TDM Flashcards
(204 cards)
1
Q
Analysis, assessment and evaluation of circulating concentration of drugs in serum, plasma and whole blood
A
THERAPEUTIC DRUG MONITORING
2
Q
Ensure that a given drug dosage produces maximal therapeutic benefit and minimal toxic adverse effects.
A
THERAPEUTIC DRUG MONITORING
3
Q
COMMON INDICATIONS OF TDM (4)
A
- Identifying non-compliance in patients.
- Preventing the consequences of overdosing and under dosing.
- Maximizing therapeutic effect, especially if there is a small difference between therapeutic and a toxic dose.
- Optimizing a dosing regimen based on drug-drug interactions.
4
Q
FACTORS TO CONSIDER ON TDM (4)
A
- Route of administration
- Distribution of drug within the body
- Rate of elimination
- Metabolic Clearance
- Renal Clearance - Rate of absorption
5
Q
- Mathematic modeling of drug concentration in circulation.
- Assists in establishing or modifying a dosage regimen.
- Takes into consideration all factors.
A
PHARMACOKINETICS
6
Q
A mathematical expression of the relationship between drug dose and drug blood level
A
PHARMACOKINETICS
7
Q
A fraction of the dose of the drug that will reach the blood. Amount of the drug that will reach the blood)
A
ƒ (Bioavailable Fraction)
8
Q
Dilution of the drug after it has been distributed in the body; use to estimate the peak drug blood level expected after a loading dose is given; the principal determinant of the dosage of the drug
A
Vd of a drug
9
Q
Highest concentration of the drug in the dosing interval
A
Peak Concentration
10
Q
Lowest concentration of the drug
A
Trough Concentration
11
Q
The time required for the drug level to reach half of its initial value; its between the peak and trough concentration
A
Half-life
12
Q
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
13
Q
Represents a linear relationship between the amount of drug eliminated per hour and the blood level of drug
A
First Order Elimination
14
Q
The difference between highest and lowest effective dosages
A
Therapeutic Range
15
Q
The ratio between the minimum toxic and maximum therapeutic serum concentration
A
Therapeutic Index
16
Q
IDEAL SAMPLE FOR TDM
A
- Serum (Red Top without the gel) or
- Plasma (EDTA or Heparin; as long as no gel separators)
17
Q
___________important (collect during the peak and collect during the trough
A
TIMING
18
Q
Collect before next dose
A
TROUGH
19
Q
1 hour orally administered
A
PEAK
20
Q
AFTER IV INFUSION
A
21
Q
TESTS (3) USED FOR TDM
A
- COLORIMETRY
- IMMUNIASSAY
- CHROMATOGRAPHY
22
Q
Most sensitive method; EMIT and FPIA
A
IMMUNOASSAY
23
Q
(4) CHROMATOGRAPHIC TESTS
A
- Thin-Layer Chromatography
- Gas Liquid Chromatography
- Gas Chromatography–Mass Spectrometry
- High-Performance Liquid Chromatography;
24
Q
Gold Standard Tests
A
Gas Chromatography–Mass Spectrometry
25
What is the most commonly used sample in Chromatographic Test?
