Therapeutic Drug Monitoring & Toxicology

Question 1

Digoxin

Answer 1

• Cardioactive
• Cardiac arrhythmia and CHF
• Serum
• Immunoassay
• Oral
• Peak: 8-10 hrs

Question 2

Quinidine

Answer 2

• Cardioactive
• Serum
• Immunoassay
• Orally
• Peak: 2 hrs

Question 3

Procainamide

Answer 3

• Cardioactive
• Serum
• Immunoassay
• Orally
• Peak: 1 hr

Question 4

N-Acetyl-Procainamide (NAPA)

Answer 4

• Cardioactive
• Metabolized from Procainamide

Question 5

Gentamicin

Answer 5

• Aminoglycoside (antibiotic, G(-), IV + IM, serum, immunoassay)
• Nephrotoxicity, ototoxicity

Question 6

Vancomycin

Answer 6

• Aminoglycoside
• Nephrotoxicity, ototoxicity, Red man syndrome
• Peak: 1 hr

Question 7

Primidone

Answer 7

Antiepileptic
- grand mal seizure
- 2 hr
- immunoassay
- serum
- orally

Question 8

Phenobarbital

Answer 8

• Antiepileptic
• Peak 10 hrs
• drowsiness, fatigue, depression, decreased mental capacity

Question 9

Phenytoin

Answer 9

• Antiepileptic
• 3-12 hr peak
• seizures, gingival hyperplasia, vitamin D and folate deficiency
• immunoassay, serum, orally

Question 10

Valproic Acid

Answer 10

• Antiepileptic
• 1-4 hr peak
• Petit mal seizure
• Toxicity: nausea, lethargy, weight gain, pancreatitis, hallucinations

Question 11

Carbamazipine (Tegretol)

Answer 11

• Antiepileptic
• 4-8 hr peak
• Rashes, leukopenia, vertigo, nausea, febrile reaction

Question 12

Ethosuximide

Answer 12

• Antiepileptic
• 2-4 hr peak

Question 13

Lithium

Answer 13

• Psychoactive
• Bipolar, depression, self-mutilating behavior
• 2-4 hr peak
• Orally
• Colorimetric
• Serum
• Toxicity: apathy, lethargy, speech difficulty, muscle weakness, renal impairment, hypothyroidism, seizures, coma

Question 14

Cyclosporine

Answer 14

• Immunosuppressive (Organ rejection, minimize toxicity, whole blood)
• Sequesters RBC
• Toxicity: renal tubular and glomerular dysfunction

Question 15

Tacrolimus

Answer 15

• Immunosuppressive
• 100x more potent than Cyclosporine
• 1-3 hr peak
• whole blood

Question 16

Methotrexate

Answer 16

• Antineoplastic
• Cancer, inhibits DNA synthesis
• 1 hr
• Orally
• Serum
• Leucovorin reverses methotrexate

Question 17

Theophylline

Answer 17

• Bronchodilator
• Asthma, chronic pulmonary disease
• Orally or IV
• Serum

Question 18

Are poisons external or internal substances?

Answer 18

External
- Venom, poison hemlock, arsenic, lead, carbon monoxide

Question 19

Are toxins external or internal substances?

Answer 19

Internal
- Botulinum, hemotoxins, mycotoxins

Question 20

TD50

Answer 20

toxic dose

Question 21

LD50

Answer 21

lethal dose

Question 22

ED50

Answer 22

effective dose

Question 23

Therapeutic index

Answer 23

TD50 or LD50 / ED50

Question 24

Ethanol

Answer 24

• Fetal alcohol syndrome & pregnancy
• Chronic consumption —> alcohol hepatitis, liver cirrhosis
• Ethanol to liver —> free aldehyde —> acetic acid

Question 25

Methanol

Answer 25

- Common lab solvent, found in many household cleaners - Methanol (metabolized by hepatic ADH) —> formaldehyde —> formic acid

Question 26

Isopropanol

Answer 26

- Rubbing alcohol - Isopropanol (metabolized by hepatic ADH) —> acetone - CNS depressant effects

Question 27

Ethylene glycol

Answer 27

- Antifreeze - Ethylene glycol (metabolized by hepatic ADH and ALDH) —> oxalic and glycolic acid - Results in severe metabolic acidosis and calcium oxalate crystals in kidneys (renal tubular damage)