Unit 5 Flashcards
1
Q
What is heme composed of?
A
Protoporphyrin ring + Fe
2
Q
What is hemoglobin composed of?
A
Heme + 4 globin chains
3
Q
What is the storage form of iron?
A
Fe3+
Ferric
4
Q
What is the functional form of iron?
A
Fe2+
Ferrous
5
Q
What are porphyrins?
A
Any class of pigments whose molecules contain a flat ring of four linked heterocyclic groups
6
Q
What is Porphyrias
A
Diseases caused by enzyme deficiencies in the Heme production pathway.
*People will generally look purple.
7
Q
What is Hemin
A
A black inorganic compound which forms from heme when RBCs are lysed and exposed to air.
8
Q
What is the most common Primary Porphyrias?
A
Porphyria Cutanea Tarda (PCT)
9
Q
What is Porphyria Cutanea Tarda deficient in?
A
Uroporphyrinogen Decarboxylase
10
Q
What test is ordered to confirm PCT
A
Serum porphyrin
11
Q
What is PCT defined by?
A
Blistering
12
Q
What is Acute Intermittent Porphyria deficient in
A
PBG Deaminase
13
Q
What is AIP defined by
A
Blistering
Nerve Impairments
14
Q
What test is ordered to confirm AIP
A
Urine porphobilinogen
15
Q
What is Erythropoietic Porphyria deficient in
A
Ferrochelatase
16
Q
What will Erythropoietic Porphyria show an increase in
A
Total erythrocyte protoporphyrin
17
Q
What is Erythropoietic Porphyria defined by
A
Blistering
18
Q
What is the rate limiting step in porphyrin synthesis
A
ALA-Dehydratase
19
Q
How do we test for ALA-Dehydratase Deficiency
A
Delta-aminolevulinic
20
Q
What is the most common presenting symptom of ALA-Dehydratase deficiency?
A
Abdominal pain
21
Q
What does ALA-Dehydratase deficiency cause
A
Accumulation of d-aminolevulinic acid
22
Q
What does lead poisoning do?
A
Inhibition of most of the enzymes in the synthetic pathway
23
Q
What secondary porphyria has an elevated level of succinylacetone
A
Hereditary tyrosinemia
24
Q
What method do we use for Porphobilinogen
A
Watson-Schwartz
25
What Porphobilinogen method do we not use but is tested on
Hoesch
26
What is a must for all samples being tested for Porphyrins
MUST BE LIGHT PROTECTED
27
How are porphyrins evaluated
HPLC
28
What is a screening test for lead poisoning
Ferrochelatase
29
What form of Bili is lipophilic
Indirect/Unconjucated
30
What form of Bili is hydrophilic
Direct/Conjugated
31
Syndromes from an increase in unconjugated bilirubin
Crigler-Najjar
Gilbert
32
Syndromes when conjugated Bilirubin with biliary obstruction
Dubin-Johnson
Rotor
33
What is delta bilirubin
Conjugated bilirubin that is covalently bound to Albumin
34
How is hem mostly produced
Breakdown of RBCs in the spleen
35
What does Heme Oxygenase in macrophages do
Oxidize heme to biliverdin
36
What does biliverdin reductase in macrophages do
Reduces biliverdin to bilirubin
37
What is bilirubin bound to while being transported
Albumin
38
What conjugates bilirubin
UGT1A1
Uridine Diphosphate Glucuronyltranferase
39
What are the serious autosomal dominant Hyperbilirubinemia disorders
Dubin-Johnson (conjugated)
Crigler-Najjar (Unconjugated)
40
What are the weak sauce autosomal recessive Hyperbilirubinemia disorders
Rotor (conjugated)
Gilbert (unconjugated)
41
What is bilirubin turned into in the gut by bacteria
Stercobilin
42
What is stercobilin turned into after it is reabsorbed
Urobilin
43
What is the main cause of Prehepatic Jaundice
Hemolysis
44
In prehepatic jaundice what are the levels of Unconjugated and conjugated bilirubin
Unconjugated will be drastically increased
Conjugated will be normal or mildly increased
45
What can cause an increased amount of unconjugated bilirun be caused by
decreased bilirubin uptake by liver cells
Increased bilirubin burden
46
What is posthepatic jaundice is from?