URINE
26
Used for the treatment of arrhythmias and CHF (Congestive Heart Failure)
CARDIOACTIVE DRUGS
27
(4) CLASSIFICATIONS OF CARDIOACTIVE DRUGS
CLASS I
CLASS II
CLASS III
CLASS IV
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Rapid sodium channel blockers
CLASS I
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Beta receptor blockers
CLASS II
30
Potassium channel blockers
CLASS III
31
Calcium channel blockers
CLASS IV
32
Classification of Antiarrhythmic Drugs (4)
CLASS I
CLASS II
CLASS III
CLASS IV
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Sodium channel blockers (membrane-stabilizing agents) (e.g., Quinidine, Procainamide, and Lidocaine
CLASS I
34
Block Na+ channel and PROLONG action potential
1A
35
Block Na+ channel and SHORTEN action potential
1B
36
Block Na+ channel with NO EFFECT on action potential
1C
37
β-blockers (e.g., propranolol)
CLASS II
38
Potassium channel blockers (main effect is to prolong the action potential) (e.g., amiodarone
CLASS III
39
Slow (L type) calcium channel blockers (e.g., verapamil)
CLASS IV
40
(6) PHASES OF ACTION POTENTIAL OF CARDIAC CELLS
PHASE 0
PHASE 1
PHASE 2
PHASE 3
PHASE 4
REFRACTORY PERIOD (PHASES 1-3)
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Rapid depolarization (inflow of Na+)
PHASE 0
42
Partial repolarization (inward Na+ current deactivated, outflow of K+)
PHASE 1
43
Plateau (slow inward calcium current)
PHASE 2
44
Repolarization (calcium current inactivates, K+ outflow)
PHASE 3
45
Pacemaker potential (Slow Na+, inflow slowing of K+ outflow) "AUTORHYTHMICITY"
PHASE 4
46
Not classified as any of the 4 classifications because it is a Cardiac Glycoside
DIGOXIN
47
Inhibits membrane Na-K-ATPase, thus it decreases K+ and Mg+ and increases Ca+ (cardiac contractility-inotropic effect, 0.8-2 ng/mL)
-Treatment for Congestive Heart Failure (CHF); used to treat atrial arrhythmia
DIGOXIN
48
DIGOXIN (ELIMINATION)
RENAL FILTRATION
49
DIGOXIN (HALF LIFE)
38 HOURS (AVERAGE ADULT)
49
DIGOXIN (PEAK)
8 HOURS AFTER ORAL DOSE
50
DIGOXIN (THERAPEUTIC LEVELS)
0.5 TO 2 ng/ml
51
DIGOXIN (TOXIC LEVEL)
>2 ng/ml
52
DIGOXIN (EFFECTS)
nausea, vomiting, visual disturbances, premature ventricular contractions, and AV node blockage
53
WHAT ARE THE (8) CARDIOACTIVE DRUGS
1. DOGOXIN
2. LIDOCAINE/XYLOCAINE (CLASS I)
3. QUINIDINE (CLASS I)
4. DISOPYRAMIDE (CLASS I)
5. PROCAINAMIDE (CLASS I)
6. PROPANOLOL (CLASS II)
7. AMIODARONE (CORDARONE, CLASS III)
8. VERAPAMIL (CLASS IV)
54
LIDOCAINE/ XYLOCAINE (CLASS I) ELIMINATION:
HEPATIC METABOLISM
55
LIDOCAINE/ XYLOCAINE (CLASS I) METABOLITE
MONOETHYLGLYCINEXYLIDIDE
56
LIDOCAINE/ XYLOCAINE (CLASS I) THERAPEUTIC LEVEL
1.5-4.0 μg/mL
57
LIDOCAINE/ XYLOCAINE (CLASS I) TOXIC LEVEL
> 4.0 μg/mL
58
LIDOCAINE/ XYLOCAINE (CLASS I) TOXIC EFFECT
CHF and Heart block
59
Quinidine (Class I) PEAKS AT:
2 hours/4-5 hours after oral dose
60
Quinidine (Class I) THERAPEUTIC LEVEL
2.3 TO 5 ug/ml
61
Quinidine (Class I) TOXIC LEVEL
>5 μg/mL
62
Quinidine (Class I) TOXIC EFFECTS
Cinchonism, Blood dyscrasia, and Hepatitis
63
Used to treat cardiac arrhythmias; used as a substitute for quinidine
DISOPYRAMIDE (CLASS I)
64
DISOPYRAMIDE (CLASS I) ELIMINATION
RENAL FILTRATION
65
DISOPYRAMIDE (CLASS I) THERAPEUTIC LEVEL
3-5 μg/mL
66
DISOPYRAMIDE (CLASS I) TOXIC LEVEL
10 μg/mL
67
DISOPYRAMIDE (CLASS I) TOXIC EFFECTS
Bradycardia and AV node blockage
68
Used to treat ventricular arrhythmia
