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MT2 > TOXICOLOGY PT 2 > Flashcards

TOXICOLOGY PT 2 Flashcards

1
Q

Blood specimens for drug monitoring can be taken at two different times: during the drugs highest therapeutic concentration (________), or its lowest (_______). Occasionally called _______, trough levels show sufficient therapeutic levels; whereas peak levels show toxicity.

A

“peak‟ level ; „trough‟ level ; residual levels

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2
Q

Sample Timing for some important drugs..

Since ______ has a long half-life a single daily dose may be employed and so the timing of concentration monitoring is not critical.

A

phenytoin

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3
Q

_________: Its half life may be as long as 48 hrs. following a single dose. A trough concentration taken just after a dose together with a peak level 3 hours later is ideal.

A

Carbamazepine

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4
Q

_______: The measurement must be made at least 6 hours after a dose to avoid inappropriate high levels.

A

Digoxin

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5
Q

_______: This drug has a narrow therapeutic index and timing of sampling is not critical if the patient is receiving one of the slow release formulations, wherein through levels should be taken.

A

Theophylline

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6
Q

________: A 12 hrs. sample gives the most precise guide to dosage adjustment

A

Lithium

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7
Q

_______: Pre dose peak; 0.5 hrs. after i.v and 1hr. after i.m, administration.

A

Gentamicin

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8
Q

Samples should be _______ and ________ as soon as possible.

A

collected and centrifuged

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9
Q

Avoid ________ tubes because these may lower drugs concentrations due to the adsorption of drug into the matrix

A

serum-separator

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10
Q

Storage of samples: _______ tubes are acceptable for most assays

A

Plastic cryovial type

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11
Q

For CSA: Whole blood to be collected in an ____ tube.

A

EDTA

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12
Q

________ may be affected by temperature and all variables should be standardized.

A

Analytical methods

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13
Q

Drug criteria to be suitable for therapeutic drug monitoring:

A

 Narrow target range
 Significant pharmacokinetic variability
 A reasonable relationship between plasma concentrations and clinical effects
 Established target concentration range
 Availability of cost-effective drug assay

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14
Q

Antiepileptic Drugs (AEDs) include

A

valproic acid,
phenytoin,
carbamazepine,
phenobarbital

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15
Q

Newer AEDs (which includes __________) are not widely monitored

A

lamotrigine,
gabapentin,
topiramate,
levetiracetam,
oxcarbazepine

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16
Q

There is a defined relationship between _______ and ______.

A

blood concentration and seizure control

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17
Q

_____ individual differences between dose and blood level

A

Large

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18
Q

______ metabolized, patients on multiple drugs

A

CYP450

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19
Q

Both under-dosing and over-dosing can result in ______

A

seizures

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20
Q

Most antibiotics (including…) have a wide therapeutic index and do not require monitoring

A

B-lactams,
macrolides,
quinolones

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21
Q

________ (gentamicin, amikacin, streptomycin and tobramycin) are bactericidal, it binds to the bacterial ribosome

A

Aminoglycosides

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22
Q

Aminoglycosides is used for treatment of __________, may cause ________

A

gram (-) bacterial infection ; hearing loss

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23
Q

_______ has an inhibitory effect on the synthesis of the bacterial cell wall and cytoplasmic membrane. It has a narrow therapeutic index and toxicity may be severe or irreversible (nephrotoxic)

A

Vancomycin

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24
Q

Vancomycin is used for treatment of __________, administered IV

  • Only the trough levels are monitored to ensure drug is within therapeutic range
A

gram (+) bacterial infection

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25
Q

Acts on gram (-) bacteria by inhibition of protein synthesis, unlike aminoglycosides it can be absorbed in the GIT

A

Chloramphenicol

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26
Q

Chloramphenicol toxic effect is

A

blood dyscrasia

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27
Q

Techniques for measurement of TDM Chromatography

A

HPLC
GC/MS

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28
Q

The separation of a substance depends on the relative distribution of mixture constituents between two phases, a mobile phase (carrying the mixture) and a stationary phase.

A

HPLC: High Pressure Liquid Chromatography

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29
Q
  • a separation method using very high temperatures to cause sample vaporization. In __________ the vaporized fractions are passed through an electrical field.
  • The molecules can be separated on the basis of molecular weight. The pattern of separation is unique to each drug and therefore establishes a “________” for identification.
  • the gold standard method for the identification of drugs of abuse.
A

GC/MS ; Mass Spectrophotometry ; fingerprint

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30
Q

uses a non-radioactive enzyme label. The assays are performed in a single step, i.e. only one antibody is used in the procedure

A

Enzyme Immunoassay

31
Q

uses radioactivity to detect the presence of the analyte. the sample is incubated with an antibody and a radio-labeled drug. the amount of radioactivity measures is compared to the radioactivity present in known standards which are included in each run. Results are quantitative.

A

RIA

32
Q

uses the creation of light scattering particles to measure drug levels.

A

PETINIA - Particle Enhanced Turbidimetric Inhibition Immunoassay

33
Q

based on competition for the target analyte antibody binding sites. Provides rapid analyses of blood and urine samples, uses an antibody specifically reactive with a particular drug.