Failure of liver to excrete conjugated bilirubin
47
In posthepatic jaundice what are the levels of Unconjugated and conjugated bilirubin
Both will be increased
48
Why is there jaundice when there is a blocked duct or biliary tract problems?
The body is reabsorbing bilirubin due to bile sludging and bc it can't get out of the body.
49
What are the tests that measure bilirubin
Evelyn-Malloy
Jendrassik-Grof
50
What does Evelyn-Malloy use as an accelerator
Methanol
51
What does Jendrassik-Grof use as an accelerator
Cafferine-benzoate-acetate
52
What is the pH for Evelyn-Malloy method?
1.2
53
What is the absorbance for the Evelyn-Malloy method?
red-purple chromagen at 560nm
54
What is the absorbance for the Jendrassik-Grof method?
Blue chromagen at 600 nm
55
What is needed to reduce alcohol interference in a sample?
To be fasting
56
How does lipemia affected bilirubin
Falsely increases
57
What does hemolysis do to the bilirubin method
decrease the reaction with diazo reagent
58
How much bilirubin will be lost in an hour if exposed to light?
50%
59
How long can bilirubin be stored?
Off cells:
2 days RT
1 week fridge
forever if frozen
60
What is Hgb electrophoresis first performed on?
Cellulose acetate strip
61
What is used with cellulose acetate for Hgb electrophoresis?
alkaline buffer (pH 8)
62
To distinguish Hgb what is the electrophoresis performed on?
Citrate Agar Gel with Acid buffer (pH 6)
63
What is the order of Hgb from slowest to fastest?
C
S
F
A
64
What hemoglobins are considered fast Hgb?
Hgb H
Barts
65
What is Hgb H made out of?
4 beta chains (Beta globin tetramer)
66
What is Barts Hgb made out of?
4 gamma chains
67
Standard alkaline and acid electrophoresis can't distinguish what 2 Hgbs?
Hgb D and G
68
How is Hgb E made?
Mutated Beta chain
69
What is HgbA1C?
Glycated hemoglobin
70
What is carboxyhemoglobin
carbon monoxide binds to hemoglobin and displaces oxygen
71
What is methemoglobin
Alkaline media or oxidizing agents transform normal Fe2+ into Fe3+, conferring a inability to reversibly bind oxygen
72
What is Sulfhemoglobin
Sulfation of hemoglobin casues an inability to bind oxygen
73
Steps in Iron Spectrophotometry Method?
1. Release Iron from transferrin with addition of acid
2. Reduction of Fe3+ to Fe2+ with ascorbic acid
3. React Fe2+ with a chromogen
74
How much of a carrier protein is bound to Iron
66%
75
What is the quantitative defect of Hgb
alpha thalassemia
76
Alpha thalassemia trait has how many genes missing?
2 genes
77
Hgb H Ds has how many genes
1
3 missing
78
What Alpha Thalassemia results in utero death?
Hgb Barts/Hydorps fetalis
-All genes are missing
79
How do we get Hgb H disease?
Inadequate alpha globin production so body produces beta hemoglobin that form together
80
What is Beta+
reduced beta hgb production
81
What is B0?
complete lack of beta hgb production
82
paracentesis fluid is from where?
peritoneal cavity
83
thoracentesis fluid is from where?
pleural cavity
84
Athrocentesis fluid is from where?
joint
85
What is ascites
Pathological accumulation of fluid in the peritoneal cavity
86
What is effusion
Pathological accumulation of fluid in most other body cavities
87
what is transudate
an effusion which is a filtrate of the plasma
88
what is exudate
an effusion which is protein-rich and usually caused by an infection or cancer
*likely has inflammatory cells and occassionally pus
89
What is Xanthrochromia
a yellowish tinge to CSF
*indicates prior bleeding in the CSF
90
What is pseudochylous
an effusion which has high levels of cholesterol
91
What can be found in refridgerated joint aspirations and urine samples
crystals
92
What can increase due to anaerobic metabolism of cells
Lactate
93
What is a spinal tap used to diagnosis?
