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Clin Chem > TDM > Flashcards

TDM Flashcards

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1
Q

What is the free portion of a drug?

A

That which interacts with site of action and produces biological response.

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2
Q

Free portion of a drug best correlates with ________ and therapeutic or toxic effects

A

concentration

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3
Q

Things that can cause the free portion of a drug to be higher than anticipated (potentially causing toxic effects)

A

Conditions that alter binding proteins (inflammation, infection, malnutrition, etc)

Presence of substances that compete for binding sites (other drugs, hormones, etc)

Renal or liver dysfunction (not eliminated as well)

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4
Q

2 ways drugs are cleared from body

A
  1. Hepatic Metabolism

2. Renal filtration

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5
Q

Serum concentration will _______ when rate of absorbance exceeds elimination and distribution of a drug

A

Increase

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6
Q

How many half- lives does it take to reach a steady state of drug in the body?

A

5 & 1/2

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7
Q

How many half-lives does it take for a drug to clear the body?

A

5 & 1/2

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8
Q

T/F Goal of therapeutic drug monitoring is to achieve a trough below therapeutic range and keep peak below toxic range

A

False (partly): Trough should in therapeutic range and peak below toxic range

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9
Q

When is a trough sample drawn?

A

Right before next dose is given

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10
Q

When is a peak sample typically drawn?

A

1 hour after last dose. Can change when drugs are metabolized quicker or slower.

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11
Q

Would a digoxin peak level drawn 1 hour after dose be an accurate representation of the concentration?
Why/why not?

A

No- Digoxin is metabolized slowly. The level of drug in the sample would be low. This should be drawn 6 to 8 hours after a dose.

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12
Q

As a rule, what tube would we use for a TDM blood sample?

A

Red top tube

Generally use non-separator tubes, but that may be changing

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13
Q

What sample types are used for TDM testing?

A

Serum, plasma, whole blood

Urine

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14
Q

What anticoagulant(s) may be used for plasma samples?

A

Heparin

no EDTA or Citrate

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15
Q

What are some Cardioactive drugs that we test for?

A 
Digoxin
Disopyramide
Procainamide
Quinidine
Norpace (quinidine substitute- hard to establish serum concentration and therapeutic values)
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16
Q

What are some TDM antibiotics?

A

Aminoglycosides, Vancomycin, Chloramphenicol

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17
Q

What is digoxin used for?

A

To treat CHF. It increases heart contraction.

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18
Q

Digoxin is eliminated by the _____

A

kidney

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19
Q

Decrease in K+ or Mg++ will ________ the effect of digoxin, whereas hyperthyroid will ______ the effect

A

increase

decrease

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20
Q

This is given to reverse toxic levels of digoxin

A

Digibind

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21
Q

How is procainamide eliminated?

What’s the active metabolite we can monitor?

A

Hepatic and renal function

NAPA (hepatic metabolite)

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22
Q

What are Aminoglycosides used to treat?

A

Infections with gram negative bacteria that are resistant to less toxic antibiotics

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23
Q

What are toxic effects of aminoglycosides (to humans)?

A

Nephrotoxicity and ototoxicity (irreversible effects)

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24
Q

Common examples of aminoglycosides

Study These Flashcards
A

Gentamycin, tobramycin, amikacin, kanamycin

25
What is gentamycin used to treat?
Severe septicemia caused by gram neg bacteria Severe infections of CNS, respiratory tract, urinary tract, GI tract Neonatal sepsis Infections of skin, bone, soft tissue
26
How is gentamycin eliminated?
Kidneys
27
Gentamycin is a major cause of _______ _____ in humans
hearing loss
28
What is tobramycin used for?
Used to fight gram neg bacteria resistant to gentamycin
29
Are aminoglycosides given as an out-patient treatment?
No. IV or IM only.
30
What is vancomycin used to treat?
Infections (endocarditis and sepsis) caused by gram + and some gram - bacteria note: Used because of MRSA & Corynebacteria
31
what is red man syndrome and what causes it?
erythemic flushing of extremities | caused by vancomycin
32
When testing for therapeutic levels of anti-epileptic drugs, we measure both _______ and _______ forms of the drug
total and free | total for most normal states; free when there is a cause for plasma protein alteration
33
Is peak or trough (or both) the most preferred sample when TDM testing for anti-epileptics?
Trough
34
Common first generation anti-epileptics (5)
``` Phenobarbitol Phenytoin (Dilantin) Valproic acid Carbamazepine Ethosuximide ```
35
Common second-gen anti-epileptics (8)
``` Felbamate Gabapentin Lamotrigine Levetiracetam (keppra) Oxcarbazepine Tiagabine Zonasimide ```
36
Second generation anti-epileptics are often _____ to first-gen drugs
supplemental
37
Common tricyclic antidepressants include:
``` Imipramine Amitriptyline Doxepin Clozapine Olanzapine ```
38
Tricyclic drugs are used to treat:
Depression, insomnia, apathy, loss of libido
39
Toxicity of Tricyclic drugs is ____ times upper limit of therapeutic dose and can cause ______, _______, and _____
2 times | Seizures, arrhythmia, and loss of consciousness
40
Generally speaking, how do TCAs and SSRIs work?
Prolong the effects of neurotransmitters by blocking their receptors
41
What kind of action do TCAs have?
non-specific; increase levels of neurotransmitters serotonin and norepi in brain by slowing uptake of them by nerve cells.
42
Do TCAs or SSRIs have more side effects and why?
TCAs do. Their action is more non-specific and can block other receptor sites.
43
What do SSRIs inhibit?
inhibits serotonin receptors, slowing the reuptake of serotonin
44
List 3 immunosuppressive drugs we monitor
Cyclosporine Tacrolimus Sirolimus
45
Preferred sample for immunosuppressive drugs
whole blood
46
When is TDM started for immunosuppressive drugs?
5 to 7 days after initiation. Test trough concentrations.
47
Sirolimus also has ________ activity
Anti-fungal
48
Tacrolimus is 100x the potency of _______
cyclosporine
49
Cyclosporine toxicity can cause...
renal tubular and glomerular dysfunction, HTN
50
Tacrolimus toxicity can cause...
similar effects as cyclosporine, with added risk of clot formation
51
Sirolimus toxicity can cause....
thrombocytopenia, anemia, leukopenia, infection, hyperlipidemia (Extremely potent med)
52
Why are anti-neoplastic drugs not aided by TDM?
Correlation of toxic & therapeutic concentration hard to establish Absorbed and incorporated into cells quickly (seconds to minutes) Dose given more important than concentration
53
How does methotrexate work?
Inhibits DNA synthesis in all cells (anti-neoplastic)
54
What are the 2 steps used for analyzing drugs of abuse or drug toxicity in a patient?
1. Screening (good sensitivity, lacks specificity)- can detect class of drugs, positives need confirmation 2. Confirmation (high sensitivity & specificity)- method used must be different than that for screening. Test usually takes longer.
55
Ingestion of ethylene glycol results in this pH state: It also leads to _______ ______ deposits in renal tubules (and crystals in urine)
acidosis Oxalic acid
56
What tests are used to measure salicylate concentration?
Immunoassays | Trinders
57
How does Trinders test work?
salicylates react with ferric nitrate and form colored product- measured spectrophotometrically
58
What are some drugs of abuse that may be tested for?
``` Amphetamines Cannabinoids Cocaine Opiates PCP Sedatives/Hypnotics (barbiturates, Benzos) ```

Clin Chem (4 decks)

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