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TDM 2 Flashcards

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1
Q

anti-inflammatory agents and painkillers, thus considered to be therapeutic in nature

A

ANALGESICS

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2
Q

salicylate/ aspirin complication

A

initial respiratory alkalosis
metabolic acidosis (use of free fatty acids producing ketones)

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3
Q

highest analytic sensitivity for salicylate TDM

A

GC or liquid chromatography

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4
Q

acetaminophen complication

A

hepato-cystic necrosis 3 to 4 days after overdose (unable to conjugate acetamidoquinone).

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5
Q

mechanism of acetaminophen complication

A

glutathione depleted due o conjugation with intermediates

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6
Q

risk factor for acetaminophen toxicity

A

chronic alcoholic

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7
Q

most common method for acetaminophen detection

A

FPIA

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8
Q

reference method for acetaminophen quantitation

A

HPLC

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9
Q

sedatives that have a tranquilizing effect through their depressant effect on the CNS.

A

BARBITURATES

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10
Q

BARBITURATES complication

A

cardiac arrest
respiratory depression

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11
Q

derived or chemically related to the substances derived from opium poppy

A

NARCOTICS

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12
Q

NARCOTICS complications

A

respiratory depression
coma
respiratory acidosis
myoglobinuria
increase in serum indicators of cardiac damage.

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13
Q

pesticides exist as

A

organic complexes
organophosphates
carbamates

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14
Q

pesticides complication

A

inhibit acetylcholinesterase
salivation
lacrimation
involuntary urination and defection
bradycardia
muscular twitching
cramps
slurred speech
behavioral changes

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15
Q

major route for the general population for pesticide

A

Food contamination

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16
Q

more common route among occupational contexts and accidental routes of exposure for pesticides

A

inhalation
transdermal absorption
ingestion

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17
Q

lab diagnosis of pesticide poisoning

A

acetylcholinesterase inhibition in red blood cells
serum pseudocholinesterase

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18
Q

tasteless gas with 200- to 225-fold greater affinity for
hemoglobin than oxygen

A

carbon monoxide

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19
Q

carbon monoxide complication

A

suffocation
death
left shift in the oxygen- hemoglobin dissociation (heart and brain)

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20
Q

lab test of carbon monoxide

A

spot test (5 mL of 40% NAOH + 5 mL of aqueous dilution of WB = pink solution > 20%COHb)
differential spectrophotometry
GC (reference)

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21
Q

4 heavy metals causing poisoning

A

lead
mercury
arsenic
cadmium

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22
Q

lead poisoning complications

A

vitamin D deficiency
Anemia (inhibition of heme)
GI irritation
weight loss
kidney damage
convulsions
altered cognition
encephalopathy
death

behavioral changes
hyperactivity
ADD (attention deficit disorder)
decrease in IQ scores

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23
Q

most common method for blood lead quantification

A

Atomic absorption spectrophotometry

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24
Q

common environmental contaminant – paint ingestion or continuous exposure in the soil

