Theraputic Drug Monitoring Flashcards by Kailea Boerste

What is TDM?

Measurement of drugs and or metabolites in body fluids - usually blood- to maintain therap. benefits

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Describe T.R

the dose, concentration or range of a drug within the drug produces the desired theraputic effect

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Describe T.R out of range

ineffective or toxic effect

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T/F most drugs require monitoring

false, most drugs dont

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Important Considerations of TDM

timing of collection (important)
Accurate measurement of []
Timely reporting of results

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When is TDM used

when drug has narrow T.R
marked pharmokeinetic variabilites
Critical Adverse effects

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Main purpose of TDM
ID?

ensure correct dosage for the T.R
ID drug interactions if multiple drugs are taken together

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Factors that affect drug concentration

Age
gender
genetics
diet
co-drugs
naturopathic

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T/F: TDM can help establish dosing regimen

Can ID non-compliance or changes if needed

Based on studies pharmokin/pharmogen

TRUE

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Describe Pharmokinetics
study of
provides a time?
absorb….
what place what time?

study of movement of drugs in the body
provides a time-course of drug [ ] as absorption/disturb/metabolism
Drugs at right place at right time

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Describe the route of drugs intake briefly

Oral most common
IV most direct/effective
IM
Sub cutaneous
Aerosol
Rectal

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Describe Bioavilability

Amount of dose that reaches site as needed

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Describe drug absorption
oral efficiency
factors that influence
how does it move across the membrane?

Oral: effic. of absorb from GI tract depends on sev. factors
solubility of GI fluid
diffuse across membrane

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T/F: Some drugs require active transport mechanisms like dietary consituents

true

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How are most drugs absorbed? What are some things needed?
ga

Most absorbed passively through GI tract into the blood stream
Drug - hydrophobic
Gastric acidity

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Gastric Acidity:
WA:
WB:

WA - efficently absorb by stomach
WB: absorbed in intestines

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What are some things that affect drug absorbtion

changes in intestinal motility/pH/inflammation/food/other drugs

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T/F morphine slows GI motility

true

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Describe drug distribution
hint:movement of drug…

movement of a drug between blood circulation/tissues/organs and the relative proportion of drug in tissues

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T/F Free fractions can not diffuse out of vasulature

False, they can diffuse out of the vasculature and into intersitial places

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The ability to leave circulation depends on what?
Hydrophobic
Polar
Ionized

Lipid solubility
High hydrophobic - easily cross
Polar can cross but dont enter
Ionized diffuse out of vasculature but slowly

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Volume of distribution to drug concentration
Hydrophobic
Ionized

Hydrophobic has large vol Distrib
Ionized or primary protein has small volume

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Briefly describe free vs bound drugs

Active fractions

most drugs are subject to binding w serum protein (Drug-protein complex)

Only free/unbound can interact with site of action/bioresponse (Active fraction)

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Briefly describe Standard dose

total plasma concentration within T.R, adverse effects w/ free fraction or no therp benefit to low free fract

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T/F changes in active fractions may not occur secondarily to changes in plasma protein concentration

False

Describe ALB majority of major..

majority of plasma protein const. major transporter of blood

T/F free fractions are influenced by other drugs

True

T/F measurement of free fractions shouldn't be considered when drugs are highly bound/or have clinical signf inconsistences

False

Describe Drug Metabolism how are all substances absorbed

All substances are absorbed from intestines and (excreted through rectum) enter hepatic portal

Describe the first pass effect in drug metabolism

drug is metabolized reduced effect before reaching circulation system certain drugs have significant hepatic metabolism

Describe an inpaired liver tam

reduced metabolism absorbtion/dosing adjustments theraputic active metabolite

T/F most drugs aren't Xenobiotics

false, most drugs are

Describe Xenobiotics

EXOGENOUS substances able to enter biochem pathway ment for endogenous pathway

Whatre the two groups for Xenobiotics

Phase 1 reactive - reactive intermediates Phase 2 - conjugate function groups to react sits in H20 sol production

T/F MFO is non specific, endo/exogeneous subst. to go through

true

Describe Drug elimination

free fractions subject to golm. filtration and renal secretion Drugs not secreted are reabsorbed

T/F elimination rates are directly related to GFR Decreased GFR results in Decreased Half life

True

T/F decrease in plasma drug [ ] is most often not a first order reaction

false it is mostly a first order process Exponential rate of loss

T/F most drugs are not administered as a single bolus but on a scheduled basis

true

How many doses are typically needed before a steady-state is achieved

5-7 doses

Describe Pharmacodynamics

biochem/physiological effects of drugs/mean of their actions is described as relationship between drug [ ] at site of action and response

