THERAPEUTIC DRUG MONITORING Flashcards
(120 cards)
1
Q
Bioavailability of intravenous administration
A
100%
2
Q
Bioavailability of oral administration
A
70%
3
Q
Weak acids are absorbed in the…
A
Stomach
4
Q
Weak bases are absorbed in the…
A
Intestine
5
Q
Is the release of the drug
A
Liberation
6
Q
The transport of drug from the site of administration to the blood
A
Absorption
7
Q
Refers to the delivery of the drug to the tissue
A
Distribution
8
Q
The process of chemical modification of the drug by the cells
A
Metabolism
9
Q
The process by which the drug and its metabolites are excreted from the body
A
Excretion
10
Q
Most drugs are absorbed by passive diffusion. At what state should the drug be in?
A. Hydrophilic
B. Hydrophobic
C. Ionized
D. Anxious
A
B. Hydrophobic
11
Q
4 factors affecting absorption
A
pH
Presence of food and other drugs
Changes in intestinal movement
Inflammation
12
Q
The location where the drugs are effective are in the…
A. Body tissues
B. Blood
C. Intestine
D. Liver
A
A. Body tissues
Drugs are effective in the body tissues, not generally in the blood
13
Q
Drugs have higher concentration in _______ than in ________
A. Blood, tissues
B. Tissues, blood
A
B. Tissues, blood
14
Q
Refers to the relationship between tissue and blood levels
A
Distribution space
15
Q
True or false
A large distribution space indicates that much of the drug moves into the tissues than stays in the circulation
A
Truly
16
Q
Where does the conversion of a parent drug to its metabolites happen?
A
Liver (extramitochondrial microsomal system of the hepatocytes-cytochrome P450 enzymes)
17
Q
The fraction of the dose that reaches the blood
A
Bioavailable fraction
18
Q
Represents the dilution of the drug after it has been distributed in the body
A
Vd of a drug
19
Q
It is used to estimate the peak drug blood level expected after a loading dose is given. It is the principal determinant of dose
A
Vd of a drug
20
Q
Metabolism wherein the 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
21
Q
Represents the linear relationship between the amount of drug eliminated per hour and the blood level of a drug
A
First-order elimination
22
Q
The time to reach the steady-state or average concentration
A
Half-life
23
Q
The biochemical pathway responsible for the greatest portion of drug metabolism
A
Mixed function oxidase (MFO) system
24
Q
The relationship between the drug concentration at the target site and response of the tissues
A
Pharmacodynamics
25
Refers to the study of genes that affect the performance of a drug in an individual
Pharmacogenomics
26
The mathematical expression of the relationship between drug dose and drug blood level
Pharmacokinetics
27
The ratio between the minimum toxic and the maximum therapeutic serum concentration
Therapeutic index
28
The difference between highest and lowest effective dosages
Therapeutic range
29
The lowest concentration of a drug obtained in the dosing interval
Trough concentration
30
Enumerate the cardioactive drugs
“Ventricles Produce Pulses Like A Queen Drunk Dances”
Verapamil
Procainamide (Pronestyl)
Propanolol
Lidocaine (Xylocaine)
Amiodarone (Cordarone)
Quinidine
Digoxin
Disopyramide
31
Enumerate the antibiotics
“Amystery Van Captures”
Aminoglycosides (gentamycin, tobramycin, amikacin, kanamycin, neomycin, streptomycin)
Vancomycin
Chloramphenicol
32
Enumerate the antiepileptic drugs
“PP Very Choosy, Eats Gun To Look Fierce”
Phenobarbital
Phenytoin (Dilatin)
Valproic acid (Depakene)
Carbamezipine (Tegretol)
Ethosuximide (Zarontin)
Gabapentin (Neurontin)
Topiramate
Lamotrigine (Lamictal)
Felbamate
33
Enumerate the psychoactive drugs
“Lit Trees = Fire”
Lithium
Tricyclic antidepressants (TCA)
Fluoxetine
34
Enumerate the bronchodilator drugs
Theophylline
35
Enumerate the immunosuppressive drugs
Cyclosporine
Tacrolimus
Rapamycin
Mycophenolate mofetil
Leflunomide
36
Enumerate the antineoplastic drugs
“BM”
Busulfan
Methotrexate
37
Enumerate the anti-inflammatory/analgesics
“ISA”
Ibuprofen
Salicylates/aspirin (Acetylsalicylic acid)
Acetaminophen (Tylenol)
38
It blocks the action of dopamine and serotonin in the limbic system; used in the treatment of schizophrenia