PROCAINAMIDE (CLASS I)
69
PROCAINAMIDE (CLASS I) PEAKS AT:
1 hour after oral dose
70
PROCAINAMIDE (CLASS I) METABOLITE
NAPA (N-acetyl procainamide)
71
PROCAINAMIDE (CLASS I) HALF LIFE
38 hours (average adult)
72
PROCAINAMIDE (CLASS I) THERAPEUTIC LEVEL:
4-10 μg/mL
73
PROCAINAMIDE (CLASS I) TOXIC LEVEL
>12 μg/Ml
74
PROCAINAMIDE (CLASS I) TOXIC EFFECT
Urticaria, Nephrotic Syndrome, Lupus-like Syndrome
75
Used to treat angina pectoris, hypertension, and coronary artery disease
PROPANOLOL (CLASS II)
76
PROPANOLOL (CLASS II) THERAPEUTIC LEVEL
50-100 ng/mL
77
PROPANOLOL (CLASS II) TOXIC EFFECTS
Bradycardia, Arterial Insufficiency, Platelet Disorder, and Pharyngitis
78
AMIODARONE CLASSIFICATION:
(Cordarone; Class III)
79
Used to treat ventricular arrhythmias
AMIODARONE (CLASS III)
80
AMIODARONE (CLASS III) THERAPEUTIC LEVEL
1.0-2.5 μg/mL
81
AMIODARONE (CLASS III) TOXIC LEVEL
>2.5 μg/mL
82
AMIODARONE (CLASS III) TOXIC EFFECTS
Bradycardia, Hepatitis, Photodermatitis, and Thyroid Dysfunction
83
VERAPAMIL CLASSIFICATION
CLASS IV
84
Used to treat angina, hypertension, and supraventricular arrhythmias
VERAPAMIL (CASS IV)
85
VERAPAMIL (CASS IV) THERAPEUTIC LEVEL
80-400 ng/mL
86
VERAPAMIL (CASS IV) TOXIC EFFECTS
Hypotension, Peripheral Edema, and Ventricular Fibrillation
87
WHAT ARE THE (3) ANTIBIOTICS
1. AMINOGLYCOSIDES
2.VANCOMYCIN
3. CHLORAMPHENICOL
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(6) AMINOGLYCOSIDES
1. Gentamicin
2. Tobramycin
3. Amikacin
4. Kanamycin
5. Neomycin
6. Streptomycin
89
Used for treatment of gram (-) bacterial infections; not given to outpatient
AMINOGLYCOSIDES
90
Administered thru IM or IV, not for oral ingestion because it is not well absorbed in GIT. (ANTIBIOTICS)
AMINOGLYCOSIDES
91
AMINOGLYCOSIDES ELIMINATION
RENAL FILTRATION
92
AMINOGLYCOSIDES TOXIC LEVEL
>30 μg/mL
12-15 μg/mL
93
AMINOGLYCOSIDES TOXIC EFFECTS
Nephrotoxicity and Ototoxicity
94
A glycopeptide effective against gram (+) cocci and bacilli
VANCOMYCIN
95
Poor oral absorption; administered by IV infusion. (ANTIBIOTICS)
VANCOMYCIN
96
VANCOMYCIN ELIMINATION
RENAL FILTRATION AND EXCRETION
97
VANCOMYCIN TOXIC LEVEL
>10 μg/mL
40 μg/mL
98
Distributes to all tissues in the body, and it concentrates in the CSF. (ANTIBIOTICS)
CHLORAMPHENICOL
99
Rapidly absorbed in the GIT (ANTIBIOTICS)
CHLORAMPHENICOL
100
CHLORAMPHENICOL TOXIC LEVEL:
>25 μg/mL
101
CHLORAMPHENICOL TOXIC EFFECTS:
Blood Dyscrasia, Cytoplasmic Vacuolation (erythroid & myeloid cells)
102
WHAT ARE THE (9) ANTIEPILIPTIC DRUGS
1. PHENOBARBITAL
2. PHENYTOIN
3. VALPROIC ACID
4. CARBAMAZEPINE (TEGRETOL)
5.ETHOSUXIMIDE (ZARONTIN)
6. GABAPENTIN ( NEURONTIN)
7. TOPIRAMATE
8. LAMOTRIGINE
9. FELBAMATE
103
A long-acting barbiturate that controls tonic-clonic seizure and focal epileptic
PHENOBARBITAL
104
PHENOBARBITAL ELIMINATION
HEPATIC METABOLISM
105
PHENOBARBITAL PEAKS AT:
10 hours after oral dose
106
PHENOBARBITAL THERAPEUTIC LEVEL
20-40 μg/mL
5-12 μg/mL
107
PHENOBARBITAL TOXIC EFFECTS:
Nystagmus, Stupor, Ataxia, and Respiratory Depression
108
Controls seizures (tonic-clonic, simple partial seizures) and short-term prophylactic agent in brain injury
PHENYTOIN
109
PHENYTOIN ELIMINATION:
HEPATIC PATHWAY
110
PHENYTOIN THERAPEUTIC RANGE:
10-20 μg/mL
111
PHENYTOIN TOXIC LEVEL
>20 μg/mL
112
Used for treatment of petite mal seizure (absence seizure) and grand mal seizure (tonic-clonic seizure).