Multiple Sclerosis
Hemorrhage
Meningitis
Other infections of CNS
94
Where does a spinal tap occur?
Epidural space between L4/5
95
What is the CSF tube order
1st- Storage/Cytology
2nd- Chemistry/Serology
3rd-Micro
4th- Heme
96
Milky consistency in Pleural Effusion indicates?
Chylothorax (lymphatic obstruction)
97
What does a putrid odor in Pleural Effusion indicate?
Anaerobic Empyema
98
What is glucose directly correlated with in Pleural Effusions?
pH bc the products of glycolysis are acidic
99
What does Black Pleural fluid suggest
-Malignant melanoma
-non-small cell lung carcinoma
-ruptured pancreatic pseudocyst
-charcoal-containing empyema
100
Peritoneal fluid is usually taken from patients with?
Ascites
101
What is ascites?
Abnormal collection of fluid in the peritoneal cavity due to either portal hypertension or low serum osmolality
102
What is transudates Specific Gravity
<1.010
103
What is Exudates Specific Gravity
>1.020
104
Why would the rare pericardial fluid test be ordered?
1. Therapeutic pericardiocentesis for cardiac temponade
2. Clinical suspicion of purulent, tuberculosis, or neoplastic pericarditis
3. Large pericardial effusions of unknown etiology
105
What are the 4 categories of Synovial Effusions
1. Inflammatory
2. Noninflammatory
3. Hemorrhagic
4. Septic
106
What are the routine Synovial testing
Gross examination
leukocyte count
gram stain and bacterial cx
crystal examination
uric acid
107
When is amniotic fluid traditionally taken?
15-18 weeks
108
Why would we collect amniotic fluid
Assess for Genetic disorders
109
How can we distinguish between urine and amniotic fluid
Urea
Glucose
Creatinine
Protein
**Urine has higher value of Urea and Creatinine
110
Preeclampsia signs and sypmtoms
Hemolysis- Elevated AST, ACP, LD
Elevated Liver Enzymes- AST, ALT, ALP
Low Platelets- profound thrombocytopenia
111
What is the only reason to evaluate seminal fluid
Infertility
112
What are the ways we assess seminal fluid
Ejaculate Volume
Total Sperm Count
Concentration
Shape of the head
Movement of the Sperm
113
What is traumatic tap
The first tube is quite bloody and the blood lessens in each subsequent tube
114
What is subarachnoid hemorrhage
The first tube is quite bloody and the last tube is just as bloody
115
What does yellow or brown CSF indicate
The old, oxidized blood is present
116
What do 10% of bacterial meningitis begin with?
Lymphocytosis
117
In bacterial meningitis what is elevated in CSF?
Protein
WBCs
Neutrophils
118
In Viral infection what is elevated in CSF?
Protein
WBCs
Lymphocytes
119
In bacterial meningitis what is decreased in CSF?
Glucose
120
In viral infection was is decreased in CSF?
Glucose
121
In Brain Tumor was in elevated in CSF?
Protein
Malignant Cells
122
In Brain tumor what has a normal value in CSF?
Glucose
WBCs
123
In a traumatic tap what is elevated in CSF
Protein
WBCs
All cells
124
What is has a normal value in a traumatic tap in CSF
Glucose
125
In multiple sclerosis what is elevated in CSF?
Protein
IgG
T Cells
126
In multiple sclerosis what has a normal value in CSF?
