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CLINICAL CHEMISTRY > THERAPEUTIC DRUG MONITORING > Flashcards

THERAPEUTIC DRUG MONITORING Flashcards

1
Q

Bioavailability of intravenous administration

A

100%

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2
Q

Bioavailability of oral administration

A

70%

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3
Q

Weak acids are absorbed in the…

A

Stomach

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4
Q

Weak bases are absorbed in the…

A

Intestine

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5
Q

Is the release of the drug

A

Liberation

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6
Q

The transport of drug from the site of administration to the blood

A

Absorption

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7
Q

Refers to the delivery of the drug to the tissue

A

Distribution

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8
Q

The process of chemical modification of the drug by the cells

A

Metabolism

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9
Q

The process by which the drug and its metabolites are excreted from the body

A

Excretion

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10
Q

Most drugs are absorbed by passive diffusion. At what state should the drug be in?

A. Hydrophilic
B. Hydrophobic
C. Ionized
D. Anxious

A

B. Hydrophobic

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11
Q

4 factors affecting absorption

A

pH
Presence of food and other drugs
Changes in intestinal movement
Inflammation

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12
Q

The location where the drugs are effective are in the…

A. Body tissues
B. Blood
C. Intestine
D. Liver

A

A. Body tissues

Drugs are effective in the body tissues, not generally in the blood

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13
Q

Drugs have higher concentration in _______ than in ________

A. Blood, tissues
B. Tissues, blood

A

B. Tissues, blood

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14
Q

Refers to the relationship between tissue and blood levels

A

Distribution space

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15
Q

True or false

A large distribution space indicates that much of the drug moves into the tissues than stays in the circulation

A

Truly

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16
Q

Where does the conversion of a parent drug to its metabolites happen?

A

Liver (extramitochondrial microsomal system of the hepatocytes-cytochrome P450 enzymes)

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17
Q

The fraction of the dose that reaches the blood

A

Bioavailable fraction

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18
Q

Represents the dilution of the drug after it has been distributed in the body

A

Vd of a drug

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19
Q

It is used to estimate the peak drug blood level expected after a loading dose is given. It is the principal determinant of dose

A

Vd of a drug

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20
Q

Metabolism wherein the drugs that are transported to the liver lost a fraction of its bioavailability before the drug reaches the general circulation

A

First-pass hepatic metabolism

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21
Q

Represents the linear relationship between the amount of drug eliminated per hour and the blood level of a drug

A

First-order elimination

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22
Q

The time to reach the steady-state or average concentration

A

Half-life

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23
Q

The biochemical pathway responsible for the greatest portion of drug metabolism

A

Mixed function oxidase (MFO) system

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24
Q

The relationship between the drug concentration at the target site and response of the tissues

A

Pharmacodynamics

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25
Q

Refers to the study of genes that affect the performance of a drug in an individual

A

Pharmacogenomics

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26
Q

The mathematical expression of the relationship between drug dose and drug blood level

A

Pharmacokinetics

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27
Q

The ratio between the minimum toxic and the maximum therapeutic serum concentration

A

Therapeutic index

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28
Q

The difference between highest and lowest effective dosages

A

Therapeutic range

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29
Q

The lowest concentration of a drug obtained in the dosing interval

A

Trough concentration

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30
Q

Enumerate the cardioactive drugs

A

“Ventricles Produce Pulses Like A Queen Drunk Dances”

Verapamil
Procainamide (Pronestyl)
Propanolol
Lidocaine (Xylocaine)
Amiodarone (Cordarone)
Quinidine
Digoxin
Disopyramide

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31
Q

Enumerate the antibiotics

A

“Amystery Van Captures”

Aminoglycosides (gentamycin, tobramycin, amikacin, kanamycin, neomycin, streptomycin)
Vancomycin
Chloramphenicol

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32
Q

Enumerate the antiepileptic drugs

A

“PP Very Choosy, Eats Gun To Look Fierce”

Phenobarbital
Phenytoin (Dilatin)
Valproic acid (Depakene)
Carbamezipine (Tegretol)
Ethosuximide (Zarontin)
Gabapentin (Neurontin)
Topiramate
Lamotrigine (Lamictal)
Felbamate

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33
Q

Enumerate the psychoactive drugs

A

“Lit Trees = Fire”

Lithium
Tricyclic antidepressants (TCA)
Fluoxetine

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34
Q

Enumerate the bronchodilator drugs

A

Theophylline

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35
Q

Enumerate the immunosuppressive drugs

A

Cyclosporine
Tacrolimus
Rapamycin
Mycophenolate mofetil
Leflunomide

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36
Q

Enumerate the antineoplastic drugs

A

“BM”

Busulfan
Methotrexate

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37
Q

Enumerate the anti-inflammatory/analgesics

A

“ISA”

