Therapeutic Drug Monitoring Flashcards

(35 cards)

1
Q
Which is true?
A.an equilibrium exists between free and protein-bound drug
B.acidic drugs are bound to globulin
C.basic drugs are bound to albumin
D.NOTA
A

A

Baliktad ang B at C

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2
Q

Which is false?
A.k-value is negative because it is decreasing
B.Indepedent of clearance mechanism, decreases in serum concentration of drugs often occur as zero-order process

A

B

first order dapat

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3
Q

Which among these chromatographic methods needs large sample volume but permits separation of parent drug from metabolites & co-administered drugs?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry

A

C

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4
Q

Which among these chromatographic methods needs allows direct analysis of biological specimen with minimal sample preparation?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry

A

D

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5
Q

Which among these chromatographic methods is adapted to simultaneous quantification of drugs and metabolites?
A.Gas Chromatography-Mass Spectrometry
B.HPLC
C.Gas-Liquid Chromatography
D.Liquid Chromatography-Mass Spectrometry

A

B

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6
Q
have parasympathetic-like effects on AV node cells; serum conc 8-10 hrs after  oral dose correlates with tissue conc
A.phenytoin
B.anti-epileptic drug
C.aminoglycosides
D.cardiotropics
A

D - used to treat arrhythmia, congestive heart failure

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7
Q

[Cardiotropics]
identify the ff:
A.general therapeutic range
B.general toxic level

A

A.0.5-2 ng/mL

B. >2 ng/mL

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8
Q
[Cardiotropics]
identify the ff:
A.half-life range. 
B.is this prolonged with dec renal fxn?
C.is it more bioavailable at elixir? or at liquid-filled capsule?
A

A.35-40 hours
B.yes
C.liquid filled capsule (90-100%). elixir or tablet is 60-85%

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9
Q

false about aminoglycosides
A.nephrotoxic effects are irreversible & ototoxic effects are reversible
B.toxic conc: above therapeutic range
C.measured via chromatography and immunoassay

A

A - baliktad kasi

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10
Q

false about anti-epileptic drugs
A.in a normal physiologic state, total drug conc is suffcient
B.most preferred specimen is whole blood
C.free drug meas may only be necessary in alteration of patient plasma protein
D.effective conc: acceptable/no side effects

A

B - serum dapat

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11
Q
Which is true?
A.aminoglycosides are antibiotics
B.phenobarbitals are cardiotropics
C.phenytoin is an amino acid
D.NOTA
A

A!

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12
Q
Phenobarbital: which is false?
A.absorption of oral dose is slow but complete
B.only trough levels are evaluated
C.50% protein-bound
D.fast-acting barbituate for seizures
A

D - slow acting! hence: A is true

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13
Q

False about phenytoin?
A.GIT absorption is sometimes incomplete
B.primidone is an inactive form that rapidly converts to Pb
C.major toxicity: seizure initiation
D.binds to protein a lot more than phenobarbital

A

B - is true for phenobarbital :)

note: 87-97% ang protein binding ng phenytoin. 50% @ phenobarbital

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14
Q

A.T/F all forms of phenytoin are detected in most immunoassays
B.Valproic acid is used for monotherapy of ___
C.GIT absorption of valproic acid: describe

A

A.F - Fosphenytoin isn’t
B.petit mal & absence seizures
C.rapid and complete

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15
Q

False about valproic acid
A.less protein bound than phenobarbital
B.nausea,lethargy,weight gain: common adverse reactions
C.hepatic dysfuction may occur even @ serum therapeutic conc

A

A - more bound!

note: 93% ang protein binding ng valproic acid. 50% @ phenobarbital

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16
Q

A.toxic level of valproic acid, please identify
B.most serious idiosyncratic drug effect of carbamazepine
C.when carbamazepine plasma conc > 15 ug/mL, what kind of anemia could be present?