Glucose
WBCs
127
What is the normal CSF IgG Index
<0.73
128
What indicates multiple sclerosis in CSF
Oligoclonal bands
129
How do we get the CSF IgG index
(CSF IgG/Serum IgG)
/
(CSF albumin/serum albumin)
130
An intact blood brain barrier has what index
<9
131
How do we get BBB index
CSF/serum albumin index =
CSF albumin / serum albumin
132
What is an effusion
Pathological accumulation of serous fluid in a body cavity
133
What is edema
accumulation of serous fluid in the tissues
134
What can cause the accumulation of serous fluid
-Decreased plasma oncotic pressure
-increased capillary hydrostatic pressure
-increased capillary permeability
135
What are the values for normal pleural fluid
Clear
<2 g/dL: Protein
<1000 WBCs
Glucose at normal serum levels
Pleural LDH < 50% plasma LDH
136
Bacterial Pleural Effusion Values
Cloudy
>>2 Protein
>>1000 WBCs
Glucose <<120
Pleural LDH >>50% plasma LDH
137
Pleural fluid glucose < 30-50 mg/dL suggests
Malignant effusion
138
Pleural LDH levels > 1000 indicate
Rheumatoid effusion
malignant effusion
Pneumocytstis jiroveci
empyema
139
Why do we perform paracentesis
1. remove serous fluid from compressing a vital organ
2. determine pathologic cause of effusion
3. classify the effusion as either transudate or exudate
140
If Serum to Ascites Albumin Gradient (SAAG) is > 1.1 it is?
Portal Hypertension
141
If Serum to Ascites Albumin Gradient (SAAG) is < 1.1 it is?
NOT portal hypertension
142
what are the 2 methods that form ascites
1. high blood pressure in the portal veins pushes some fluid into the peritoneum
*usually transudate
2. Serum is drawn into the peritoneal membrane by low plasma oncotic pressure and higher oncotic pressure in the abdominal cavity. *liver failure
143
Peritoneal Fluid Amylase will be increased due to?
Pancreatitis or bowl perforation up to 2000 IU/L
144
Peritoneal Fluid LDH will be increased due to?
Bacterial Peritonitis 1:1
Ratio above 1 = infection, bowl perforation, or tumor
145
Serum Pro-BNP will be elevated in Peritoneal Fluid bc?
Heart failure
146
Pericardial Effusion is usually ordered with what tests?
1. Serum electrolytes
2. CBC
3. Cardiac biomarker levels
4. Other markers of inflammation
147
Synovial fluid should be ran how fast?
Within 2 hours
148
What can Synovial fluid be diluted with if necessary?
Saline
149
Gout is made up of what crystals
monosodium urate
150
Pseudogout is made out of what crystals
Calcium pyrophosphate
151
Synovial Fluid Normal Values
Transparent
Clear
0-150 WBC
<25 PMN
0 RBC
0-10 Glucose
152
Synovial Fluid Group 1 noninflammatory values
Transparent
Xanthochromatic
<3000 WBC
<30 PMN
0 RBC
0-10 glucose
153
Synovial Fluid Group 2 inflammatory values
Transparent/Opaque
Xanthochromatic to bloody
3000-75,000 WBC
>50 PMN
0 RBC
0-40 Glucose
154
Synovial Fluid Group 3 Infectious Values
Opaque
White
50,000-200,000 WBC
>90 PMN
Yes RBC
20-100 Glucose
155
Synovial Fluid Group 4 Hemorrhagic Values
Opaque
Red/brown to Xanthochromatic
50-10,000 WBC
<50 PMN
Yes RBC
0-20 Glucose
156
Spectrophotometry for bilirubin and HDFN is detected at
Abs 450
157
What is the range of absorbances for bilirubin
350-550
*but peaks at 450
158
When does AFP peak in the amniotic fluid
13-15 weeks gestation
159
What cutoff suggests a neural tube defect
>2.5 MoMS AFP
The higher the level the more brain is exposed
160
What is preeclampsia
Toxemia of pregnancy
161
Diagnosis for preeclampsia
BP >140/90
Protein >5 in 24 hr urine
