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PH 166 > Therapeutic Drug Monitoring > Flashcards

Therapeutic Drug Monitoring Flashcards

1
Q 
Which is true?
A.an equilibrium exists between free and protein-bound drug
B.acidic drugs are bound to globulin
C.basic drugs are bound to albumin
D.NOTA
A

A

Baliktad ang B at C

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2
Q

Which is false?
A.k-value is negative because it is decreasing
B.Indepedent of clearance mechanism, decreases in serum concentration of drugs often occur as zero-order process

A

B

first order dapat

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3
Q

Which among these chromatographic methods needs large sample volume but permits separation of parent drug from metabolites & co-administered drugs?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry

A

C

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4
Q

Which among these chromatographic methods needs allows direct analysis of biological specimen with minimal sample preparation?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry

A

D

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5
Q

Which among these chromatographic methods is adapted to simultaneous quantification of drugs and metabolites?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry

A

B

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6
Q 
have parasympathetic-like effects on AV node cells; serum conc 8-10 hrs after  oral dose correlates with tissue conc
A.phenytoin
B.anti-epileptic drug
C.aminoglycosides
D.cardiotropics
A

D - used to treat arrhythmia, congestive heart failure

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7
Q

[Cardiotropics]
identify the ff:
A.general therapeutic range
B.general toxic level

A

A.0.5-2 ng/mL

B. >2 ng/mL

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8
Q 
[Cardiotropics]
identify the ff:
A.half-life range. 
B.is this prolonged with dec renal fxn?
C.is it more bioavailable at elixir? or at liquid-filled capsule?
A

A.35-40 hours
B.yes
C.liquid filled capsule (90-100%). elixir or tablet is 60-85%

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9
Q

false about aminoglycosides
A.nephrotoxic effects are irreversible & ototoxic effects are reversible
B.toxic conc: above therapeutic range
C.measured via chromatography and immunoassay

A

A - baliktad kasi

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10
Q

false about anti-epileptic drugs
A.in a normal physiologic state, total drug conc is suffcient
B.most preferred specimen is whole blood
C.free drug meas may only be necessary in alteration of patient plasma protein
D.effective conc: acceptable/no side effects

A

B - serum dapat

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11
Q 
Which is true?
A.aminoglycosides are antibiotics
B.phenobarbitals are cardiotropics
C.phenytoin is an amino acid
D.NOTA
A

A!

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12
Q 
Phenobarbital: which is false?
A.absorption of oral dose is slow but complete
B.only trough levels are evaluated
C.50% protein-bound
D.fast-acting barbituate for seizures
A

D - slow acting! hence: A is true

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13
Q

False about phenytoin?
A.GIT absorption is sometimes incomplete
B.primidone is an inactive form that rapidly converts to Pb
C.major toxicity: seizure initiation
D.binds to protein a lot more than phenobarbital

A

B - is true for phenobarbital :)

note: 87-97% ang protein binding ng phenytoin. 50% @ phenobarbital

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14
Q

A.T/F all forms of phenytoin are detected in most immunoassays
B.Valproic acid is used for monotherapy of ___
C.GIT absorption of valproic acid: describe

A

A.F - Fosphenytoin isn’t
B.petit mal & absence seizures
C.rapid and complete

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15
Q

False about valproic acid
A.less protein bound than phenobarbital
B.nausea,lethargy,weight gain: common adverse reactions
C.hepatic dysfuction may occur even @ serum therapeutic conc

A

A - more bound!

note: 93% ang protein binding ng valproic acid. 50% @ phenobarbital

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16
Q

A.toxic level of valproic acid, please identify
B.most serious idiosyncratic drug effect of carbamazepine
C.when carbamazepine plasma conc > 15 ug/mL, what kind of anemia could be present?