A

lead

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25
found in antibacterial agents, pesticides and batteries.
mercury
26
mercury poisoning complications
GI irritation severe kidney damage neurologic symptoms
27
can be ingested without significant effects
elemental mercury
28
only moderately toxic
cationic mercury
29
the most toxic mercury
organic mercury
30
mercury deposits in
hydrophobic compartments (brain, peripheral nerves)
31
mercury poisoning is commonly detected with the use
atomic absorption
32
found in pesticides, weed killer and is an ingredient in some paint
arsenic
33
arsenic poisoning complication
purging gastroenteritis shredding of the stomach lining formation of line in the fingernails death (hemorrhagic gastroenteritis)
34
lab test for arsenic poisoning
urine atomic absorption spectrophotometry
35
Metal found in many industrial processes, with its main use being in electroplating and galvanizing.
cadmium
36
common human sources of cadmium
tobacco products shellfish and vegetable
37
cadmium toxicity
binds to proteins and cellular constituents, accumulates in the kidney
38
cadmium poisoning complications
nausea vomiting and abdominal pain respiratory irritation dizziness, weakness, fever and chills COPD renal tubular dysfunction (proteinuria, glucosuria and aminoaciduria) Vit D deficiency Itai-itai (severe osteomalacia and osteoporosis from cadmium contaminated rice)
39
cadmium lab diagnosis
urine/whole blood -AAS
40
Supertoxic substance that can exist as a gas, solid, or in solution.
cyanide
41
cyanide is found in
rodenticides pyrolysis product from burning of some plastics
42
cyanide toxicity
binds to iron of the heme molecule leading to depletion of cellular ATP
43
cyanide complications
headache dizziness respiratory depression seizure, coma and death
44
most common lab diagnosis of cyanide poisoning
Ion-selective electrode photometric analysis of two-well microdiffusion separation
45
lab diagnosis for chronic low level cyanide exposure
urinary thiocyanate concentration
46
reference method for most of the analytes under substance of abuse
GC-MS
47
disadvantages of lab techniques for substance of abuse
only detect recent drug use does not differentiate between single use or chronic abuse
48
ethanol complication
alcoholic hepatitis cirrhosis
49
ethanol metabolism is enacted by ___ converting alcohol to ___, further acted upon by ____. final metabolite ___ is excreted in urine
alcohol dehydrogenase acetaldehyde aldehyde dehydrogenase acetic acid
50
reference method for ethanol determination
GC
51
0.01 – 0.05 g/ 100 ml stage
Subclinical
52
Subclinical manifestation of alcohol
normal
53
0.04 – 0.12 g/100 ml
euphoria
54
euphoria manifestation
Sociability talkativeness increased self-confidence decreased inhibition Diminution of attention, judgment and control sensory-motor impairment Slowed information processing
55
0.09 – 0.25 g/ 100 ml stage
excitement
56
excitement stage manifestation
- decreased sensory response - emotional instability - sensory-motor incoordination - increased reaction time - reduced visual acuity - loss of critical judgment - impairment of perception, memory and comprehension - drowsiness - impaired balance
57
0.18 – 0.30 g/ 100 mL
Confusion
58
confusion stage manifestations
▪ Disorientation, mental composition, dizziness ▪ Exaggerated emotional state ▪ Disturbance of vision ▪ Increased pain threshold
59
0.27 – 0.40 g/ 100 mL
Stupor
60
stupor manifestations
General inertia approaching loss of motor function ▪ Greatly decreased response to stimuli ▪ Notable muscular incoordination, inability to stand or walk ▪ Vomiting, incontinence of urine and feces ▪ Impaired consciousness, sleep or stupor
61
0.35 – 0.50 g/ 100 mL
Coma
62
coma stage
Complete unconsciousness ▪ Anesthesia, depressed or abolished reflexes ▪ Subnormal temperature ▪ Impaired circulation and respiration ▪ Possibly death
63
0.45
Death from respiratory arrest
64
widely used in paints, solvents, antifreeze and solid canned fuels.
methanol
65
metabolites of methanol
formaldehyde and formic acid
66
methanol complication
metabolic acidosis pancreatic necrosis visual impairment
67
CNS stimulants that block dopamine receptors in the brain
Amphetamines
68
Amphetamines use
narcolepsy and ADD treatment
69
amphetamine/ MDMA/ ecstasy complications
violent behavior, seizures hyperthermia liver toxicity renal failure
70
CNS stimulant that is metabolized by cholinesterase.
cocaine
71
cocaine complications
hypertension myocardial infarction seizure cardiotoxicity sudden death.
72
metabolite of cocaine found in urine after 3 days
benzoylecgonine
73
Produce psychologic effects and are stored in fat cells.
cannabinoid compounds
74
cannabinoid compounds complication
rare and not severe
75
Phencyclidine
abused anesthetic stimulant hallucinogen depressant
76
phencyclidine complications
violent tendencies seizures respiratory depression death.
77
Opiates use
analgesic sedation anesthesia
78
opiates treatment
naloxone
79
lab diagnosis of opiates
immunoassay --> initial GC-MS confirmatory
80
types of cardioactive drugs
Digoxin Antiarrhythmic drugs
81
chemical agents that maintains normal heart function
Cardioactive drugs
82
major cardiac glycoside and alters the force of contraction through its effect on the ATPase pump in heart muscle.
digoxin
83
Blood specimens for digoxin should be collected when
8 hours after dose
84
digoxin complications
nausea rapid heart rate visual impairment
85
prescribed to treat irregular heartbeat that produces inappropriate ventricular contraction or tachycardia.
Antiarrhythmic drugs
86
5 antiarrhythmic drugs
lidocaine procainamide disopyramide quinidine propanolol
87
two active metabolites of lidocaine
monoethylglycinexylidide glycinexylide
88
Procainamide produces
N-acetylprocainamide
89
adverse reactions of disopyramide
anticholinergic effects
90
used as an alternative to quinidine if the side effects of the said drug become intolerable
disopyramide
91
produces several active metabolites
Quinidine
92
increases digoxin when taken with digoxin
quinidine
93
monitoring of quinidine
only involves trough level
94
generally prescribed for hypertension, certain arrythmias, migraine and other conditions related to sympathetic stimulation.
propanolol
95
propanolol toxicity
excessive inhibition of sympathetic nervous system bradycardia hypotension cardiac failure
96
alters transmission of nerve impulses within the brain to minimize the seizures of epilepsy
Anticonvulsants
97
relax bronchial smooth muscle for the relief or prevention of asthma.
Bronchodilators
98
most common bronchodilator
Theophylline
99
Theophylline metabolites
caffeine
100
3 types of psychotropic or antipsychotic drugs
lithium antidepressants fluoxetine
101
used to treat manic-depressive illness.
lithium
102
lithium is eliminated as
unchanged drug
103
used to treat depression
tricyclic antidepressants
104
TAD peak serum concentrations are reached in the range of
2-12 hours
105
TAD complications
drowsiness constipation blurred vision memory loss. seizure cardiac arrythmia unconsciousness
106
blocks serotonin uptake by nerve terminals in the CNS and by platelets
Fluoxetine
107
medications to treat cancer
Antineoplastic drugs
108
rapidly metabolized or incorporated into cellular macromolecular structures within seconds to minutes of their administration.
Antineoplastic drugs
109
antibiotics with serious side effects requiring moniyoring
amikacin gentamycin tobramycin vancomycin chloramphenicol
110
amikacin toxic effects
nephrotoxicity ototoxicity
111
gentamicin toxic effects
nephrotoxicity ototoxicity vertigo respiratory paralysis
112
tobramycin toxic effects
nephrotoxicity ototoxicity vertigo respiratory paralysis
113
vancomycin close monitoring is recommended for patients with
reduced renal function propensity for bacterial infection
114
Chloramphenicol toxicity
toxic to bone marrow aplastic anemia blood dyscrasias cardiovascular collapse
115
aspirin use
analgesic antipyretic, anti-inflammatory drug.
116
lab diagnosis of salicylates
GC LC (highest sensitivity, specificity) immunoassays chromogenic assay (trinder salicylate + ferric nitrate)
117
acetaminophen use
analgesic

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