TDM

Question 1

the activity of measuring drug concentrations in blood to determine the dose of the medication to an individual.

Answer 1

Therapeutic drug monitoring (TDM)

Question 2

central assumption of TDM

Answer 2

relationship between drug concentrations and
efficacy or toxicity outcomes

Question 3

the study of chemical agents and their effects on
humans.

Answer 3

Pharmacology

Question 4

only involved therapeutic drugs that are
valuable in the prevention, diagnosis and treatment of diseases.

Answer 4

Pharmacology

Question 5

part of pharmacology that is concerned primarily
with the application or administration of drugs to patients for the purpose of
prevention and treatment of diseases.

Answer 5

Pharmacotherapeutics

Question 6

comprises the processes of interaction of pharmacologically
active substances with their target sites and the study of their mechanism of action
in leading to therapeutic or adverse effects.

Answer 6

Pharmacodynamics

Question 7

processes of uptake, distribution,
biotransformation and elimination of drugs by the body.

Answer 7

Pharmacokinetics

Question 8

biochemical or physical process that occurs at the site of action and is usually mediated through a receptor.

Answer 8

mechanism of action

Question 9

reflects the fraction of the dose
administered that reaches the systemic circulation.

Answer 9

bioavailability

Question 10

Bioavailability of more than ___ is the most practical for drugs to be orally useful except for those with _____

Answer 10

70%
high hepatic rate

Question 11

acidic drugs are bound
primarily to

Answer 11

albumin

Question 12

basic drugs

Answer 12

globulins

Question 13

Most drug metabolism takes
places in the

Answer 13

microsomal fraction of the
hepatocytes

Question 14

Serum concentrations of the drug rise when the rate of

Answer 14

absorption exceeds distribution
and elimination.

Question 15

determines the effectiveness of drug

Answer 15

drug concentration

Question 16

administered initially to achieve the desired blood
concentration quickly

Answer 16

loading dose

Question 17

consequent drug doses are lower to maintain the desired therapeutic level

Answer 17

maintenance dose).

Question 18

reached when the amount of drug entering the
body is equal to the amount of drug being eliminated

Answer 18

steady state

Question 19

The rate at which a drug is cleared from the body is measured by its

Answer 19

half-life

Question 20

Most drugs are not administered singularly but are delivered on a scheduled basis and with this type of administration, serum drug concentrations would be fluctuating between the

Answer 20

peak level (maximum level)
trough level (minimum drug level).

Question 21

scheduled administration ensures a trough level within the

Answer 21

therapeutic range

Question 22

About _____ doses are required before a steady state of fluctuation is acquired.

Answer 22

7

Question 23

Considerations in analysis of xenobiotics in TDM

Answer 23

time and date of suspected exposure and sample collection
history from patient or witnesses
physical state of patient

Question 24

most widely used and definitive confirmatory procedure

Answer 24

gas chromatography-mass
spectrometry

Question 25

analytical factors that affect measurement of drugs

Answer 25

Dose of the drug given to the patient Specimen collection and handling Timing of sample collection Availability of reference methods and their performance characteristics

Question 26

affect drug concentrations variably through adsorption of the drug by the gel after prolonged contact.

Answer 26

thixotropic gel

Question 27

preferred anticoagulant for most drug analysis.

Answer 27

Heparin

Question 28

trough concentrations for most drugs are collected

Answer 28

right before the next dose

Question 29

Peak concentrations are drawn ______oral administration.

Answer 29

1 hr

Question 30

Premature sampling might give

Answer 30

falsely elevated

Question 31

ability of a given method to detect a compound of interest among many potential substances present in a sample.

Answer 31

Method selectivity

Question 32

a drug-enzyme complex is used as the marker.

Answer 32

enzyme-mediated immunologic technique

Question 33

These procedures have been applied mainly to the qualitative detection of drugs of abuse and toxins

Answer 33

thin-layer chromatography (TLC) high-performance liquid chromatography (HPLC), and gas chromatography-mass spectroscopy (GC-MS)

Question 34

involves compounds that are directly heated into the gas phase to make them labile

Answer 34

Gas-liquid chromatography

Question 35

molecule-ions pass through __ wherein they are separated based on their molecular weight

Answer 35

quadrupole detector

Question 36

The presence of the molecule-ion on the plate is detected by a

Answer 36

charge multiplier detector system

Question 37

Non-volatile compounds are detected with

Answer 37

LC-MS

Question 38

Two interface methods have been the gold standard for LC-MS:

Answer 38

electrospray (ES atmospheric pressure chemical ionization (APCI).

Question 39

URINE advantages

Answer 39

- available in sufficient quantities - higher concentrations than in blood - availability of POCT - well-researched testing techniques

Question 40

URINE disadvantages

Answer 40

- short to intermediate window of detection - easy to adulterate or substitute - may require observed collection - “shy bladder” syndrome

Question 41

BLOOD ADVANTAGES

Answer 41

- detects recent drug use - established laboratory test method

Question 42

BLOOD DISADVANTAGES

Answer 42

- expensive - limited window of detection - poor venous access

Question 43

HAIR ADVANTAGES

Answer 43

- longest window of detection - detect changes in drug use over time (from 7-10 days)

Question 44

HAIR disadvantages

Answer 44

- cannot detect use within the previous 7-10 days - difficult to interpret results - costly and time consuming to prepare specimen for testing

Question 45

breath advantages

Answer 45

- well-established method for alcohol testing - readily available

Answer 46

- used only for alcohol and other volatiles - short window of detection - difficult to obtain adequate sample, especially with patients who are very intoxicated or uncooperative - uncommon in clinical setting

Question 47

ORAL FLUID/SALIVA advantages

Answer 47

-non-invasive specimen collection - easy to collect - reduced risk of adulteration - directly observed specimen collection - parent drug rather than the metabolite can be the target of the assay - able to detect same-day use - availability of POCTs - detect residual drug in the mouth

Question 48

ORAL FLUID/SALIVA disadvantages

Answer 48

- limited specimen volume - contamination from residual drug in the mouth cannot be correlated with blood concentrations - short window of detection - requires supervision for 10-30 minutes before sampling - salivation reduced by stimulant use - need for elution solvent to efficiently remove drugs adsorbed to the collection device - cannabinoids in oral fluid arise from contamination of oral cavity than excretion in saliva from blood