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Clinical Chemistry 2 > Theraputic Drug Monitoring > Flashcards

Theraputic Drug Monitoring Flashcards

1
Q

What is an individualized system for drug administration and management?

A

Therapeutic Drug Monitoring (TDM)

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2
Q

What does TDM measure during therapy?

A

Drug concentrations

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3
Q

What are the goals of TDM?

A

Achieve therapeutic range
Determine timing and dosage
Ensure compliance
Monitor drug interactions
Assess preventive effects

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4
Q

When is a steady-state drug level reached?

A

When administration equals metabolism and excretion rates

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5
Q

How is the decline rate of a single drug dose expressed?

A

Half-life

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6
Q

What are the three blood concentration levels in TDM?

A

Subtherapeutic
Therapeutic
Toxic

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7
Q

What is the release of an active ingredient from a dose form called?

A

Liberation

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8
Q

What is drug uptake into systemic circulation called?

A

Absorption

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9
Q

What are the mechanisms of drug absorption?

A

Diffusion
Transport
Pinocytosis

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10
Q

What is first-pass elimination/metabolism?

A

Hepatic metabolism after absorption

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11
Q

How long does drug distribution take?

A

30 minutes to 2 hours

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12
Q

What is the term for the absorbed drug available for distribution?

A

Bioavailability

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13
Q

What is the transformation of a parent drug into water-soluble metabolites?

A

Metabolism

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14
Q

What are the routes of drug elimination?

A

Urine
Feces
Sweat
Saliva

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15
Q

What is the mathematical study of drug disposition over time?

A

Pharmacokinetics

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16
Q

What type of kinetics depends on drug concentration?

A

First-order kinetics

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17
Q

What type of kinetics has a constant elimination rate?

A

Zero-order kinetics

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18
Q

What factor determines zero-order kinetics?

A

Liver metabolic capacity

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19
Q

What specimens are used in TDM?

A

Serum
Plasma
Urine metabolites
Whole blood (cyclosporine, tacrolimus)

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20
Q

Why should serum separator tubes (SSTs) be avoided?

A

They interfere with drug measurement

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21
Q

When should drug levels be measured?

A

After steady state is achieved

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22
Q

When is trough concentration measured?

A

Immediately or 30 minutes before the next dose

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23
Q

What does trough concentration indicate?

A

Lowest drug level in the blood

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24
Q

When is peak concentration measured?

A

One hour after oral dose (except digoxin, measured after 8 hours)

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25
Q

Why is peak concentration measured?

A

To assess drug toxicity

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26
Q

When is peak concentration measured for IV infusion?

A

After infusion completion

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27
Q

What reaction detects acetaminophen in urine?

A

Indophenol blue formation with o-cresol

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28
Q

What reaction detects salicylate in the Trinder assay?

A

Colored complex formation with ferric nitrate

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29
Q

What method uses drug-specific antibodies for detection?

A

Immunoassay

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30
Q

What are two common immunoassay techniques?

A

EMIT (Enzyme-Multiplied Immunoassay Technique)
FPIA (Fluorescence Polarization Immunoassay)

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31
Q

What specimen is preferred for chromatography?

A

Urine

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32
Q

What chromatography techniques are used in TDM?

A

Thin-Layer Chromatography (TLC)
High-Performance Liquid Chromatography (HPLC)
Gas Chromatography-Mass Spectrometry (GC-MS, gold standard)

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33
Q

What substances are detected using chromatography?

A

Tricyclic antidepressants
Volatile drugs

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34
Q

What drug classifications are monitored in TDM?

A

Cardioactive
Antibiotics
Antiepileptics
Psychoactive
Bronchodilators
Immunosuppressives
Antineoplastics
Anti-inflammatory (Analgesics)
Neuroepileptics

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35
Q

What are the four classifications of cardioactive drugs and their mechanisms?

A

Class I: Rapid sodium channel blockers (Quinidine, Procainamide, Lidocaine)
Class II: Beta receptor blockers (Propranolol)
Class III: Potassium channel blockers (Amiodarone)
Class IV: Calcium channel blockers (Verapamil)

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36
Q

What are the uses of Digoxin?

A

Atrial arrhythmia
Congestive Heart Failure (CHF)

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37
Q

What is the mechanism of action of Digoxin?

