TUMOR MARKERS, TDM, & TOXICOLOGY Flashcards
(156 cards)
1
Q
Tumor type : liver
Tumor marker : ?
A
AFP
2
Q
Also increased in germ cell tumors
A
AFP
3
Q
Tumor type : Colorectal
Tumor marker : ?
A
CEA
4
Q
Tumor type : Ovarian
Tumor marker : ?
A
CA-125
5
Q
Tumor type : GASTRIC
Tumor marker : ?
A
CA 72-4
6
Q
Also increased in colorectal cancer
A
CA 72-4
7
Q
Tumor type : pancreatic
Tumor marker : ?
A
CA 19-9
8
Q
Also related to Lewis blood group antigens ; also increased in gastric and colorectal cancers
A
CA 19-9 pancreatic
9
Q
Tumor type : breast
Tumor marker : ?
A
CA 15-3, 27.29
ER, PR, HER-2 / neu
10
Q
Used to monitor therapy and detect recurrence
A
CA 15-3, 27.29
11
Q
Prognostic and hormonal therapy indicator ; detected in biopsy specimens using immunohistochemistry
A
ER, PR, HER-2/neu
12
Q
Tumor type : prostate
Tumor marker : ?
A
PSA
13
Q
Used for prostate cancer screening in combination with DRE
A
PSA
14
Q
Tumor type : NEUROENDOCRINE TUMORS
Tumor marker : ?
A
NEURON-SPECIFIC ENOLASE
15
Q
Prognostic indicator and monitoring progression
A
NEURON-SPECIFIC ENOLASE
16
Q
Tumor type : Lung
Tumor marker : ?
A
CYFRA 21-1
17
Q
Subunit of cytokeratin fragment expressed in simple epithelia
A
CYFRA 21-1
18
Q
Tumor type : URINARY BLADDER
Tumor marker : ?
A
NUCLEAR MATRIX PROTEIN
19
Q
Oncogene -encoded protein
A
Nuclear matrix protein
20
Q
Tumor type : thyroid
Tumor marker : ?
A
Thyroglobulin
21
Q
Increased in other thyroid diseases
A
Thyroglobulin
22
Q
Major source of thyroglobulin assay interference
A
Anti-thyroglobulin antibody
23
Q
Tumor type : medullary thyroid
Tumor marker : ?
A
calcitonin
24
Q
Screening, response to therapy, and monitoring recurrence
A
Calcitonin
25
Tumor type : ovarian, testicular
Tumor marker : ?
B-hCG
26
Also increased in gestational trophoblastic diseases e.g. choriocarcinoma, hydatidiform mole, GI neoplasia
B-hCG
27
Tumor type : NEUROBLASTOMA
Tumor marker : ?
Homovanillic acid (HVA) , vanillylmandelic acid (VMA)
28
Determined on 24 hr urine using HPLC
HVA, VMA
29
Tumor type : PHAEOCHROMOCYTOMA
Tumor marker : ?
Metanephrine, normetanephrine
30
Determined on 24 hr urine or plasma using HPLC
Metanephrine , normetanephrine
31
Highest point ; amount of drug absorbed and distributed is greater than the amount metabolized and excreted
Peak
32
Lowest concentration achieved just before the next dose
Trough
33
Time required for the concentration of the drug to decrease by half
Half-life
34
Amount of drug absorbed and distributed equals amount metabolized and excreted ; usually reached after 5-7 half-lives
Steady state
35
Lowest concentration of drug in the blood that will produce adverse response
MINIMUM TOXIC CONCENTRATION (MTC)
36
Lowest concentration of drug in the blood that will produce desired effect
Minimum effective concentration
37
Range of values between the MEC and MTC that produce therapeutic effect
Therapeutic range
38
Drug dose that produces beneficial effect in 50% of the population
ED50 (EFFECTIVE)
39
Drug dose tat produces adverse effects in 50% of the population
TD50 (TOXIC)
40
Drug dose that produces death in 50% of the population
LD50 (LETHAL)
41
THERAPEUTIC INDEX
RATIO OF ED50 TO TD50
42
Used as a semi-quantitative screening test ; interpretation of results utilizes Rf values of solutes in complains to aqueous standards
Thin-layer chromatography
43
Distance migrated by a sample component / distance migrated by the solvent
Rf
44
For insufficiently volatile and thermolabile compounds
Liquid chromatography
45
Type of liquid chromatography where the mobile phase is a liquid that is passed over the stationary phase of the column
HPLC
46
Polar stationary phase and nonpolar mobile phase
Normal-phase LC
47
Nonpolar stationary phase and polar mobile phase
Reverse-phase LC
48
Useful for compounds that are naturally volatile or can easily be converted into a volatile form (various organic molecules including many drugs)
Gas chromatography
49
Time it takes for a compound to elude l used as basis for identification of a solute
Retention time (tr)
50
Proportional to the amount of solute present ; see for quantification
Peak area/height
51
Common detector system in GC or HPLC ; produces a signal for identification and quantification of the solutes