Oliguria <500 mL/24 hr urine
Thrombocytopenia <100,000
162
What is L/S ratio
Lecithin Sphingomyelin ratio that is used for fetal lung maturity
163
<1.5 L/S ratio indicates
Lung Immaturity
164
>2.0 L/S ratio indicates
Lung Maturity
165
What are other tests to evaluate surfactant production of the fetus
1. Phosphatidylglycerol
2. Foam Stability Index
166
Why would we do a sweat chloride test on infants
Presence of CFTR mutation
167
Elevated sweat chloride is seen in
cystic fibrosis
168
Decreased sweat sodium concentration is seen in
SIADH
Liddle Disease
Hypoaldosteronism
169
Transudate values
Straw colored to amber
Clear
Normal glucose
Normal protein
Normal WBC
170
Exudate values
Brown, yellow, green
Milky
Low glucose
High protein
High WBC
171
To officially diagnosis exudate the specimen MUST have
Elevated total protein ratio and LD ratio
>0.6
172
What causes transudate
Decreased relative serum oncotic pressure (hepatitis)
Increased hydrostatic pressure (CHF)
Renal Failure
173
What causes Exudate
Infection
Autoimmune disease
Occasionally cancer
174
Hemoglobin A1 is composed of
2 Alpha
2 Beta
175
Hemoglobin A2 is composed of
2 alpha
2 delta
176
What is fetal hemoglobin composed of
2 alpha
2 gamma
177
What is Coproporphyrinogen 3 seen in
Heme synthesis
178
What is the purpose of HMB synthase
Converts PBG (Porphobilinogen) to HMB (Uroporphyrinogen I)
179
What is the purpose of ALA dehydratase
Convert Aminolevulinic Acid to PBG (Porphobilinogen)
180
What is the purpose of Ferrochelatase
Convert Protoporphyrin IX to Heme with Fe2+
181
what is AIP classified as?
Serious Acute Neurological disease
*life threatening
182
What are the most common hemoglobins
S
C
D
E
183
About 70% of all hemoglobinopathies have a defective
Beta globin chain
184
What are the serous fluids
Pleural fluid
Pericardial fluid
Peritoneal fluid
185
Exudative Pleural Effusion Criteria
Pleural fluid protein/serum protein >0.5
Pleural Fluid LDH/Serum LDH >0.6
186
Peritoneal SAAG <1.1 and Neutrophil count >250 indicates
Peritonitis
187
What makes fluid Serous
they are from dialyzing of the plasma
188
What are the Non-Serous fluids
CSF
Amniotic Fluid
Sweat analysis
Synovial fluid
189
What makes fluid non-serous
Cells that secrete this fluid and they manipulate the constituents inside the fluid
190
What forms CSF
Choroid plexuses in each of the ventricles of the brain
191
What is Therapeutic Drug Monitoring
measuring specific drugs at designated intervals to maintain a stable concentration in a patient's bloodstream
192
What is toxicology
The study of substances that cause adverse effects in a human
i.e. xenobiotic
193
What is Pharmacodynamics
what the DRUG does to the body
194
What is pharmacokinetics
What the BODY does to the drug
195
What is steady state
the rates of addition and subtraction of a drug are equal
196
what is half life
time it takes for the drug to decrease by half
197
what is therapeutic range
the concentration window at which a drug can achieve its desired effect
198
what is peak
the highest concentration of drug in the body, usually 30 min to 2 hrs after the last dose
199
what is trough
the lowest concentration of drug in the body, usually just prior to the next dose
200
what is the most common cause of treatment failure in TDM
noncompliance
201
What are the 4 biological events for Pharmacokinetics
1. Absorption
2. Distribution
3. Metabolism
4. Excretion
202
Absorption increases with what factors?