A

Inhibits Sodium-Potassium Adenosine Triphosphatase (Na-K-ATPase)

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38
Q

When is the peak serum level of Digoxin reached post-oral dose?

A

8 hours

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39
Q

What is the half-life of Digoxin?

A

38 hours

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40
Q

What is the therapeutic range of Digoxin?

A

0.5-2 ng/mL

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41
Q

What are the toxic effects of Digoxin?

A

Nausea
Vomiting
Visual disturbances
Premature ventricular contractions
Atrioventricular (AV) node blockage

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42
Q

What is another name for Lidocaine?

A

Xylocaine

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43
Q

What is another name for Procainamide?

A

Pronestyl

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44
Q

What is another name for Amiodarone?

A

Cordarone

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45
Q

What are the uses of Lidocaine?

A

Ventricular arrhythmia
Local anesthetic

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46
Q

How is Lidocaine administered?

A

Intravenous (IV) infusion

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47
Q

What proteins does Lidocaine bind to?

A

Albumin and Alpha-1 Acid Glycoprotein (AAG)

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48
Q

What is the therapeutic range of Lidocaine?

A

1.5 – 4.0 μg/mL

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49
Q

What is a toxic effect of Lidocaine?

A

Congestive Heart Failure (CHF)
Heart block

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50
Q

What is the primary use of Quinidine?

A

Ventricular arrhythmia

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51
Q

When does Quinidine reach peak serum levels post-oral dose?

A

2-4 hours

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52
Q

What is the therapeutic range of Quinidine?

A

2.3-5.0 μg/mL

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53
Q

What are the toxic effects of Quinidine?

A

Cinchonism
Blood dyscrasias
Hepatitis

54
Q

What is the primary use of Procainamide?

A

Ventricular arrhythmia

55
Q

What is the major metabolite of Procainamide?

A

N-acetyl-procainamide (NAPA)

56
Q

When does Procainamide reach peak serum levels?

A

1 hour post-dose

57
Q

What is the therapeutic range of Procainamide?

A

4-10 μg/mL

58
Q

What are the toxic effects of Procainamide?

A

Reversible lupus-like syndrome
Nephrotic syndrome
Urticaria

59
Q

What is the primary use of Disopyramide?

A

Arrhythmia

60
Q

What additional effect does Disopyramide have?

A

Anticholinergic effects

61
Q

What is the therapeutic range of Disopyramide?

A

3-5 μg/mL

62
Q

What are the toxic effects of Disopyramide?

A

Bradycardia
AV node blockage

63
Q

What are the uses of Propranolol?

A

Angina pectoris
Hypertension
Coronary artery disease
Thyrotoxicosis

64
Q

What is the therapeutic range of Propranolol?

A

50-100 ng/mL

65
Q

What are the toxic effects of Propranolol?

A

Bradycardia
Arterial insufficiency
Platelet disorder
Pharyngitis

66
Q

What are the uses of Amiodarone?

A

Ventricular arrhythmias
Hyperthyroidism

67
Q

What is the therapeutic range of Amiodarone?

A

1.0 – 2.5 μg/mL

68
Q

What are the uses of Verapamil?

A

Angina
Hypertension
Supraventricular dysfunction

69
Q

What is the therapeutic range of Verapamil?

A

80-400 ng/mL

70
Q

What are examples of aminoglycoside antibiotics?

A

Gentamicin
Tobramycin
Amikacin
Kanamycin
Neomycin
Streptomycin

71
Q

How are aminoglycosides administered?

A

Intramuscular (IM) or Intravenous (IV)

72
Q

How are aminoglycosides eliminated?

A

Renal filtration

73
Q

What is a toxic effect of aminoglycosides?

A

Hearing loss

74
Q

What is Vancomycin used to treat?

A

Gram-positive cocci and bacilli infections

75
Q

How is Vancomycin administered?

A

Intravenous (IV) infusion

76
Q

What are the toxic effects of Vancomycin?

A

Red man syndrome
Nephrotoxicity
Ototoxicity

77
Q

What is the mechanism of action of Chloramphenicol?

A

Inhibits protein synthesis in Gram-negative bacteria

78
Q

What are the toxic effects of Chloramphenicol?