A

A. > 120 ug/mL
B.leukopenia
C.aplastic anemia

17
Q 
False about tricyclic antidepressants
A.orally admin
B.varying degree of absorption
C.85-95% protein-bound
D.therapeutic effects are seen in 1-3 days
A

D – therapeutic effects are not seen for 2-4 weeks after therapy initiation

18
Q

A.Why should tricyclic antidepressants @ plasma be evaluated when steady state has been achieved?
B.most preferable method for TCA screening
C.T/F TCA is eliminated by hepatic metabolism

A

A.high variability in half-life & absorption
B.immunoassays using polyclonal antibodies
C.T

19
Q

[cyclosporine]
A.primary clinical use
B.specimen of choice for

A

A. suppression of host vs graft reaction of heterotopic transplanted organs
B. whole blood

20
Q

A.How can overuse of cyclosporine lead to hypertension?

B.T/F For cyclosporine,relationship between oral dose & blood conc is poor.

A

A. renal tubular & glomerular dysfunction

B. T

21
Q 
[cyclosporine]
used to measure its drug conc
A.immunoassay
B.chromatographic method
C.electrophoresis
A

A!

B – separation, quantification of parent drug fr metabolites

22
Q

antineoplastic drugs]
Which is false?
A.admin route for most is intravenous
B.therapeutic range conc: all w/o toxic effects
C.correlation between plasma conc and therapeutic benefit are hard to establish

A

B

23
Q

[methrotrexate]
A. this drug + ____ = antineoplastic power duo
B. What does this do @ DNA in cells?
C. T/F Efficacy dep on controlled period of inhibition

A

A.leucovorin rescue
B.inhibit DNA synthesis
C. T

24
Q

Which is/are false?
A.TDM must be done for most drugs.
B.Serum: most commonly used specimen for TDM
C.Binding of drug leads to altered cell functions
D.Drugs never compete for binding sites

A 
A = limited number of drugs only
D = nope, they do esp similar structures!
25
Q

accdg to Tietz, what are the 3 purposes of TDM

A

assess therapeutic compliance
assess efficacy
elucidate cause of drug-induced toxicity

26
Q

differentiate pharmacodynamics from pharmacokinetics

A

pharmacodynamics: relate drug conc at the sie of action to magnitude of effect
pharmacokinetics: relates dose, dosing interval and admin route to drug conc @ blood

27
Q

A.What is kinetic homogeneity

B.Why is important?

A

A.assumes that changes in drug conc @ blood vs time are proportional to changes in local conc @ tissue
B.basis on which all therapeutic conc & toxic conc are established

28
Q

A.What is steady state

B.T/F The larger the difference bet min effect.con & min. toxic conc, the more TDM is needed

A

A.point at which body conc of drug is in equil with dose rate admin & rate of elim
B.F – smaller dapat

29
Q

A.What is bioavailability?

B.What is first-pass effect?

A

A.fraction of drug absorbed @ systemic circ
B.Drugs orally admin: first exposed @ liver, metabolized before reaching the rest of the body… while IV drugs  directly systemic circ

30
Q

Which is false?
A.absorption rate constant of a drug is usually less than elimination rate constant
B.displacement of a drug from plasma protein-binding sites never causes clinical toxicity
C.Liver is the principal organ for drug metab

A

B – if free drug conc is increased, clinical toxicity is possible

31
Q

enumerate 4 most impt determinants of drug dist

A
  1. binding of drug to circulating blood comp
  2. binding to fixed receptors
  3. passing of drug through membrane barriers
  4. Does it dissolve in lipids?
32
Q

enumerate disease states that alter free drug conc

A
  1. increase in non-protein nitrogen compounds in uremia
  2. acid-base and electrolyte imbalances
  3. decrease in albumin
33
Q

Why do….
A.hydrophobic drugs have large volume of distribution index?
B.ionized substances/plasma-bound ones have small volume of dist index?

A

A.partitioning of hydrophilic compartments

B.sequestration @ vasculature

34
Q 
volume of dist index =
A.	(IV injected dose) + (plasma conc)
B.	(IV injected dose) - (plasma conc)
C.	(IV injected dose) * (plasma conc)
D.	(IV injected dose) / (plasma conc)
A

D

35
Q

A.What do phase I / phase II rxns in the liver do?

B.4 ways on how drugs are eliminated fr body

A

A.convert the lipophilic drugs to more water-soluble forms

B.biliary, intestinal, pulmonary, renal

PH 166 (28 decks)

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