1. Increased surface area for absorption
2. increased contact time with the absorptive surface
3. increased blood flow
4. increased solubility of the drug
203
What is bioavailability
The extent and rate at which administration of the drug increases the blood concentration
204
What is therapeutic window
Below the min effective concentration for the adverse effect
Above the min effective concentration for the desired effect
205
What factors decide on distribution of the drug
Blood flow
capillary permeability
drug binding in tissues
target tissue volume
206
Tissue distribution depends on?
1. partitioning of drug between blood and the tissue of interest
2. lipid solubility
3. pH gradient
207
What is biotransformation
Change the polarity, activate, or inactivate molecules to regulate their effect on our bodies
208
Phase 1 reactions are
Oxidation
Reduction
Hydrolysis
**made water soluble and quickly excrete in urine
209
Phase 2 Reactions
Add a functional group by a covalent bond
*render drug inactive
Excrete in urine or feces
210
What is volume of distribution
A measure of how broadly the body distributes the drug
211
What is volume of distribution dependent upon
total amount of drug in the body and the plasma concentration
212
What type of drug will have a large volume of distribution
Fat soluble
213
How do we get the Vd (volume of distribution)
total amount of drug in body/ plasma concentration
214
what type of drug will have a small volume of distribution
water soluble
215
Protein bound water soluble drugs have what Vd
similar to that of ordinary water soluble drugs
216
What is the active portion of a drug?
The free portion
217
What are the proteins that bind most of the circulating drugs
Albumin
a1-glycoprotein
218
Overdose of a drug can happen in liver disease because?
Hypoalbuminemia allowing more free drug to circulate
219
What organ is the primary route for drug excretion
kidneys
220
Clearance is co-dependent on?
Renal perfusion and renal function
221
What is first pass effect
Meds that are ingested enter the enteric circulation and go to the liver which will metabolize, partition, or excrete many compounds. Drugs can be inactivated before they reach their target location.
222
What is the major drug metabolism system
P450 Oxidase system
223
What does P450 Oxidase system do?
Serves as the terminal electron donor
224
Creation of conjugation compunds usually involves
Sulfation
Acetylation
225
What do sulfates or acetates do to the drugs
inactive them
226
In order to absorb drugs what does it need to come in contact with?
Circulatory system
227
What do we need to do with drugs that have an active metabolite
decrease the dose as the drug is still active after it starts the metabolic process
228
How many half lives does it take to achieve a steady state
5 half lives
229
Upon cessation of the drug how many half lives until the body eliminates the drug
5 half lives
230
What is zero order elimination
the same amount of drug is eliminated per unit of time. regardless of the plasma concentration.
*elimination rate is constant
231
What is first order elimination
The same proportion of the drug is eliminated per unit of time. This leads to a variable amount of eliminated based on the plasma concentration.
*as concentration drops so does the elimination rate
232
What is agonist
accentuates the intended response and second messengers of the receptor
233
What is antagonist
prevents the intended response from occurring or causing an opposing effect
234
What may agonists and antagonists do at the same site
compete for binding
235
If the substrate can't fit at the active site it is
Noncompetitive
236
What is the dosing rate equation
Clearance x Steady State Concentration
237
What are the toxicity symptoms from Aminoglycosides
Neurotoxicity
Ototoxicity
Renal Impairment
238
What are the toxicity symptoms from Vancomycin
Ototoxicity
Nephrotoxicity
Red Man Syndrome
239
What are the toxicity symptoms from Phenytoin
Nystagmus
ataxia
slurred speech
seizures
coma
240
What are the toxicity symptoms from Methotrexate (MXT)
Aplastic anemia
spontaneous GI hemorrhage
241
What are the toxicity symptoms from Digoxin
