
    -prevents rejection of liver and kidney transplants
23
Q

What are antineoplastic drugs used for❓

Give examples

A

Inhibit RNA or DNA synthesis of tumor cells, leading to death

Methotrexate (🚫 DNA synthesis)

24
Q

The efficacy of methotrexate is dependent on what❓

A

A controlled period of inhibition that is detrimental to neoplastic cells

*Leucovorin rescue

25
Q

What are antihypertensive drugs used for❓

How do they function❓

Give examples

A

Treatment of high blood presssure

Dilate blood vessels

Na nitroprusside (short term control of hypertension)

26
Q

What are the techniques used in measuring TDM❓

A

Immunoassay
Chromatography
Mass spectrometry

27
Q

What drugs are frequently associated with poisoning❓

A 
Ethanol
Paracetamol 
Salicylates 
Benzodiazepines 
Tramadol
28
Q

What antidote is used in the management of acetaminophen/paracetamol poisoning❓

A

N-acetylcysteine

29
Q

What happens in paracetamol poisoning❓

A 
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
30
Q

What are the clinical features of paracetamol poisoning❓

A

Nausea and vomiting first 24hrs

Consciousness is maintained

Abdominal pain
Abnormal prothrombin time
Elevated liver enzymes
Bilirubin

Encephalopathy
Liver failure
Renal failure

31
Q

How is paracetamol poisoning treated❓

A

Specific antidote N-acetylcystein given IV

Oral methionine assist in glutathione regeneration

Fluid and electrolyte management

Acid base homeostasis

Regular blood level monitoring

32
Q

What metabolic changes are observed in alcohol poisoning❓

A 
Hypertriglyceridaemia
Hypoglycemia 
Hyperuricaemia 
Hypogonadism 
Cushing like syndrome
Thiamine deficiency

⬆️RBC volume
⬆️plasma GGT

33
Q

Blood level >3g/L (65mmol/L) is diagnostic of alcohol poisoning

True or false

A

True

34
Q

What are the sources of lead❓

A

Old paint
Cosmetics
Pipelines

35
Q

Lead poisoning is symptomatic at what concentration❓

A

Symptomatic- 5 micromol/L

Upper limit- 2.9 micromol/L

Follow up- 0.5 micromol/L

36
Q

What are the clinical features of lead poisoning❓

A

Nausea
Vomiting
Encephalopathy
Convulsions

37
Q

How would you treat a case of lead poisoning❓

A

Fluid rehydration

Use of chelating agent like IV sodium calcium edetate

Oral dimercaptosuccinic acid to promote excretion

38
Q

Acetaminophen/paracetamol poisoning occurs when >= 150mg/kg

True or false

A

True

Clinical Pathology (6 decks)

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