Mass spectrometry
52
Uses microparticles as solid phase, an enzyme label, and fluorogenic substrate
Micro particle enzyme immunoassay (MEIA)
53
A homogenous assay in which the activity of an enzyme as a label is inhibited by the binding of antibody to antigen conjugated with enzyme
Enzyme-multiplied immunoassay technique (EMIT)
54
Uses polarized light to excite a fluorescent label ; rat of rotation is inversely proportional to the degree of polarization and analyte concentration
Fluorescence polarization immunoassay (FPIA)
55
Drug activity or fate of drugs in the body
PHARMACOKINETICS
56
PHARMACOKINETICS is influence by the
Absorption
Distribution
Metabolism
57
Through the GI tract for orally administered drugs ; dependent on many factors and is related to the drug’s bioavailability
Absorption
58
Amount of drug absorbed relative to the quantity given ; affected by firs-pass metabolism, which reflects the activity of metabolic enzymes, in the intestine and liver
Bioavailability
59
Diffusion out of the vasculature into interstitial ad intracellular spaces ; dependent on the lipid solubility of the drug
Distribution
60
Hepatic uptake and enzymatic bio transformation in the hepatic microsomes via the cytochrome P450 enzyme system
METABOLISM
61
Elimination through hepatic or renal clearance or a combination of the two
Excretion
62
Biochemical and physiological effects of drugs and the mechanisms of their actions ; involves receptor binding, post receptor effects and chemical interactions
Pharmacodynamics
63
TDM SPECIMEN CONSIDERATIONS
_____ must be established before sampling
Steady sate
64
TDM SPECIMEN CONSIDERATIONS
______ when toxicity is suspected
STAT Sampling
65
TDM SPECIMEN CONSIDERATIONS
_______ before the next dose is administered
Trough specimen
66
TDM SPECIMEN CONSIDERATIONS
1 hour after oral administration ; 0.5 hour after completion of IV administration
Peak specimen
67
Specimen preferred for most drug assays
Serum
68
Suitable for most drugs lithium and free drug assays
Heparinized plasma
69
May falsely decreased TCAs and anti-arrythmics
SST/PST
70
Appropriate for immunosuppressants
EDTA WB
71
Recommended for the impedance method of aspirin determination
Hirudin
72
A cardiac glycoside used to treat congestive heart failure ; inhibits sodium, potassium ATPase, causing decrease in intracellular potassium and increase in intracellular calcium resulting in improved contraction of cardiac muscle
DIGOXIN
73
Used to treat tachyarrhthymias
Antiarrhythmics
74
Cardioadictive drugs classes I-IV
Sodium channel blockers
Beta blockers
Potassium channel blockers
Calcium channel blockers
“So Be It Pota Ca”
75
Cardioadictive drug class I
Lidocaine, quinidine, disopyramide, procainamide
76
Cardioadictive drug class II
Propanolol
77
Cardioadictive drug class III
Amiodarone
78
Cardioadictive drug class IV
Verapamil
79
Metabolized to monoethylglycinexylidide (MEGX), which enhances toxicity
LIDOCAINE
80
Metabolized to N-acetylprocainamide (NAPA) which exhibits the same physiologic effect as the parent drug
Procainamide
81
First generation (classical) anticonvulsants
Phenobarbital
Benzodiazepines
Phenytoin (Dilantin)
Carbamazepine (tegretol)
Ethosuximide
Valproic acid (Depakote)
82
First generation anticonvulsants used to treat granola or tonic-clonic seizure
Phenobarbital
Benzodiazepines
Phenytoin
Carbamazepine
83
Inactive form of phenobarbital
Primidone
84
New generation anticonvulsants
Tiagabine, vigbatrin, gabapentin, topiramate, felbamate
85
BRONCHODILATOR (B-andrenergic agonists) : used to treat asthma and COPDs
Theophylline
86
BRONCHODILATOR (B-andrenergic agonists) :
Minor metabolite of theophylline ; treatment of neonatal apnea
Caffeine
87
PSYCHOACTIVE DRUG : Major tranquilizers used to treat schizophrenia
Neuroleptics
88
Neuroleptics:
Phenothiazines — chlorpromazine
Butyrophenones — haloperidol (Haldol)
89
PSYCHOACTIVE DRUG : antimanic drug ; used to treat bipolar disorder/ manic depressive disorder
Lithium
90
PSYCHOACTIVE DRUG : used to treat clinical depression (major depressive disorder)
ANTIDEPRESSANT
91
ANTIBIOTICS : used to treat gram negative infection by inhibiting protein synthesis ; toxic effects include nephrotoxicity and ototoxicity (Deafness)
Aminoglycosides
92