Ibuprofen
Salicylates/aspirin (Acetylsalicylic acid)
Acetaminophen (Tylenol)

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38
Q

It blocks the action of dopamine and serotonin in the limbic system; used in the treatment of schizophrenia

A

Neuroleptics (antipsychotic major tranquilizers)

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39
Q

Classification of cardioactive drugs:

Rapid sodium channel blockers

A

Class I

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40
Q

Classification of cardioactive drugs:

Beta receptor blockers

A

Class II

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41
Q

Classification of cardioactive drugs:

K+ channel blockers

A

Class III

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42
Q

Classification of cardioactive drugs:

Calcium channel blockers

A

Class IV

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43
Q

Enumerate the class I cardioactive drugs

A

Quinidine
Procainamide
Lidocaine

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44
Q

Enumerate the class II cardioactive drugs

A

Propanolol

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45
Q

Enumerate the class III cardioactive drugs

A

Amiodarone

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46
Q

Enumerate the class IV cardioactive drugs

A

Verapamil

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47
Q

Treatment for atrial arrhythmias and congestive heart failure

A

Digoxin

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48
Q

Its therapeutic actions and toxicities can be influenced by serum electrolytes: it inhibits membrane Na-K-ATPase, thus it decreases K and Mg, and increases Ca (cardiac contractilty-inotropic effect)

A

Digoxin

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49
Q

Hyperthyroid individuals are resistant to this drug

A

Digoxin

50
Q

Used to correct ventricular arrhythmia and for treatment of AMI
It can be used as a local anaesthetic

A

Lidocaine

51
Q

This drug isn’t administered orally due to almost complete hepatic removal of the absorbed drug

A

Lidocaine

52
Q

Naturally occurring drug for the treatment of arrhythmia

A

Quinidine

53
Q

It is used to treat ventricular arrythmia
Its toxic effects includes reversible lupus-like syndrome (ANA), nephrotic syndrome, and urticaria

A

Procainamide

54
Q

Used to treat cardiac arrhythmias; used as a substitute for quinidine

A

Disopyramide

55
Q

This drug has anticholinergic effects which include dry mouth and constipation

A

Disopyramide

56
Q

Used in the treatment of thyrotoxicosis; suppresses the conversion of T3 to T4

A

Propanolol

57
Q

Blocks potassium channels in the cardiac muscle; use for treatment of ventricular arrhythmias

A

Amiodarone

58
Q

It is an iodine-containing drug which can cause hyperthyroidism or hypothyroidism

A

Amiodarone

59
Q

Treatment of angina, hypertension, and supraventricular arrhythmias

A

Verapamil

60
Q

Used for treatment of gram-negative bacterial infections

A

Aminoglycosides

61
Q

Toxic level:
It may cause damage to the 8th cranial nerve at toxic levels (hearing loss)

A

Aminoglycosides

62
Q

An antibiotic that requires trough and peak measurements

A

Aminoglycosides

63
Q

A glycopeptide effective against gram-positive cocci and bacilli

A

Vancomycin

64
Q

Its toxic side effects occur in the therapeutic range; causes red-man syndrome, nephrotoxicity and ototoxicity

A

Vancomycin

65
Q

This drug distributes to all tissues, and concentrates in the CSF

A

Chloramphenicol

66
Q

A long acting barbiturate that controls grand mal tonic-clonic seizure and focal epileptic; not used for petit mal

A

Phenobarbital

67
Q

Used for treating withdrawal symptoms in infants whose mothers are addicted to opiate or barbiturate

A

Phenobarbital

68
Q

Used to treat cases of congenital hyperbilirubinemia; enhances bilirubin metabolism

A

Phenobarbital

69
Q

Controls seizures (tonic-clonic, simple partial seizures); a short term prophylactic agent in brain injury
It is not used for petit mal or atomic seizures

A

Phenytoin

70
Q

Used for treatment of petit mal, atomic seizure, and grand mal

A

Valproic acid

71
Q

This drug is highly protein bound (93%)

A

Valproic acid

72
Q

A tricyclic compound related to imipramine. It is effective for grand mal seizures and treating seizures accompanied by pain; it has antineuralgic action

A

Carbamazepine

73
Q

Can cause idiosyncratic effects: rashes, leukopenia, nausea, vertigo, febrile reactions

A

Carbamazepine

74
Q

DOC for controlling petit mal

A

Ethosuximide

75
Q

Chemically similar to neurotransmitter gamma aminobutyric acid
It is used for partial seizures; for adjunctive therapy

A

Gabapentrine

76
Q

Drugs used for adjunctive therapy for partial seizures

A

Gabapentin
Topiramate
Lamotrigine

77
Q

Treatment for manic-depressive illness (bipolar disorders) and is the DOC for the prevention of chronic cluster headache

A

Lithium

78
Q

Inhibits thyroid hormone synthesis and release by the inhibition of iodine uptake