Palpitations
nausea
vomiting
drowsiness
242
What are the toxicity symptoms from Lithium
Seizures
Hypopnea
Dysrhythmias
Anemia
243
What is the toxicity symptom from Cyclosporin A
Nephrotoxic
244
What is the MOA for Aminoglycosides
Inhibits bacterial protein synthesis by binding 30S ribosomal subunit and misreading of the genetic code
245
What type of organism is Aminoglycosides used for
Gram + and Gram =
Can be used against Fungi
246
What is the MOA for Vancomycin
Binds to the bacterial cell wall causing disruption in the glycopeptide polymerization, results in immediate cessation of cell wall synthesis
247
What is vancomycin produced by
Bacterium
248
What is the MOA for Phenytoin
Limitation of seizure propagation along the neurons by reduction of nerve impulse potentiation
249
What is the use for Phenytoin
Anticonvulsant
*control tonic-clonic (grand mal) seizures
250
What is the MOA for Methotrexate
Folate analog that inhibits dihydrofolate reductase, which inhibits purine synthesis and thereby, DNA synthesis
251
What is MXT used for
To treat cancers
252
What is Lithium used for
Treatment of mania, depression and bipolar disorder
253
What do Tricyclic Antidepressants do
Inhibit the neural reuptake of Norepinephrine and 5-HT
254
What are some examples of Tricyclic Antidepressants
1. amitriptyline
2. desipramine
3. doxepin
4. imipramine
5. notriptyline
255
When is Theophylline assessed
At the PEAK
256
What was Theophylline used for
treatment of respiratory disorders bc it relaxes the bronchial smooth muscles
***NO LONGER USED
257
What is the MOA for Digoxin
blocks the Na/K- ATPase in the cardiac myocyte, improves contractability
258
What is Digoxin used for
CHF
259
Digoxin overdose causes
Vision changes
260
What is Cyclosporine A also called?
Calcineurin Inhibitors
261
What is the MOA for Warfarin
Inhibits Vit K oxide reductase which impairs the prodcution of Vit K dependent coag factors (FVII, IX, X, II, Proteins C & S)
262
What phase is 1st in Acetaminophen metabolism
Phase 2
263
What is for Acetaminophen elimination
Rumack-Matthew Nomogram
264
If the point of Acetaminophen is below the line on the Nomogram what will likely NOT be depleted
Glutathione
265
What can an Acetaminophen overdose do
Lead to oxidative stress and depletion of glutathione, which creates reactive oxygen species and may cause liver failure
266
Routes of drug administration
Enteral (mouth)
Parenteral
Pulmonary
Rectal
Topical
267
What are the Parenteral routes of administration
IV (100% bioavailability)
IM
Subcutaneous
Intraarterial
Intrathecal
268
What is the gold standard confirmation method for positive drug screens
GC/MS
269
What does alcohol increase in our body
Estrogen
270
What are common indicators of alcohol abuse
GGT
AST
AST/ALT ratio >2
HDL
MCV
271
What is cocaine metabolized to
Benzoylecgonine
272
How long can cocaine be detected after a single use
up to 3 days
273
In chronic, heavy users of cocaine how long can it be detected
20 days
274
How long can THC be detected
5 days after a single use
4 weeks in chronic use
275
How is THC screened
Immunoassay
276
Where are toxicities seen in Carbon Monoxide
brain and heart
277
Why is elimination of mercury slow
Highly protein bound
278
What is qualitative testing
does not give a value
Yes/ No
279
What is quantitative testing
actually tells you how much of a substance is present
280
What is Xenobiotic
chemicals that are not normally found in humans
281
What is Poison
eXogenous agents that have an adverse effect
282
what is toxin
eNdogenous substances that have an adverse effect
283
What is effective dose 50 (ED50)
dose at which 50% of all patients taking this drug see clinical benefit
284
What is toxic dose 50 (TD50)
dose at which 50% of all patients taking this drug experience a specific side effect
285
What is lethal dose 50 (LD50)
dose at which 50% of all patients taking this drug experience death as a side effect
286
What is acute toxicity
exposure to a dose high enough to elicit immediate short term effects
287
what is chronic toxicity
repeated or frequent exposure at low doses which are insufficient to cause an immediate acute response
