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Clinical Chem Snoopy style > Theraputic Drug Monitoring > Flashcards

Theraputic Drug Monitoring Flashcards

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1
Q

What is TDM?

A

Measurement of drugs and or metabolites in body fluids - usually blood- to maintain therap. benefits

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2
Q

Describe T.R

A

the dose, concentration or range of a drug within the drug produces the desired theraputic effect

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3
Q

Describe T.R out of range

A

ineffective or toxic effect

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4
Q

T/F most drugs require monitoring

A

false, most drugs dont

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5
Q

Important Considerations of TDM

A

timing of collection (important)
Accurate measurement of []
Timely reporting of results

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6
Q

When is TDM used

A

when drug has narrow T.R
marked pharmokeinetic variabilites
Critical Adverse effects

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7
Q

Main purpose of TDM
ID?

A

ensure correct dosage for the T.R
ID drug interactions if multiple drugs are taken together

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8
Q

Factors that affect drug concentration

A

Age
gender
genetics
diet
co-drugs
naturopathic

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9
Q

T/F: TDM can help establish dosing regimen

Can ID non-compliance or changes if needed

Based on studies pharmokin/pharmogen

A

TRUE

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10
Q

Describe Pharmokinetics
study of
provides a time?
absorb….
what place what time?

A

study of movement of drugs in the body
provides a time-course of drug [ ] as absorption/disturb/metabolism
Drugs at right place at right time

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11
Q

Describe the route of drugs intake briefly

A

Oral most common
IV most direct/effective
IM
Sub cutaneous
Aerosol
Rectal

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12
Q

Describe Bioavilability

A

Amount of dose that reaches site as needed

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13
Q

Describe drug absorption
oral efficiency
factors that influence
how does it move across the membrane?

A

Oral: effic. of absorb from GI tract depends on sev. factors
solubility of GI fluid
diffuse across membrane

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14
Q

T/F: Some drugs require active transport mechanisms like dietary consituents

A

true

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15
Q

How are most drugs absorbed? What are some things needed?
ga

A

Most absorbed passively through GI tract into the blood stream
Drug - hydrophobic
Gastric acidity

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16
Q

Gastric Acidity:
WA:
WB:

A

WA - efficently absorb by stomach
WB: absorbed in intestines

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17
Q

What are some things that affect drug absorbtion

A

changes in intestinal motility/pH/inflammation/food/other drugs

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18
Q

T/F morphine slows GI motility

A

true

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19
Q

Describe drug distribution
hint:movement of drug…

A

movement of a drug between blood circulation/tissues/organs and the relative proportion of drug in tissues

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20
Q

T/F Free fractions can not diffuse out of vasulature

A

False, they can diffuse out of the vasculature and into intersitial places

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21
Q

The ability to leave circulation depends on what?
Hydrophobic
Polar
Ionized

A

Lipid solubility
High hydrophobic - easily cross
Polar can cross but dont enter
Ionized diffuse out of vasculature but slowly

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22
Q

Volume of distribution to drug concentration
Hydrophobic
Ionized

A

Hydrophobic has large vol Distrib
Ionized or primary protein has small volume

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23
Q

Briefly describe free vs bound drugs

Active fractions

A

most drugs are subject to binding w serum protein (Drug-protein complex)

Only free/unbound can interact with site of action/bioresponse (Active fraction)

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24
Q

Briefly describe Standard dose

A

total plasma concentration within T.R, adverse effects w/ free fraction or no therp benefit to low free fract

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25
Q

T/F changes in active fractions may not occur secondarily to changes in plasma protein concentration

A

False

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26
Q

Describe ALB
majority of
major..

A

majority of plasma protein const.
major transporter of blood

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27
Q

T/F free fractions are influenced by other drugs

A

True

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28
Q

T/F measurement of free fractions shouldn’t be considered when drugs are highly bound/or have clinical signf inconsistences

A

False

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29
Q

Describe Drug Metabolism
how are all substances absorbed

A

All substances are absorbed from intestines and (excreted through rectum) enter hepatic portal

30
Q

Describe the first pass effect in drug metabolism

A

drug is metabolized reduced effect before reaching circulation system
certain drugs have significant hepatic metabolism

31
Q

Describe an inpaired liver
tam

A

reduced metabolism absorbtion/dosing adjustments theraputic active metabolite

32
Q

T/F most drugs aren’t Xenobiotics

A

false, most drugs are

33
Q

Describe Xenobiotics

A

EXOGENOUS substances able to enter biochem pathway ment for endogenous pathway

34
Q

Whatre the two groups for Xenobiotics

A

Phase 1 reactive - reactive intermediates
Phase 2 - conjugate function groups to react sits in H20 sol production

35
Q

T/F MFO is non specific, endo/exogeneous subst. to go through

A

true

36
Q

Describe Drug elimination

A

free fractions subject to golm. filtration and renal secretion
Drugs not secreted are reabsorbed

37
Q

T/F elimination rates are directly related to GFR

Decreased GFR results in Decreased Half life

A

True

38
Q

T/F decrease in plasma drug [ ] is most often not a first order reaction

A

false it is mostly a first order process
Exponential rate of loss

39
Q

T/F most drugs are not administered as a single bolus but on a scheduled basis

A

true

40
Q

How many doses are typically needed before a steady-state is achieved

A

5-7 doses

41
Q

Describe Pharmacodynamics

A

biochem/physiological effects of drugs/mean of their actions is described as relationship between drug [ ] at site of action and response

42
Q

What is the most common mechanism of action

A

drug activates receptors at site of action

43
Q

Describe Emax
EC50

A

max efficiency
50% max efficiency

44
Q

Describe tolerance

A

constant exposure of receptors to drugs that leads to less of a response

45
Q

What is the single most important factor in specimen collection

When is peak? (Oral/IV)

A

timing

Peak in oral is after 1 hr
Peak in IV is 90 min

46
Q

T/F drug only appears after steady state is achieved

What is the specimen of choice

A

true

Serum is the specimen of choice (gel may interfere)

47
Q

Describe Pharmacogenomics
effectivness?