Neuroleptics (antipsychotic major tranquilizers)
39
Classification of cardioactive drugs:
Rapid sodium channel blockers
Class I
40
Classification of cardioactive drugs:
Beta receptor blockers
Class II
41
Classification of cardioactive drugs:
K+ channel blockers
Class III
42
Classification of cardioactive drugs:
Calcium channel blockers
Class IV
43
Enumerate the class I cardioactive drugs
Quinidine
Procainamide
Lidocaine
44
Enumerate the class II cardioactive drugs
Propanolol
45
Enumerate the class III cardioactive drugs
Amiodarone
46
Enumerate the class IV cardioactive drugs
Verapamil
47
Treatment for atrial arrhythmias and congestive heart failure
Digoxin
48
Its therapeutic actions and toxicities can be influenced by serum electrolytes: it inhibits membrane Na-K-ATPase, thus it decreases K and Mg, and increases Ca (cardiac contractilty-inotropic effect)
Digoxin
49
Hyperthyroid individuals are resistant to this drug
Digoxin
50
Used to correct ventricular arrhythmia and for treatment of AMI
It can be used as a local anaesthetic
Lidocaine
51
This drug isn’t administered orally due to almost complete hepatic removal of the absorbed drug
Lidocaine
52
Naturally occurring drug for the treatment of arrhythmia
Quinidine
53
It is used to treat ventricular arrythmia
Its toxic effects includes reversible lupus-like syndrome (ANA), nephrotic syndrome, and urticaria
Procainamide
54
Used to treat cardiac arrhythmias; used as a substitute for quinidine
Disopyramide
55
This drug has anticholinergic effects which include dry mouth and constipation
Disopyramide
56
Used in the treatment of thyrotoxicosis; suppresses the conversion of T3 to T4
Propanolol
57
Blocks potassium channels in the cardiac muscle; use for treatment of ventricular arrhythmias
Amiodarone
58
It is an iodine-containing drug which can cause hyperthyroidism or hypothyroidism
Amiodarone
59
Treatment of angina, hypertension, and supraventricular arrhythmias
Verapamil
60
Used for treatment of gram-negative bacterial infections
Aminoglycosides
61
Toxic level:
It may cause damage to the 8th cranial nerve at toxic levels (hearing loss)
Aminoglycosides
62
An antibiotic that requires trough and peak measurements
Aminoglycosides
63
A glycopeptide effective against gram-positive cocci and bacilli
Vancomycin
64
Its toxic side effects occur in the therapeutic range; causes red-man syndrome, nephrotoxicity and ototoxicity
Vancomycin
65
This drug distributes to all tissues, and concentrates in the CSF
Chloramphenicol
66
A long acting barbiturate that controls grand mal tonic-clonic seizure and focal epileptic; not used for petit mal
Phenobarbital
67
Used for treating withdrawal symptoms in infants whose mothers are addicted to opiate or barbiturate
Phenobarbital
68
Used to treat cases of congenital hyperbilirubinemia; enhances bilirubin metabolism
Phenobarbital
69
Controls seizures (tonic-clonic, simple partial seizures); a short term prophylactic agent in brain injury
It is not used for petit mal or atomic seizures
Phenytoin
70
Used for treatment of petit mal, atomic seizure, and grand mal
Valproic acid
71
This drug is highly protein bound (93%)
Valproic acid
72
A tricyclic compound related to imipramine. It is effective for grand mal seizures and treating seizures accompanied by pain; it has antineuralgic action
Carbamazepine
73
Can cause idiosyncratic effects: rashes, leukopenia, nausea, vertigo, febrile reactions
Carbamazepine
74
DOC for controlling petit mal
Ethosuximide
75
Chemically similar to neurotransmitter gamma aminobutyric acid
It is used for partial seizures; for adjunctive therapy
Gabapentrine
76
Drugs used for adjunctive therapy for partial seizures
Gabapentin
Topiramate
Lamotrigine
77
Treatment for manic-depressive illness (bipolar disorders) and is the DOC for the prevention of chronic cluster headache
Lithium
78
Inhibits thyroid hormone synthesis and release by the inhibition of iodine uptake
Lithium
79
Inhibits the effect of ADH on the kidney
Lithium
Demeclocycline
80
Treatment for depression, insomnia, extreme apathy and loss of libido