A

EMIT - Enzyme Multiplied Immunoassay Technique

34
Q

Method uses a fluorescent molecule as the label instead of an enzyme, making it more sensitive.

A

FPIA - Fluorescence Polarization Immunoassay

35
Q

a chemical reaction that emits energy in the form of light. When used in combination with immunoassay technology, the light produced by the reaction indicates the amount of analyte in a sample.

A

Chemiluminescence

36
Q

COLORIMETRY..

acetaminophen in urine is detected by boiling to form ______ which reacts with o-cresol to form _______

A

p-amphenol ; indophenol blue

37
Q

COLORIMETRY…

Tinder assay for salicylate using ferric nitrate forming a _____

A

(+) colored complex

38
Q

study of substances toxic to the body

A

toxicology

39
Q

absorption of toxins from the GIT is by ______

A

passive diffusion

40
Q

common substances causing toxicity

A

Alcohol
Carbon Monoxide
Cyanide

41
Q

Alcohol includes

A

ethyl, methanol

42
Q

most common abused rug, it is converted to acetic acid - resulting in acidosis, it causes diuresis by inhibiting ADH

A

Alcohol

43
Q

specimen in Alcohol

A

serum, plasma, whole blood (use of alcohol-free cleanser)

44
Q

In alcohol the ff are elevated

A

GGT,
AST,
HDL,
MCV

45
Q

Alcohol fetal dose

A

300 to 400 ml of pure alcohol consumed in less than an hour.

46
Q

Colorless, odorless, tasteless gas produced by incomplete combustion of carbon-containing substances like gasoline.

A

Carbon monoxide

47
Q

Carbon monoxide method

A

co-oximetry (carboxyhemoglobin)

48
Q

a component of insecticides and rodenticides - common suicide agent, it expresses its toxicity by binding to iron resulting to hypoxia

A

Cyanide

49
Q

Metals

A

Arsenic
Cadmium
Lead
Mercury

50
Q

component of ant poison, rodenticides, .s and metal alloys. Common homicide or suicide agent. It expresses it toxicity by binding to the thiol groups in proteins

A

arsenic

51
Q

a significant environmental pollutant - pigment in paints and plastics poisoning can result from ingestion of acidic foods stored or prepared in metal containers containing _____

A

cadmium

52
Q

an enzyme inhibitor, it is a component of household paints. Exposure can result to encephalopathy, birth defects and compromised immunity. Low level exposure may cause behavioral changes such as hyperactivity and attention deficit disorder, low IQ.

A

Lead

53
Q

LEAD..

Blocks ______ resulting to anemia

A

delta aminolevulinic acid synthetase

54
Q

toxic blood level in lead

A

> 70 ug/dL

55
Q

also an enzyme inhibitor which may result to loss of glomerular function. If inhaled or absorbed through the skin it can accumulate in the CNS.

A

Mercury

56
Q

DRUGS OF ABUSE/SUBSTANCES OF ABUSE

A

Amphetamines
Annabolic Steroids
Cannabinoids
Cocaine
Opiates
Sedative Hypnotics
Lysergic Acid Diethylamide - hallucinogen
Acetaminophen
Salicylate

57
Q

therapeutically used for treating narcolepsy and attention deficit disorder. Increases mental alertness and physical capacity and has anorectic property.

A

Amphetamines

58
Q

amphetam-like compounds

A

Ephedrine, Pseudoephedrine, Phenypropanolamine

59
Q

recreational abused drug

A

Methylenedioxymethamphetamine (ecstasy)

60
Q

chemically associated with testosterone. it improves athletic performance by increasing muscle mass.

A

Annabolic steroids

61
Q

most potent psychoactive substance of cannabis satibus. It induces a sense of well being and euphoria.

A

Cannabinoids (Tetrahydrocannabinol)

62
Q

derived from coca plant erythroxylon and used as additive to some foods, and as local anesthesia. It is a potent CNC stimulant that elicits a sense of excitement and euphoria. It causes sudden death due to direct toxicity on myocardium.

A

Cocaine

63
Q

used as analgesic, sedative and anesthesia, derived from opium poppy

A

opiates

64
Q

common tested opiates

A

morphine and codeine

65
Q

a derivative of heroin (highly addictive) a strong analgesic

A

morphine

66
Q

an antitussive opiate

A

codeine

67
Q

CNS depressants, toxicity is initiated by ethanol

A

Sedative Hypnotics

68
Q

secobarbital, pentobarbital, phenobarbital

A

Barbiturates

69
Q

diazepam (valium), lorazepam (ativan), chlordiazepoxide (librium)

A

Benzodiazepines

70
Q

hallucinogen

A

Lysergic Acid Diethylamide

71
Q

overdose of this drug can cause hepatocellular injury

A

Acetaminophen ; analgesic, anti-pyretic

72
Q

anti-inflammatory, analgesic, anti-pyretic

A

salicylate

73
Q

Salicylate..

_______ is metabolized to salicylic acid

A

aspirin (acetylsalicylic acid)

74
Q

inhibit enzymes in the krebs cycle causing pyruvate to be converted to lactic acid, lipid metabolism is increased and amino acid is decreased. Accumulation of organic acids causes metabolic acidosis

A

Salicylate

MT2 (45 decks)

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