Therapeutic Drug Monitoring And Clinical Toxicology

Question 1

What are the drug groups you know?

Answer 1

Cardioactive

Antibiotics

Antiepileptic

Psychotherapeutic

Antiasthmatic

Immunosuppressive

Antineoplastic

Antihypertensive

Question 2

Name the cardioactive drugs you know

Answer 2

Digoxin

Lidocaine

Quinidine

Procainamide

Question 3

What drug group does digoxin belong❓

Answer 3

Cardioactive drug

Question 4

What does digoxin do❓

Answer 4

Cardiac glycoside that allows for better cardiac contraction and rhythm

Question 5

How does digoxin function❓

Answer 5

Inhibits membrane Na, K ATPase pump

⬇️intracellular K
⬆️Ca

Question 6

The peak after administration of digoxin occurs….

Answer 6

2 hours post dose

Question 7

What’s the therapeutic range of digoxin❓

What are its toxic effects❓

How is it excreted❓

Answer 7

O.8-2ng/mL

Premature ventricular contractions
Atrioventricular node blockage

By renal filtration

Question 8

How is digoxin measured in serum?

Answer 8

Immunoassay

Question 9

What drug group does lidocaine belong❓

What does it do❓

Answer 9

Cardioactive drug

• Used to correct ventricular arrhythmias
• Used to correct ventricular fibrillation

Question 10

What’s the therapeutic range of lidocaine❓

What are its toxic effects❓

How is it excreted❓

Answer 10

1.5-4.0 micrograms/mL

CNS depression

Completely eliminated by the liver if orally given as MEGX (monoethylglycinexylidide)

Question 11

What drug group does quindine belong❓

What does it do❓

How does it work❓

Answer 11

Cardioactive drug

Prevents cardiac arrhythmias, atrial flutter and fibrillation

🚫Na and K channels

Question 12

What drug group does procainamide belong❓

What does it do❓

How does it work❓

Answer 12

Cardioactive drug

Used to treat cardiac arrhythmias

🚫Na channels

Question 13

How is procainamide measured in serum?

Answer 13

NAPA (N-acetyl procainamide)

Question 14

Name the antibiotics you know

Answer 14

Aminoglycosides

Vancomycin

Question 15

What drug group do aminoglycosides belong❓

What do they do❓

Answer 15

Antibiotics

Used to treat infections with gram-negative bacteria that are resistant to less toxic antibiotics

Question 16

How do aminoglycosides function❓

Give a few examples

Answer 16

Inhibit protein synthesis of the microorganisms

Gentamycin, tobramycin, amikacin, kanamycin

Question 17

Aminoglycosides are associated with nephro and ototoxicity

True or false

Answer 17

True

Question 18

What drug group does vancomycin belong❓

What does it do❓

How does function❓

Answer 18

Antibiotics

Used to treat infections with more-resistant gram-positive cocci and bacilli

Inhibits cell wall synthesis

Question 19

What are antiepileptic drugs used for❓

Give examples

Answer 19

To treat seizure disorders and epilepsy

First generation:
Phenobarbital- Barbiturate primidone
Phenytoin- Dilantin 
Valproic acid- Depakene
Carbamazepine- Tegretol 

Second generation: 
Felbamate
Gabapentin 
Levetiracetam
Oxcarbazpine 
Tigabine 
Topiramate 
Zonisamide

Question 20

What are psychotherapeutic drugs used for❓

Give examples

Answer 20

Used to treat manic depression (bipolar disorder)

Lithium
Tricyclic antidepressants
Clozapine

Question 21

What are antiasthmatic drugs used for❓

Give examples

Answer 21

Used to treat breathing or respiratory disorders of adults or children like asthma

Theophylline
Theobromine

Question 22

What are immunosuppressive drugs used for❓

Give examples

Answer 22

1.
•Used to treat autoimmune diseases
•Used to prevent organ rejection

2. •Cyclosporine
   •Tacrolimus (Prograf)
   -prevents rejection of liver and kidney transplants

Question 23

What are antineoplastic drugs used for❓

Give examples

Answer 23

Inhibit RNA or DNA synthesis of tumor cells, leading to death

Methotrexate (🚫 DNA synthesis)

Question 24

The efficacy of methotrexate is dependent on what❓

Answer 24

A controlled period of inhibition that is detrimental to neoplastic cells

*Leucovorin rescue

Question 25

What are antihypertensive drugs used for❓ How do they function❓ Give examples

Answer 25

Treatment of high blood presssure Dilate blood vessels Na nitroprusside (short term control of hypertension)

Question 26

What are the techniques used in measuring TDM❓

Answer 26

Immunoassay Chromatography Mass spectrometry

Question 27

What drugs are frequently associated with poisoning❓

Answer 27

``` Ethanol Paracetamol Salicylates Benzodiazepines Tramadol ```

Question 28

What antidote is used in the management of acetaminophen/paracetamol poisoning❓

Answer 28

N-acetylcysteine

Question 29

What happens in paracetamol poisoning❓

Answer 29

``` NORMAL: Following the use of acetaminophen ⬇️ n-acetyl-p-benzoquinoneimine (NAPQI) formed through the action of cytochrome p450 ⬇️ Glutathione detoxifies NAPQI ``` ``` In POISONING: High doses of paracetamol ⬇️ High NAPQI levels ⬇️ Exhaustion of glutathione ⬇️ 🚫detoxification of excess NAPQI ⬇️ NAPQI accumulates ⬇️ hepatotoxicity ```

Question 30

What are the clinical features of paracetamol poisoning❓

Answer 30

Nausea and vomiting first 24hrs Consciousness is maintained Abdominal pain Abnormal prothrombin time Elevated liver enzymes Bilirubin Encephalopathy Liver failure Renal failure

Question 31

How is paracetamol poisoning treated❓

Answer 31

Specific antidote N-acetylcystein given IV Oral methionine assist in glutathione regeneration Fluid and electrolyte management Acid base homeostasis Regular blood level monitoring

Question 32

What metabolic changes are observed in alcohol poisoning❓

Answer 32

``` Hypertriglyceridaemia Hypoglycemia Hyperuricaemia Hypogonadism Cushing like syndrome Thiamine deficiency ``` ⬆️RBC volume ⬆️plasma GGT

Question 33

Blood level >3g/L (65mmol/L) is diagnostic of alcohol poisoning True or false

Answer 33

True

Question 34

What are the sources of lead❓

Answer 34

Old paint Cosmetics Pipelines

Question 35

Lead poisoning is symptomatic at what concentration❓

Answer 35

Symptomatic- 5 micromol/L Upper limit- 2.9 micromol/L Follow up- 0.5 micromol/L

Question 36

What are the clinical features of lead poisoning❓

Answer 36

Nausea Vomiting Encephalopathy Convulsions

Question 37

How would you treat a case of lead poisoning❓

Answer 37

Fluid rehydration Use of chelating agent like IV sodium calcium edetate Oral dimercaptosuccinic acid to promote excretion

Question 38

Acetaminophen/paracetamol poisoning occurs when >= 150mg/kg True or false

Answer 38

True