Tricyclic antidepressants (TCAs)
81
Major metabolite of TCA
Desipramine
82
Blocks the reuptake of serotonin in central serotonergic pathways
Fluoxetine
83
Treatment for OCD
Fluoxetine
84
It belongs to the methylated xanthine class
Its action is specific to the relaxation of bronchial smooth muscle
Theophylline
85
It is used in the treatment of asthma and chronic obstructive pulmonary disease
Theophylline
86
Drug for primary apnea prematurity (absence of respiratory effort in newborn infants)
Theophylline
87
This drug crosses the placenta and may be teratogenic in pregnant females
Theophylline
88
Used to prevent rejection of allogenic organ transplants by inhibiting the cellular immune response by blocking the production of IL-2
Cyclosporine
89
Used for suppressing acute graft-versus-host disease (GVHD)
Cyclosporine
90
A macrolide lactone antibiotic that is 100x more powerful than cyclosporine
Tacrolimus
91
This drug is elevated in the presence of cholestasis
Tacrolimus
92
Similar to tacrolimus; major side effects are lipid abnormalities and thrombocytopenia
Rapamycin
93
Decreases renal allograft rejection
Mycophenolate mofetil
94
Inhibits lymphocyte proliferation; for treatment of RA
Leflunomide
95
It inhibits DNA synthesis in all cells by blocking dihydrofolate reductase
Methotrexate
96
Drug used to reverse the action of methotrexate
Leucovorin
97
An alkalyting agent used to treat leukemias and lymphomas prior to bone marrow transplantation
Busulfan
98
It is a commonly used analgesic, antipyretic and anti-inflammatory drug that directly stimulates the respiratory system and an inhibitor of the kreb’s cycle. It also has an anticoagulant property (antiplatelet activity) by inhibiting the action of cyclooxygenase
Salicylates
99
It decreases thromboxane and prostaglandin formation through inhibition of cyclooxygenase
Salicylates
100
Is a common cause of fatal drug poisoning in children characterized by.... xonrinue okes
Acute aspirin intoxication
101
An inhibitor of prostaglandin metabolism. It is commonly used as analgesic and antipyretic drug
Acetaminophen
102
Overdosage of this drug leads to hepatoxicity
Acetaminophen
103
toxic effects: mixed acid-base disturbance (metabolic acidoses and respiratory alkalosis), hypoglycemia, and Reye’s syndrome
Salicylates
104
Toxic effect: xyanosis due to methemoglobinemia, CNS depression and seizure
Acetaminophen
105
It has analgesic and anti-inflammatory actions with a lower risk of toxicities than salicylates and acetaminophen
Ibuprofen
106
Toxic effects: nausea, vomiting, blurred vision, abdominal pain, edema
Ibuprofen
107
Used in the treatment of acute schizonphrenia
Antipsychotic major tranquilizers
108
Specimen of choice for TDM
Serum or plasma
109
Whole blood EDTA sample is required for which drugs?
Cyclosporine and tacrolimus
110
When are trough concentrations drawn?
Immediately (or 30 minutes) before the next dose
111
Relationship between trough level and drug clearance rate
Inversely proportional
112
When are peak concentration drawn for orally administered drugs?
One hour after an orally administered dose (except digoxin)
113
When are peak concentrations drawn for IV infused drugs?
Peak levels are determined after the infusion is completed
114
How are drugs identified when using immunoassay method?
The drug must bind to antibody before it is identified
115
Method in which drugs are identified according to how far they have travelled or separated and to how they appear with each of the satains
Thin layer chromatography
116
Acidic drugs are extracted at what pH?
4.5
117
Alkaline drugs are extracted at what pH?
9.0
118
Method ideal for the separation of tricyclic antidepressants and its metabolites
HPLC
119
Gold standard for TDM
GC-MS
120
True or false
Toxicity is avoided as long as the dose of drug is within accepted therapeutic range
FALSE
Altered pharmacokinetics may result in toxicity even when the dose of drug is whin accepted therapeutic range. This is caused by the presence of unmeasured metabolites that are physiologically active and the presence of a higher than expected concentration of free drug