A

A. > 120 ug/mL
B.leukopenia
C.aplastic anemia

17
Q
False about tricyclic antidepressants
A.orally admin
B.varying degree of absorption
C.85-95% protein-bound
D.therapeutic effects are seen in 1-3 days
A

D – therapeutic effects are not seen for 2-4 weeks after therapy initiation

18
Q

A.Why should tricyclic antidepressants @ plasma be evaluated when steady state has been achieved?
B.most preferable method for TCA screening
C.T/F TCA is eliminated by hepatic metabolism

A

A.high variability in half-life & absorption
B.immunoassays using polyclonal antibodies
C.T

19
Q

[cyclosporine]
A.primary clinical use
B.specimen of choice for

A

A. suppression of host vs graft reaction of heterotopic transplanted organs
B. whole blood

20
Q

A.How can overuse of cyclosporine lead to hypertension?

B.T/F For cyclosporine,relationship between oral dose & blood conc is poor.

A

A. renal tubular & glomerular dysfunction

B. T

21
Q
[cyclosporine]
used to measure its drug conc
A.immunoassay
B.chromatographic method
C.electrophoresis
A

A!

B – separation, quantification of parent drug fr metabolites

22
Q

antineoplastic drugs]
Which is false?
A.admin route for most is intravenous
B.therapeutic range conc: all w/o toxic effects
C.correlation between plasma conc and therapeutic benefit are hard to establish

23
Q

[methrotrexate]
A. this drug + ____ = antineoplastic power duo
B. What does this do @ DNA in cells?
C. T/F Efficacy dep on controlled period of inhibition

A

A.leucovorin rescue
B.inhibit DNA synthesis
C. T

24
Q

Which is/are false?
A.TDM must be done for most drugs.
B.Serum: most commonly used specimen for TDM
C.Binding of drug leads to altered cell functions
D.Drugs never compete for binding sites

A
A = limited number of drugs only
D = nope, they do esp similar structures!
25
accdg to Tietz, what are the 3 purposes of TDM
assess therapeutic compliance assess efficacy elucidate cause of drug-induced toxicity
26
differentiate pharmacodynamics from pharmacokinetics
pharmacodynamics: relate drug conc at the sie of action to magnitude of effect pharmacokinetics: relates dose, dosing interval and admin route to drug conc @ blood
27
A.What is kinetic homogeneity | B.Why is important?
A.assumes that changes in drug conc @ blood vs time are proportional to changes in local conc @ tissue B.basis on which all therapeutic conc & toxic conc are established
28
A.What is steady state | B.T/F The larger the difference bet min effect.con & min. toxic conc, the more TDM is needed
A.point at which body conc of drug is in equil with dose rate admin & rate of elim B.F – smaller dapat
29
A.What is bioavailability? | B.What is first-pass effect?
A.fraction of drug absorbed @ systemic circ B.Drugs orally admin: first exposed @ liver, metabolized before reaching the rest of the body… while IV drugs  directly systemic circ
30
Which is false? A.absorption rate constant of a drug is usually less than elimination rate constant B.displacement of a drug from plasma protein-binding sites never causes clinical toxicity C.Liver is the principal organ for drug metab
B – if free drug conc is increased, clinical toxicity is possible
31
enumerate 4 most impt determinants of drug dist
1. binding of drug to circulating blood comp 2. binding to fixed receptors 3. passing of drug through membrane barriers 4. Does it dissolve in lipids?
32
enumerate disease states that alter free drug conc
1. increase in non-protein nitrogen compounds in uremia 2. acid-base and electrolyte imbalances 3. decrease in albumin
33
Why do…. A.hydrophobic drugs have large volume of distribution index? B.ionized substances/plasma-bound ones have small volume of dist index?
A.partitioning of hydrophilic compartments | B.sequestration @ vasculature
34
``` volume of dist index = A. (IV injected dose) + (plasma conc) B. (IV injected dose) - (plasma conc) C. (IV injected dose) * (plasma conc) D. (IV injected dose) / (plasma conc) ```
D
35
A.What do phase I / phase II rxns in the liver do? | B.4 ways on how drugs are eliminated fr body
A.convert the lipophilic drugs to more water-soluble forms | B.biliary, intestinal, pulmonary, renal