A

Lithium

79
Q

Inhibits the effect of ADH on the kidney

A

Lithium
Demeclocycline

80
Q

Treatment for depression, insomnia, extreme apathy and loss of libido

A

Tricyclic antidepressants (TCAs)

81
Q

Major metabolite of TCA

A

Desipramine

82
Q

Blocks the reuptake of serotonin in central serotonergic pathways

A

Fluoxetine

83
Q

Treatment for OCD

A

Fluoxetine

84
Q

It belongs to the methylated xanthine class
Its action is specific to the relaxation of bronchial smooth muscle

A

Theophylline

85
Q

It is used in the treatment of asthma and chronic obstructive pulmonary disease

A

Theophylline

86
Q

Drug for primary apnea prematurity (absence of respiratory effort in newborn infants)

A

Theophylline

87
Q

This drug crosses the placenta and may be teratogenic in pregnant females

A

Theophylline

88
Q

Used to prevent rejection of allogenic organ transplants by inhibiting the cellular immune response by blocking the production of IL-2

A

Cyclosporine

89
Q

Used for suppressing acute graft-versus-host disease (GVHD)

A

Cyclosporine

90
Q

A macrolide lactone antibiotic that is 100x more powerful than cyclosporine

A

Tacrolimus

91
Q

This drug is elevated in the presence of cholestasis

A

Tacrolimus

92
Q

Similar to tacrolimus; major side effects are lipid abnormalities and thrombocytopenia

A

Rapamycin

93
Q

Decreases renal allograft rejection

A

Mycophenolate mofetil

94
Q

Inhibits lymphocyte proliferation; for treatment of RA

A

Leflunomide

95
Q

It inhibits DNA synthesis in all cells by blocking dihydrofolate reductase

A

Methotrexate

96
Q

Drug used to reverse the action of methotrexate

A

Leucovorin

97
Q

An alkalyting agent used to treat leukemias and lymphomas prior to bone marrow transplantation

A

Busulfan

98
Q

It is a commonly used analgesic, antipyretic and anti-inflammatory drug that directly stimulates the respiratory system and an inhibitor of the kreb’s cycle. It also has an anticoagulant property (antiplatelet activity) by inhibiting the action of cyclooxygenase

A

Salicylates

99
Q

It decreases thromboxane and prostaglandin formation through inhibition of cyclooxygenase

A

Salicylates

100
Q

Is a common cause of fatal drug poisoning in children characterized by…. xonrinue okes

A

Acute aspirin intoxication

101
Q

An inhibitor of prostaglandin metabolism. It is commonly used as analgesic and antipyretic drug

A

Acetaminophen

102
Q

Overdosage of this drug leads to hepatoxicity

A

Acetaminophen

103
Q

toxic effects: mixed acid-base disturbance (metabolic acidoses and respiratory alkalosis), hypoglycemia, and Reye’s syndrome

A

Salicylates

104
Q

Toxic effect: xyanosis due to methemoglobinemia, CNS depression and seizure

A

Acetaminophen

105
Q

It has analgesic and anti-inflammatory actions with a lower risk of toxicities than salicylates and acetaminophen

A

Ibuprofen

106
Q

Toxic effects: nausea, vomiting, blurred vision, abdominal pain, edema

A

Ibuprofen

107
Q

Used in the treatment of acute schizonphrenia

A

Antipsychotic major tranquilizers

108
Q

Specimen of choice for TDM

A

Serum or plasma

109
Q

Whole blood EDTA sample is required for which drugs?

A

Cyclosporine and tacrolimus

110
Q

When are trough concentrations drawn?

A

Immediately (or 30 minutes) before the next dose

111
Q

Relationship between trough level and drug clearance rate

A

Inversely proportional

112
Q

When are peak concentration drawn for orally administered drugs?

A

One hour after an orally administered dose (except digoxin)

113
Q

When are peak concentrations drawn for IV infused drugs?

A

Peak levels are determined after the infusion is completed

114
Q

How are drugs identified when using immunoassay method?

A

The drug must bind to antibody before it is identified

115
Q

Method in which drugs are identified according to how far they have travelled or separated and to how they appear with each of the satains

A

Thin layer chromatography

116
Q

Acidic drugs are extracted at what pH?

A

4.5

117
Q

Alkaline drugs are extracted at what pH?

A

9.0

118
Q

Method ideal for the separation of tricyclic antidepressants and its metabolites

A

HPLC

119
Q

Gold standard for TDM

A

GC-MS

120
Q

True or false

Toxicity is avoided as long as the dose of drug is within accepted therapeutic range

A

FALSE

Altered pharmacokinetics may result in toxicity even when the dose of drug is whin accepted therapeutic range. This is caused by the presence of unmeasured metabolites that are physiologically active and the presence of a higher than expected concentration of free drug

CLINICAL CHEMISTRY (4 decks)

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