VALPROIC ACID
113
Orally administered; GIT absorption is rapid and complete (ANTIEPILIPTIC)
VALPROIC ACID
114
VALPROIC ACID ELIMINATION
HEPATIC METABOLISM
115
VALPROIC ACID THERAPEUTIC RANGE:
50-100 μg/mL
116
VALPROIC ACID TOXIC LEVEL:
>100 μg/mL
>200 μg/mL
117
A tricyclic compound related to imipramine (TCA
CARBAMAZEPINE (TEGRETOL)
118
Effective for grand mal seizures and treating seizures accompanied by pain.
CARBAMAZEPINE (TEGRETOL)
119
It has serious toxic effects and not frequently used; orally administered
CARBAMAZEPINE (TEGRETOL)
120
CARBAMAZEPINE (TEGRETOL) ELIMINATION
HEPATIC METAMOLISM
121
CARBAMAZEPINE (TEGRETOL) THERAPEUTIC RANGE
4-16 μg/mL
122
CARBAMAZEPINE (TEGRETOL) TOXIC LEVEL
>12 μg/mL
123
CARBAMAZEPINE (TEGRETOL) TOXIC EFFECTS
Hematologic Dyscrasia, Aplastic Anemia, Irregular Pulse and Ataxia
124
Drug of choice for controlling petite mal seizures; orally administered.
ETHOSUXIMIDE (ZARONTIN)
125
ETHOSUXIMIDE (ZARONTIN) THERAPEUTIC RANGE
40-100 μg/mL
126
ETHOSUXIMIDE (ZARONTIN) TOXIC LEVEL
>100 μg/mL
127
ETHOSUXIMIDE (ZARONTIN) TOXIC EFFECTS
GI Disturbances, Ataxia, SLE, Aplastic Anemia, and Panytopenia
128
Chemically similar to neurotransmitter gamma aminobutyric acid (GABA
GABAPENTIN (NEURONTIN)
129
Used for partial seizures; adjunctive therapy.
130
GABAPENTIN (NEURONTIN) THERAPEUTIC RANGE
2-15 μg/mL
131
GABAPENTIN (NEURONTIN) TOXIC EFFECTS
Ataxia and Drowsiness
132
(3) ANTIEPILIPTIC DRUGS FOR PARTIAL SEIZURES
1. TOPIRAMATE
2. LAMOTRIGINE
3. FELBAMATE
133
(LACTAMICAL) FOR PATIAL SEIRZURES
LAMOTRIGINE
134
(3) PSYCHOACTIVE DRUGS
1. LITHIUM
2. TRICYCLIC ANTIDEPRESSANTS (TCA)
3. FLUOXETINE (PROZAC)
135
Drug of choice for the prevention of Chronic Cluster Headache
LITHIUM
135
Used for treatment of manic-depressive illness (bipolar disorders)
LITHIUM
136
LITHIUM THERPEUTIC RANGE
0.8-1.2 mmol/L
137
LITHIUM TOXIC LEVEL
>1.2 mmol/L
>2 mmol/L
138
LITHIUM TOXIC EFFECTS
Severe Dehydration, Nephrotoxicity, and Hypothyroidism
139
used for the treatment of depression, insomnia, extreme apathy and loss of libido.