Antibiotic used to treat gram positive infection ; may cause erythemic flushing of extremities called REDMAN SYNDROME
VANCOMYCIN
93
Used to prevent graft-versus-host disease
Immunosuppressant
94
Immunosuppressant : block T lymphocyte function
Calcineurin inhibitors
95
Immunosuppressant (Calcineurin inhibitors) : fat-soluble cyclical peptide isolated from Trichoderma
Cyclosporine
96
Immunosuppressant (Calcineurin inhibitors) : macrolide lactone isolated from Streptomyces ; 100x more potent than cyclosporine (administered in much lower doses) ; associated with thrombus formation in patients with toxic levels
Tacrolimus
97
Immunosuppressant : sirolimus (rapamycin), everolimus, mycophenolate, leflunomide
Proliferation signal inhibitors
98
ANTINEOPLASTIC : Inhibits DNA synthesis ; requires administration of LEUCOVORIN
Methotrexate
99
To rescue host cells from methotrexate inhibition
Leucovorin
100
ANTINEOPLASTIC : alkylating agent used to treat leukemias and lymphomas before bone marrow transplantation
Busulfan
101
Associated with a single, short-term exposure to a substance, the dose oof which is sufficient to cause immediate toxic effects
Acute toxicity
102
Results from repeated frequent exposure for extended periods at doses insufficient to cause an immediate response l may affect different systems
Chronic toxicity
103
Used as an analgesic, antipyretic, and anti-inflammatory ; exhibits antiplatelet activity through inhibition of clyclooxgenase ; toxic effects include mixed acid base disorders, Reye syndrome
Acetylsalicylate (Aspirin)
104
Preferred over aspirin inhibitors patients with a bleeding disorder ; toxic effect hepatotoxicity
Acetaminophen (Tylenol)
105
Domapinergic pathway stimulants : local anesthetic ; primary metabolite ______ ; short half life of _______
Cocaine ; benzoylecgonine ; 1-2 hours (05.-1 hr)
106
Domapinergic pathway stimulants : used to treat narcolepsy
Amphetamines (methamphetamine)
107
Domapinergic pathway stimulants : euphoria-producing synthetic phenylethylamines
Designer drugs
108
Domapinergic pathway stimulants : MDMA
ECSTASY
109
DEPRESSANTS :
SEDATIVE/HYPNOTICS
OPIATES/NARCOTICS
110
SEDATIVE / HYPNOTICS
BARBITURATES
BENZODIAZEPINES
METHAQUALONE (QUAALUDE)
111
Not structurally similar to but has many of the properties of barbiturates
METHAQUALONE
112
Depressant used for sedation, analgesia, and anesthesia
Opiates/narcotics
113
Opium, morphine, and codeine
Naturally occurring narcotics
114
Heroin, hydyromorphone (Dilaudid), and oxycodone (percodan)
Chemically modified narcotics
115
Hallucinogens/psychedelics : primary cannabinoid component
tetrahydrocannabinol
116
Hallucinogens/psychedelics :
Major urinary metabolite of cannabis saliva
tetrahydrocannabinol carboxylic acid
117
Hallucinogens/psychedelics : structurally similar to serotonin l acts as serotonin agonist l produces panic reactions and undulating vision
Lysergic acid diethylamide
118
Hallucinogens/psychedelics : structurally similar to serotonin l acts as serotonin agonist l produces panic reactions and undulating vision
Lysergic acid diethylamide
119
Hallucinogens/psychedelics : angel dust or angel hair
Phencyclidine
120
Hallucinogens/psychedelics : a tricyclic compound with varied actions and paradoxical symptoms in pediatric medicine
Phencyclidine
121
Hallucinogens/psychedelics : commonly used as an anesthetic for short surgical procedures
Ketamine
122
Miscellaneous classes : derivatives of serotonin with hallucinogenic properties e.g. dimethyltryptamine and psilocin/psilocybin
Tryptamines
123
Miscellaneous classes : produce effects similar to to hose of the amphetamines
Piperazines
124
Miscellaneous classes : psychoactive designer drugs that produce amphetamine-or cocaine-like effects ; causes false positive methamphetamine screening result
Synthetic cathinones (bath salts)
125
Miscellaneous classes : non-benzodiazepine agents
Sleep aids
126
Miscellaneous classes : CNS depressant used in pain management
Muscle relaxants
127
Most commonly abused substance in the world l chronic exposure is associated with toxic hepatitis and cirrhosis
Ethanol
128
Blood alcohol legal intoxication (% w/v)
>0.1
129
BAC (w/v%) : 0.01-0.05
Level of impairment : no obvious impairment
Influence : ?