A

science of studying variations and developing drug therapies to compensate for genetic drift impacting therapy regimens

Effectiveness depends on pt response

48
Q

T/F responders to drugs have more benefit while non responders do not have a beneficial effect

A

true

49
Q

What is the primary drug affecting gene metabolism, What does it encode for?

A

CYP450
Encodes for Cytochrome P450

50
Q

Briefly Describe Digoxin
What kind of drug
treats?
inhibits?
peak?
elim?

Drugs that impact?

A

cardiactive drug
treats arrythmias
Inhibits NaK-ATPase
Peak 2-3 hrs
Elim through renal

Digibind (overdose)
biotin do not use at same time

51
Q

Describe briefly Quiniaine
What kind of drug
natural from?
routes
peak

A

Cardioactive drug
natural from bark
Oral/GI
peak 2hrs

52
Q

Briefly decribe Disopyramide
what kind of drug
substitute for?
peak?
elim?
binds to

A

Cardioactive drug
Substitute for Quiniaine
Peak 1-2 hr
renal elim
binds to serum/plasma prt

53
Q

Briefly Describe Procanamide
What kind of drug
rapid in?
peak?
elim?

A

Cardioactive drug
oral rapid
peak 1 hr
renal/hepatic

54
Q

Describe NAPA

A

Hepatic metabolizm of procanimide

55
Q

Describe Aminoglycosides briefly
what type of drug
what kind of infections
inhibits?
incr
poor?
what kind of drug absorb

A

Abx
Gram Neg/Gram pos infections
inhibits bacteria synth
incr. bld [ ] can affect
POORLY ABSORBED IN GI
IV/IM

56
Q

Describe Getamiein Briefly
what kind of drug
treats?
how many times a day
doses?

A

Abx
Treats GNR - life threatening
2-3x a day
can do high doses

57
Q

Briefly describe Tobramycin
What kind of drug
treats
what kind of toxin

A

ABX
Treats GNR
Ototoxic/Nephrotoxic
Baseline with audiology testing

58
Q

Decribe Amiracin
what kind of drug
infection
taken how

A

Abx
severe blood infection
orally

59
Q

Describe Vancomycin
what kind of drug
Treats
Syndromes?
Poor
What kind of toxin

A

ABX
GPC/GNR
Redman syndrome
poor GI absorb
nephro/auto toxin

60
Q

Briefly describe Anti epileptic drugs
whatis critical?

A

treat/supress seizures
TDM critical

61
Q

Describe Primidone
what kind of drug
treats
converted by?
Gets to what quicker

A

Anti epileptic drug
grand mal seizures
conv. by liver met
gets to steady state quicker

62
Q

Describe Phenorbital
what kind of drug
action is fast or slow?
Elim
What is measured

A

Anti-epileptic
slow acting oral
Elim w hepatic
only troughs measured

63
Q

Describe Phenytonin/free phenytonin
treats what
dosing problems
bound/free

A

Common treat for seizures/short term prophy agent in brain injury
seizures in hyper/hypo dosing
total and free fraction (90% bound 10%free)

64
Q

Describe Volproic acid (depakole)
what kind of drug
rapid?
bound?
what metabolism
Dysfunction?

A

Anti epileptic
oral-gi rapid
HIGHLY PRT BOUND
hept met
dysf 6 mos

65
Q

Describe Carbamazepine
what kind of drug
effects?

Gabapentin
what kind of drug
binds to? in what kind of pts?

A

severe adverse effects/last resort/high variable/toxic

Gaba- seizures/pain management
binds to protein (pt w liver disease)

66
Q

Describe Lithium
what kind of drug
rapid/slow?
binding?

A

phsychoactive drug
mood alt
oral rapid
doesnt bind to proteins

67
Q

Describe Tricyclic antidepressents (TAD)

Clozapin

Olanzapine

A

depression/insom/loss of libido

Clo - schizophrenia refractory
TDM checks

Ola- schizophrenia/mania

68
Q

Describe Cyclosporin
What diseases/dependent on/what type of blood

Tacroliaus
Potency

Sirolinus
Anti…

A

Cyclo - cyclic polypept - suppresses graft vs host/whole blood/temp depend

T -100x more potent

S - antifungal kidney transplant

69
Q

Describe Anti neoplastics
what type of dose
drug?
M

A

treat cancers rapid met
delivered dose
METHOTREXATE

70
Q

Describe Bronchodilators

A

Respiratory disorders/asthsma
people who cant use inhalers

THEOPHYLLINE

Clinical Chem Snoopy style (8 decks)

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