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Lab Drug Monitoring
MLT Therapeutic Drug Monitoring
| Question | Answer |
|---|---|
| What are some of the most common monitored therapeutic drugs(TD)? | Theophylline, Lidocaine, Valproic acid, Vancomycin, Digoxin, Phenobarbitals, Chloramphenicol, and Ethanol. |
| Theophylline is an effective muscle relaxant for what type of muscle tissue? | Smooth Muscle. |
| What TD stimulates CNS and increases resp rate? | Theophylline. |
| What testing methodology is used to monitor theophylline? | Fluorescent Polarized Immuno Assay. (FPIA) |
| Specimen of choice for theophylline | Non-hemolyzed serum/heparinized plasma. |
| Therapeutic range for theophylline | 10-20 ug/mL |
| Theophylline toxic level | Toxic > 25 ug/mL |
| What TD is absorbed 70% orally? | Digoxin |
| How is Digoxin useful? | Improves cardiac contractions in CHF. |
| What is the testing methodology for digoxin? | FPIA |
| Specimen of choice for digoxin is... | Non-hemolyzed serum/plasma |
| What is important to consider when obtaining a specimen that is being monitored during digoxin therapy? | Timing: collect 8 hours after dose. The level may rise to 8-10 ng/mL in the first 8hrs. |
| Therapeutic range for Digoxin... | 0.8 - 2.0 ng/mL |
| Digoxin therapy levels are considered toxic when.... | digoxin levels > 3 ng/mL |
| What TD corrects ventricular arrhythmias associated with MI, cardiac surgery, and digitalis intoxication? | Lidocaine |
| What testing methodology is utilized when monitoring lidocaine usage? | EIA or HPLC |
| Specimen of choice when collecting lidocaine... | Non-hemolyzed serum/plasma |
| Therapeutic range for lidocaine... | 1.5 - 5.0 ug/mL |
| Lidocaine levels considered toxic when... | lidocaine > 5.0 ug/mL |
| Phenobarbitals are monitored when being used as treatment for febrile seizures and... | neonatal seizures |
| Testing methodology of choice for phenobarbitals is... | FPIA |
| Specimen of choice... | Non-hemolyzed serum/plasma |
| Primary drug in the treament of absence(petit-mal) and myoclonic seizures... | Valproic acid |
| Testing methodology of choice for valproic acid is... | FPIA |
| Specimen of choice for valproic acid is... | Non-Hemolyzed serum/plasma |
| What is the therapeutic range for valproic acid? | 50 - 100 ug/mL |
| When is valproic acid levels considered toxic... | valproic acid > 100 ug/mL |
| Name this TD...Multipurpose Antibiotic. Quickly diminished due to dose related toxicities, primarily aplastic anemia. | Chloramphenicol |
| Testing methodology of choice for chloramphenicol... | HPLC or GLC |
| Specimen collection of choice for chloramphenicol... | Non-hemolyzed serum/plasma |
| Therapeutic range for chloramphenicol... | 10 - 20 ug/mL |
| When is chloramphenicol levels considered toxic... | chloramphenicol > 25 ug/mL |
| What TD is an effective antibiotic against GPC/GPR, prevents wall synthesis, and is effective against S. Epi and S. aureus? | Vancomycin |
| Testing methodology of choice when monitoring vancomycin levels is.... | FPIA |
| Therapeutic Range for vancomycin... | Trough: 5 - 10 ug/mL Peak: 30 - 40 ug/mL |
| Cholinesterase is an essential enzyme, why do we monitor the levels of this enzyme in our body? | Deficiency can lead to serious illness. |
| Uses for this drug include evaluation of secondary to insecticide exposure or monitoring organphosphorous or carbamate insecticide poisoning.... | cholinesterase |
| Testing methodology of choice for cholinesterase is... | spectrophotometry |
| Specimen requirements... | Plasma(EDTA), you must seperate plasma from cells immediately. |
| Name the percentages of insecticide poisoning... | 15-25% Slight Poison, 25-35% moderate poison, 35-50% severe poison |
| What is the normal reference range for cholinesterase? | 4,000 - 12,000 U/L |
| When determining the level of ethanol in blood, the amount of ethanol in the blood is directly proportional to the amount of what? | NADH(this is what the test actually measures to determine ethanol levels) |
| What is the testing methodology of choice for ethanol? | REA(reactive enzyme assay) |
| Ethanol collection specimen requirements... | Non-Hemolyzed serum/plasma(in a gray top tube, sodium fluoride) or Whole Blood |
| Recording or interpreting of ethanol levels should be expressed in... | mg/dL or gm% |
| This TD is a commonly used analgesic where abuse can lead to respiratory alkalosis. | Salicylate |
| Testing methodology of choice for salicylate is... | FPIA |
| Specimen collection of choice for Salicylate... | Non-hemolyzed serum/plasma(heparinized) |
| Therapeutic range for salicylate... | salicylate < 30 mg/dL |
| Salicylate levels considered toxic when... | salicylate > 30 mg/dL |
| This TD is also a commonly used analgesic that is taken PRN and poses no risk....however there can be delayed toxicity: liver necrosis 3-4 days post OD.(due to the metabolite, not the parent drug) | acetaminophen |
| What is the antidote for an acetaminophen OD? | N-acetylcysteine |
| Testing methodology of choice for acetaminophen... | FPIA |
| Specime requirements for acetaminophen collection... | Non-hemolyzed serum/plasma(heparinized) |
| Therapeutic range for acetaminophen... | 10 - 25 mg/mL |
| Acetaminophen levels considered toxic when... | acetaminophen is 100 - 250 mg/mL |
| What is the Initial and Confirmatory test level for Marijuana? | initial: 50 ng/mL confirmatory: 15 ng/mL |
| What is the Initial and Confirmatory test level for Cocaine? | initial: 300 ng/mL Confirmatory: 150 ng/mL |
| What is the Initial and Confirmatory test level for an Opiate metabolite? | initial: 300 ng/mL Confirmatory: 300 ng/mL |
| list the screening methods for abused drugs... | EIA or FPIA |
| list the confirmatory methods for abused drugs... | GC/MS |
Created by:
HM2 La Croix
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