Subclinical
130
BAC (w/v%) : 0.03-0.12
Level of impairment : mild euphoria ; some impairment of motor skills
Influence : ?
Euphoria
131
BAC (w/v%) : 0.09-0.25
Level of impairment : loss of critical judgment ; memory impairment
Influence : ?
Excitement
132
BAC (w/v%) : 0.18-0.30
Level of impairment : mental confusion ; strongly impaired motor skills
Influence : ?
Confusion
133
BAC (w/v%) : 0.27-0.40
Level of impairment : impaired consciousness
Influence : ?
Stupor
134
BAC (w/v%) : 0.35-0.50
Level of impairment : complete unconsciousness ; deep, possibly fatal, coma
Influence : ?
Coma
135
BAC (w/v%) : >0.45
Level of impairment : respiratory arrest
Influence : ?
Death
136
Reference method for ethanol
Gas-liquid chromatography
137
Most commonly used / effective screening test for ethanol
Osmometry / osmolal gap
138
Causes acidosis, blindness, and death due to formation of formaldehyde and formic acid
Methanol
139
Produces severe acute ethanol-like symptoms that persist for a long period of time
Isopropanol
140
Ingestion produces severe metabolic acidosis and renal tubular damage
Ethylene glycol
141
245x greater affinity for Hb compared to oxygen ; shifts the oxyhemoglobin dissociation curve to the left (hypoxia)
Carbon monoxide
142
Commonly used as rodenticide/insecticided ; characteristic odor of BITTER ALMONDS ; binds to heme iron and mitochondrial cytochrome oxidase inhibiting oxidative phosphorylation and causing cellular hypoxia
Cyanide
143
Aspiration is associated with pulmonary edema and shock, which can rapidly progress to death ; ingestion causes metabolic acidosis or alkalosis and may produce lesions or perforations in the esophagus and GI tract resulting in hematemesis abdominal pain and possibly shock
Caustic agent
144
Component of insecticides, pesticides, herbicides ; high affinity for KERATIN, binds to sulfhydril groups of proteins ; characterized by GARLIC BREATH odor and metallic taste ; associated with transverse WHIITE STRIATIONS in the nail beds called MEES LINE S
ARSENIC
145
Metal food container or industrial exposure ; may cause RENAL TUBULAR DAMAGE
Cadmium
146
Inhibits many enzymes and affects vitamin D metabolism and heme synthesis pathway
Lead
147
Enzymes inhibited in the heme synthesis pathway
ALA dehydrates / PBG synthase
Ferrochelatase / heme synthase
148
Inhibition of ALA dehydrates / PBG synthase causes high ____
Delta-aminolevulinic acid in urine
149
Inhibition of Ferrochelatase / heme synthase causes high ____
Free erythrocyte protoprophyrin
150
Acquired through inhalation, ingestion ; may also cause renal tubular damage
Mercury
151
Metallic form of mercury ; liquid at room temperature ; nontoxic
Elemental
152
Mercurous and mercuric forms ; moderately toxic
Cationic / inorganic
153
Alkyl, Aryl, and alkoxyalkyl forms ; environmental pollutants ; extremely toxic
Organic
154
Most toxic organic mercury because of their lipophilic nature that can easily cross membranes
Alkyl (methyl mercury)
155
Condition associated with methyl mercury
Minamata disease
156
Condition associated with methyl mercury
Minamata disease
