flashcard 16
(81 cards)
What is analytical biochemistry?
Analytical biochemistry is the application of chemical techniques to separate, identify, and quantify the biochemical components in biological samples for purposes such as screening, diagnosis, prognosis, and monitoring.
What is clinical biochemistry?
Clinical biochemistry is an applied form of biochemistry focused on analysing bodily fluids (e.g., blood, urine, CSF) for diagnostic and therapeutic purposes, often organized into sub-specialties like routine chemistry, special chemistry, endocrinology, toxicology, therapeutic drug monitoring, urinalysis, and faecal analysis.
Name three sub-specialties of clinical biochemistry.
1) Clinical endocrinology (hormone analysis), 2) Toxicology (drugs of abuse and toxic chemicals), 3) Therapeutic Drug Monitoring (measuring medication levels to optimize dosage).
What tests are included in a basic metabolic panel?
Electrolytes (sodium, potassium, chloride, bicarbonate), blood urea nitrogen (BUN), creatinine, and glucose.
What additional tests are found in a comprehensive panel beyond the basic panel?
Calcium, liver function enzymes (ALP, ALT, AST), bilirubin, albumin, total protein, and any other tests tailored to specific clinical questions (e.g., thyroid, cardiac markers).
List the analytes measured in liver function tests (LFTs).
Total protein, albumin, globulins, A/G ratio, protein electrophoresis, urine protein, direct and indirect bilirubin (total bilirubin), AST, ALT, GGT, and ALP.
Why is protein electrophoresis performed as part of LFTs?
To separate serum proteins into fractions (albumin, α-, β-, γ-globulins), detect abnormal patterns (e.g., monoclonal gammopathy), and provide more detailed information than total protein alone.
Which enzymes are most sensitive indicators of hepatocellular injury?
ALT is most liver-specific; AST also rises in hepatocellular injury but can be elevated by muscle damage. GGT and ALP help distinguish hepatocellular injury from cholestasis.
Why is GGT measured alongside ALP?
Because GGT is specific to hepatobiliary injury, whereas ALP can also originate from bone or placenta; concurrent elevation of GGT and ALP confirms a hepatic source.
Name four common cardiac markers.
H-FABP, Troponin (I or T), Myoglobin, CK-MB, and B-type natriuretic peptide (BNP).
What is near patient testing (point-of-care testing)?
Testing performed at or near the site of patient care (e.g., bedside), offering faster results and requiring smaller samples but potentially less accuracy compared to central laboratory testing.
Give two examples of near patient tests.
Blood glucose meters and urine dipstick tests.
What are the advantages of near patient testing?
Faster turnaround time, smaller sample volumes, immediate clinical decision-making, and convenience for acute or ambulatory settings.
What are the disadvantages of near patient testing?
Potentially lower accuracy and precision, greater variability between operators, and limited test menus compared to centralized labs.
Which types of drugs commonly require therapeutic drug monitoring (TDM)?
Antibiotics, antiepileptics, cardiac drugs (e.g., digoxin), immunosuppressants (e.g., cyclosporine), antipsychotics, and anticoagulants (e.g., warfarin).
What factors affect drug availability in the body?
Absorption, distribution (protein binding, tissue sequestration), metabolism (phase I and phase II pathways), excretion (renal, biliary), dosing regimen, compliance, physiological differences (body mass, age), and drug interactions.
What is the difference between maximum tolerated dose (MTD) and minimum effective dose (MED)?
MTD is the highest dose that can be administered without unacceptable toxicity; MED is the lowest dose that produces the desired therapeutic effect. The therapeutic window lies between MED and MTD.
How many half-lives does it usually take to reach steady state drug concentration?
Approximately 4–5 half-lives.
What factors should be considered when designing a dosing regimen?
Peak and trough levels, half-life, therapeutic window, frequency of dosing, route of elimination, and patient-specific factors (renal/hepatic function, interactions).
What is quality control (QC) in clinical biochemistry?
Procedures to confirm validity of biochemical results by monitoring analytical performance, including internal QC (controls, reproducibility, drift) and external QC (proficiency testing, e.g., UKNEQAS).
What is a Levey‐Jennings chart used for?
To plot consecutive quality control measurements over time against mean and standard deviation limits, detecting trends (gradual shifts) or shifts (sudden deviations) in assay performance.
Define enzyme induction in drug interactions.
Enzyme induction occurs when a drug (inducing agent) increases the expression or activity of metabolic enzymes (e.g., CYP450), leading to faster metabolism of substrate drugs and reduced efficacy.
Give an example of a clinically important enzyme induction.
Rifampicin induces CYP3A4, accelerating warfarin metabolism and reducing its anticoagulant effect, risking thrombosis.
Define enzyme inhibition in drug interactions.
Enzyme inhibition occurs when a drug inhibits the activity of metabolic enzymes, slowing metabolism of substrate drugs and increasing their plasma concentrations, potentially causing toxicity.