Orally administered
TRICYCLIC ANTIDEPRESSANTS (TCA)
140
TRICYCLIC ANTIDEPRESSANTS (TCA) ELIMINATION
HEPATIC METABOLISM
140
TRICYCLIC ANTIDEPRESSANTS (TCA) METABOLITE
DESIPRAMINE
141
TRICYCLIC ANTIDEPRESSANTS (TCA) THERAPEUTIC RANGE
100-300 ng/ml
142
TRICYCLIC ANTIDEPRESSANTS (TCA) PEAKS AT:
2-12 hours
143
TRICYCLIC ANTIDEPRESSANTS (TCA) TOXIC EFFECTS
Drowsiness, Blurred Vision, Memory Loss, Seizure, Cardiac Arrhythmia, and Unconsciousness
144
Blocks the reuptake of serotonin in central serotonergic pathways
FLUOXETINE (PROZAC)
145
Used for treatment of obsessive-compulsive disorders
FLUOXETINE (PROZAC)
146
FLUOXETINE (PROZAC) THERAPEUTIC RANGE
90-300 ng/mL
147
FLUOXETINE (PROZAC) TOXIC EFFECTS:
Attempted Suicide, Decreased Libido, and Sexual Function
148
BRONCHODILATOR DRUG
THEOPHYLLINE
149
- Belongs to the Methylated Xanthine Class.
- Its action is specific to the relaxation of bronchial smooth muscle.
- Used in the treatment of asthma and other chronic obstructive pulmonary disease.
THEOPHYLLINE
150
THEOPHYLLINE ELIMINATION
RENAL AND HEPATIC
151
THEOPHYLLINE THERAPEUTIC RANGE
10-20 μg/mL
152
THEOPHYLLINE TOXIC LEVEL
>20 μg/mL
153
THEOPHYLLINE TOXIC EFFECTS
GI Bleeding, Seizures, Tachycardia, Syncope
154
WHAT ARE THE (5) IMMUNOSUPPRESSIVE DRUGS
1. CYCLOSPORINE
2. TARCOLIMUS (PROGRAF/FK-506)
3. RAPAMYCIN (SIROLIMUS)
4. MYCOPHENOLATE MOFETIL
5. LEFLUNOMIDE (LFM)
155
* Inhibits the cellular immune response by blocking production of interleukin-2.
* Used to prevent rejection of allogenic organ transplants.
CYCLOSPORINE
156
CYCLOSPORINE ELIMINATION
HEPATIC
157
CYCLOSPORINE TOXIC LEVEL
>500 ng/mL
158
CYCLOSPORINE TOXIC EFFECTS
Renal Tubular and Glomerular Dysfunctions, GI Disturbance, Hirsutism and Hematologic Dyscrasia
159
100x more powerful than cyclosporine
TACROLIMUS (PROGRAF/FK-506)
160
TACROLIMUS (PROGRAF/FK-506) ELIMINATION
HEPATIC
161
TACROLIMUS (PROGRAF/FK-506) TOXIC EFFECTS
Thrombus Formation, Nephrotoxicity, and Neurotoxicity
162
Similar to tacrolimus; major side effects are lipid abnormalities and thrombocytopenia
RAPAMYCIN (SIROLIMUS)
163
Decreases renal allograft rejection
MYCOPHENOLATE MOFETIL
164
Inhibits lymphocyte proliferation; for treatment of rheumatoid arthritis
LEFLUNOMIDE (LFM)
165
WHAT ARE THE (2) ANTINEOPLASTIC DRUGS
1. METHOTREXATE
2. BUSULFAN
166
* Effective therapy for a variety of neoplastic conditions; also, an immunosuppressive agent.