A

Blood dyscrasia (Aplastic anemia)
Cytoplasmic vacuolation

80
Q

What neurotransmitters do neuroepileptics block?

A

Dopamine
Serotonin

81
Q

What are examples of neuroepileptics?

A

Phenothiazines (Chlorpromazine)
Butyrophenones (Haloperidol)

82
Q

What condition do neuroepileptics treat?

A

Schizophrenia

83
Q

What toxic effects do neuroepileptics cause?

A

Aplastic anemia
Muscle rigidity

84
Q

What is Lithium used to treat?

A

Bipolar disorder
Chronic cluster headaches

85
Q

What does Lithium inhibit?

A

Iodine uptake

86
Q

What toxic effects does Lithium cause?

A

Seizures
Coma

87
Q

What do Tricyclic Antidepressants (TCAs) treat?

A

Depression
Insomnia

88
Q

What are examples of TCAs?

A

Imipramine
Amitriptyline
Doxepin
Nortriptyline
Trazodone

89
Q

What is the major metabolite of TCAs?

A

Desipramine

90
Q

What is the other name for Fluoxetine?

91
Q

What does Fluoxetine block?

A

Serotonin reuptake

92
Q

What disorder does Fluoxetine treat?

A

Obsessive-compulsive disorder

93
Q

What toxic effect is associated with Fluoxetine?

A

Attempted suicide

94
Q

What condition does Theophylline treat?

A

Asthma
Chronic Obstructive Pulmonary Disease (COPD)

95
Q

What is the function of Theophylline?

A

Relaxes bronchial smooth muscles

96
Q

What birth defect is linked to Theophylline?

A

Teratogenicity

97
Q

What does Cyclosporine block?

A

Interleukin-2 production

98
Q

What does Cyclosporine have a high affinity for?

A

Red blood cells

98
Q

What conditions does Cyclosporine prevent?

A

Allogenic organ transplant rejection
Graft-versus-host disease (GVHD)

99
Q

What specimen is used for Cyclosporine testing?

A

Whole blood

100
Q

What is the other name for Tacrolimus?

101
Q

How much stronger is Tacrolimus than Cyclosporine?

102
Q

What class of drug is Tacrolimus?

A

Macrolide antibiotic

103
Q

What specimen is used for Tacrolimus testing?

A

Whole blood

104
Q

What toxic effects does Tacrolimus cause?

A

Thrombus formation
Nephrotoxicity
Neurotoxicity

105
Q

What is the other name for Rapamycin?

106
Q

What side effects does Sirolimus cause?

A

Lipid abnormalities
Thrombocytopenia

107
Q

What condition is Mycophenolate Mofetil used for?

A

Renal allograft rejection

108
Q

What does Leflunomide inhibit?

A

Lymphocyte proliferation

109
Q

What condition does Leflunomide treat?

A

Rheumatoid arthritis

110
Q

What condition is Methotrexate used for?

A

Cancer treatment
Immunosuppression

111
Q

What does Methotrexate inhibit?

A

DNA synthesis (Dihydrofolate reductase)

112
Q

What antidote is used for Methotrexate toxicity?

A

Leucovorin

112
Q

What toxic effect is associated with Methotrexate?

A

Leukopenia

113
Q

What condition does Busulfan treat?

A

Leukemia
Lymphoma before bone marrow transplant

114
Q

What is a toxic effect of Busulfan?

A

Hepatic occlusive disease

115
Q

What is the other name for Salicylate?

116
Q

What does Aspirin directly stimulate?

A

The respiratory system

117
Q

What enzyme does Aspirin inhibit?

A

Cyclooxygenase

118
Q

What fatal condition does Aspirin cause in children?

A

Reye’s Syndrome

119
Q

What lab method detects Aspirin?

A

Trinder’s assay

120
Q

What is the other name for Acetaminophen?

121
Q

What does Acetaminophen inhibit?

A

Prostaglandin metabolism

122
Q

What toxic effects does Acetaminophen overdose cause?

A

Hepatotoxicity
Cyanosis

123
Q

What advantage does Ibuprofen have over Salicylates?

A

Lower toxicity

124
Q

What side effects does Ibuprofen cause?

A

Vomiting
Abdominal pain
Nausea

Clinical Chemistry 2 (6 decks)

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