What is the most common mechanism of action

drug activates receptors at site of action

Describe Emax EC50

max efficiency 50% max efficiency

Describe tolerance

constant exposure of receptors to drugs that leads to less of a response

What is the single most important factor in specimen collection When is peak? (Oral/IV)

timing Peak in oral is after 1 hr Peak in IV is 90 min

T/F drug only appears after steady state is achieved What is the specimen of choice

true Serum is the specimen of choice (gel may interfere)

Describe Pharmacogenomics effectivness?

science of studying variations and developing drug therapies to compensate for genetic drift impacting therapy regimens Effectiveness depends on pt response

T/F responders to drugs have more benefit while non responders do not have a beneficial effect

true

What is the primary drug affecting gene metabolism, What does it encode for?

CYP450 Encodes for Cytochrome P450

Briefly Describe Digoxin What kind of drug treats? inhibits? peak? elim? Drugs that impact?

cardiactive drug treats arrythmias Inhibits NaK-ATPase Peak 2-3 hrs Elim through renal Digibind (overdose) biotin do not use at same time

Describe briefly Quiniaine What kind of drug natural from? routes peak

Cardioactive drug natural from bark Oral/GI peak 2hrs

Briefly decribe Disopyramide what kind of drug substitute for? peak? elim? binds to

Cardioactive drug Substitute for Quiniaine Peak 1-2 hr renal elim binds to serum/plasma prt

Briefly Describe Procanamide What kind of drug rapid in? peak? elim?

Cardioactive drug oral rapid peak 1 hr renal/hepatic

Describe NAPA

Hepatic metabolizm of procanimide

Describe Aminoglycosides briefly what type of drug what kind of infections inhibits? incr poor? what kind of drug absorb

Abx Gram Neg/Gram pos infections inhibits bacteria synth incr. bld [ ] can affect POORLY ABSORBED IN GI IV/IM

Describe Getamiein Briefly what kind of drug treats? how many times a day doses?

Abx Treats GNR - life threatening 2-3x a day can do high doses

Briefly describe Tobramycin What kind of drug treats what kind of toxin

ABX Treats GNR Ototoxic/Nephrotoxic Baseline with audiology testing

Decribe Amiracin what kind of drug infection taken how

Abx severe blood infection orally

Describe Vancomycin what kind of drug Treats Syndromes? Poor What kind of toxin

ABX GPC/GNR Redman syndrome poor GI absorb nephro/auto toxin

Briefly describe Anti epileptic drugs whatis critical?

treat/supress seizures TDM critical

Describe Primidone what kind of drug treats converted by? Gets to what quicker

Anti epileptic drug grand mal seizures conv. by liver met gets to steady state quicker

Describe Phenorbital what kind of drug action is fast or slow? Elim What is measured

Anti-epileptic slow acting oral Elim w hepatic only troughs measured

Describe Phenytonin/free phenytonin treats what dosing problems bound/free

Common treat for seizures/short term prophy agent in brain injury seizures in hyper/hypo dosing total and free fraction (90% bound 10%free)

Describe Volproic acid (depakole) what kind of drug rapid? bound? what metabolism Dysfunction?

Anti epileptic oral-gi rapid HIGHLY PRT BOUND hept met dysf 6 mos

Describe Carbamazepine what kind of drug effects? Gabapentin what kind of drug binds to? in what kind of pts?

severe adverse effects/last resort/high variable/toxic Gaba- seizures/pain management binds to protein (pt w liver disease)

Describe Lithium what kind of drug rapid/slow? binding?

phsychoactive drug mood alt oral rapid doesnt bind to proteins

Describe Tricyclic antidepressents (TAD) Clozapin Olanzapine

depression/insom/loss of libido Clo - schizophrenia refractory TDM checks Ola- schizophrenia/mania

Describe Cyclosporin What diseases/dependent on/what type of blood Tacroliaus Potency Sirolinus Anti...

Cyclo - cyclic polypept - suppresses graft vs host/whole blood/temp depend T -100x more potent S - antifungal kidney transplant

Describe Anti neoplastics what type of dose drug? M

treat cancers rapid met delivered dose METHOTREXATE

Describe Bronchodilators

Respiratory disorders/asthsma people who cant use inhalers THEOPHYLLINE

Theraputic Drug Monitoring Flashcards

(70 cards)