* Inhibits DNA synthesis in all cells, by blocking dihydrofolate reductase
METHOTREXATE
167
METHOTREXATE TOXIC LEVEL
0.01 μmol/L
168
METHOTREXATE TOXIC EFFECTS
Leucopenia, GI Ulceration, Thrombocytopenia, Cirrhosis
169
An alkalyting agent used to treat leukemias and lymphomas prior to bone marrow transplantation
BUSULFAN
170
WHAT ARE THE (3) ANTI INFLAMMATORY / ANALGESIC DRUGS
1. SALICYLATES / ASPIRIN (ACETYLSALICYLIC ACID)
2. ACETAMINOPHEN (TYLENOL)
3. IBUPROFEN
171
* Commonly used analgesic, antipyretic, and anti-inflammatory drug.
* Has an anticoagulant property-antiplatelet activity
SALICYLATES / ASPIRIN (ACETYLSALICYLIC ACID)
172
SALICYLATES / ASPIRIN (ACETYLSALICYLIC ACID) THERAPEUTIC LEVEL
5 mg/dL
173
SALICYLATES / ASPIRIN (ACETYLSALICYLIC ACID) TOXIC LEVEL
>30 mg/dL
174
SALICYLATES / ASPIRIN (ACETYLSALICYLIC ACID) TOXIC EFFECTS
Mixed Acid Base Disturbances
175
SALICYLATES / ASPIRIN (ACETYLSALICYLIC ACID) METHODS:
1. Trinder Assay
2. Enzymatic Assay
3. HPLC
4. EMIT
176
- Inhibitor of prostaglandin metabolism
- Commonly used as analgesic and antipyretic drug
ACETAMINOPHEN (TYLENOL)
177
178
ACETAMINOPHEN (TYLENOL) THERAPEUTIC LEVEL
25 μg/mL
179
ACETAMINOPHEN (TYLENOL) TOXIC LEVEL
>50 μg/mL
180
ACETAMINOPHEN (TYLENOL) TOXIC EFFECTS
Cyanosis, CNS Depression, and Seizure
181
ACETAMINOPHEN (TYLENOL) METHOD
HPLC
182
Has analgesic and anti-inflammatory actions
IBUPROFEN
183
IBUPROFEN THERAPEUTIC LEVEL
10-50 μg/mL
184
IBUPROFEN TOXIC LEVEL
>100 μg/mL
185
IBUPROFEN TOXIC EFFECTS
Nausea, Vomiting, Blurred Vision, Abdominal Pain, Edema
186
* Block the action of dopamine and serotonin in the limbic system.
* Used in the treatment of acute schizophrenia
NEUROLEPTICS (ANTIPSYCHOTIC MAJOR TRANQUILIZERS)
187
NEUROLEPTICS (ANTIPSYCHOTIC MAJOR TRANQUILIZERS) (2) CLASSES
➢ Phenothiazines (chlorpromazine)
➢ Butyrophenones (haloperidol)
188
NEUROLEPTICS (ANTIPSYCHOTIC MAJOR TRANQUILIZERS) TOXIC EFFECTS:
Cholestasis, Orthostatic Hypotension, Aplastic Anemia, Muscle Rigidity
189
_____- is actually not a common test, it is only performed for drugs that has a narrow therapeutic level
TDM
190
it will help to ensure that maximum benefit/effect atoang makuha from being effective or being therapeutic and the least of the toxic effects niya
TDM
191
if ma overdose it will become ____
TOXIC
192
if under dose problematic due _______
liver and kidney are involved in the metabolism of drugs
193
is only indicated to those drugs that has a narrow therapeutic index
TDM
194
Has 70% bioavailability
ORAL
195
METABOLIC CLEARANCE THROUGH
LIVER
195
Has 100% bioavailability
IV OR INTRAVENOUS
196
RENAL CLEARANCE THROUGH
KIDNEYS
197
For a successful passive diffusion of the drug, drug must be ______ or very ______ to enter the cell
HYDROPHOBIC
198
WEAK ACIDS ARE ABSORBED IN ___
STOMACH
199
WEAK BASES ARE ABSORBED IN ___
INTESTINE
200
What are the several factors that affects absorption (4)
1. Changes in the intestinal movement can affect the absorption
2. The pH whether alkaline or acid
3. If there’s inflammation
4. If there is presence of other drugs and also food that will affect the rate of absorption
