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Toxicology & TDM
The Drugs!
| Question | Answer |
|---|---|
| Antibiotics--Aminoglycosides -used to treat infections w/ gram-____ bacteria that are resistant to less toxic antibiotics | gram-negative |
| Types of Aminoglycoside Drugs (x3AGT) | Amikacin Gentamicin Tobramycin |
| Antibiotics--Aminoglycosides: TRUE or FALSE Drugs are very polar & poorly absorbed by the intestines. | True |
| Antibiotics--Aminoglycosides -Distributed in what fluid? -Do they cross the Cell Membrane? -Do they bind to plasma proteins? | Distributed in the extracellular fluid but do not cross cell membranes nor do they bond to plasma proteins |
| Antibiotics--Aminoglycosides -Hours for elimination of half lives | 2-3 hours |
| Antibiotics--Aminoglycosides -Clearance is dependent on... | Renal function |
| Antibiotics--Aminoglycosides -Trough measurements (monitors what?) | Trough--monitors Toxicity |
| Antibiotics--Aminoglycosides -values exceeding trough levels predict what? | renal damage |
| Antibiotics--Aminoglycosides -Peak values are measuring? | Therapeutic Levels |
| Antibiotics--Aminoglycosides -what deactivates gentamicin by creating an inactive complex? | Heparin |
| Glycopeptide Antibiotics--Vancomycin -can damage what? | Auditory Nerve & Kidneys |
| Glycopeptide Antibiotics--Vancomycin -effective against what type of bacteria? | Gram-[+] cocci & bacilli |
| Antiepileptic Drugs -3 first generation drugs (PPV) | Phenobarbital Phenytoin (Dilantin) Valproic Acid (Depakene or Depakote) |
| Antiepileptic Drugs -Phenobarbital is a slow acting barbiturate that effectively controls | several types of seizures |
| Antiepileptic Drugs -Phenytoin (Dilantin) is commonly used for treatment of | seizure disorders |
| Antiepileptic Drugs -Phenytoin (Dilantin) is used short-term in ____ to prevent_____ | brain injury to prevent loss of functional tissue |
| Antiepileptic Drugs -Valproic Acid (Depakene) is used as a ______ for treatment of _____ & _____ seizures | used as a monotherapy for treatment of petit mal & absense seizures |
| Antiepileptic Drugs-Phenobarbital -eliminated how and is dependent on what? | Hepatic elimination & age dependent Children 70 hrs, Adults 100 hrs |
| Antiepileptic Drugs-Phenobarbital -reduced liver function ______ half life | increases |
| Antiepileptic Drugs-Phenobarbital -when should you collect the sample? | late in the dose interval (trough preferred) |
| Antiepileptic Drugs -what is used in the treatment of tonic-clonic and complex-partial seizures? | Primidone aka Mysoline |
| Antiepileptic Drugs -what is the major metabolite of primidone? | phenobarbital |
| Antiepileptic Drugs -what drug is used in the treatment of primary or secondary generalized tonic-clonic seizures? | Phenytoin aka Dilantin |
| Antiepileptic Drugs -what % of phenytoin is protein bound? | 90% |
| Antiepileptic Drugs -what will give higher free drug levels of phenytoin? | Hypoalbuminemia |
| Antiepileptic Drugs-Phenytoin -small dosage increments result in ____ changes in blood concentration | large |
| Antiepileptic Drugs-Phenytoin -how many hours after dose will you see toxic symptoms? | 4-5 hrs |
| Antiepileptic Drugs -which drug is rapidly and almost completely absorbed after oral dose? | Valproic Acid aka Depakene or Depakote |
| Antiepileptic Drugs-Valproic Acid -Half life is variable--dependent on? | dosage and age |
| Antiepileptic Drugs -what % of valproic acid is protein bound? | 93% of drug is protein bound |
| Antiepileptic Drugs-Valproic Acid -more free drug is available in | hepatic disease, uremia or altered protein states |
| Antiepileptic Drugs-Valproic Acid -free drug is influenced by..... | other protein bound meds (such as phenytoin) |
| Antiepileptic Drugs -which drug is used for treatment of tonic-clonic and complex-partial seizures as a last resort? | Caramazepine aka Tegretol |
| Antiepileptic Drugs-Caramazepine -chronic therapy induces _____ which will shorten the half life | liver enzymes |
| Antiepileptic Drugs-Caramazepine -decreased liver functions _____ levels | increase |
| Antiepileptic Drugs-Caramazepine -drug can induce (x3) | leukopenia, thrombocytopenia & aplastic anemia |
| Antiepileptic Drugs-Caramazepine -trough is used to measure therapy unless intoxication is suspected--then measure how many hours after dose? | 2-4 hours after oral dose |
| Antiepileptic Drugs- -which drug is used to manage acute lymphoblastic leukemia in children, choriocarcinoma & trophoblastic tumors in women | Methotrexate |
| Antiepileptic Drugs-Methotrexate -decreases _____ nucleotide synthesis by inhibiting the enzyme _____ reductase | decreases pyrimidine nucleotide synthesis by inhibiting the enzyme dihydrofolate reductase |
| Antiepileptic Drugs-Methotrexate -treatment is followed by _____ to rescue cells from methotrexate inhibition | Leucovorin |
| Antiepileptic Drugs-Methotrexate -what 3 cytotoxic effects can PT develop? | Myelosuppression, Gastrointestional mucositis and hepatic cirrohsis |
| Antiepileptic Drugs-Methotrexate -high dose methotrexate followed by leucovorin rescue is an effective therapy for.... | neoplastic conditions |
| Antipsychotic Drugs -what drug treats manic depression? | Lithium |
| Antipsychotic Drugs-Lithium -values exceeding ____ after 12 hrs indicates risk of intoxication | 1.5 meg/L |
| Antipsychotic Drugs-Lithium -Lithium excretion parallels what? | Sodium |
| Antipsychotic Drugs-Lithium -standard methodology | ion-specific electrode or flame emission |
| Tricyclic Antidepressants -treats (x4) | depression insomnia extreme apathy loss of libido |
| Tricyclic Antidepressants--Name the metabolites of Amitriptyline Doxepin Imipramine | Nortriptyline Nordoxepin Desipramine |
| Tricyclic Antidepressants-methods should address the following -sensitive to concentrations as low as | 25 mg/ml |
| Tricyclic Antidepressants-methods should address the following -distinguish and measure both | parent and metabolite |
| Tricyclic Antidepressants-methods should address the following -discriminate b/t tricyclic & | tetracyclinc (many OTC meds) |
| Bronchodilators -relaxes bronchial smooth muscle to relieve or prevent asthma | Theophylline |
| Bronchodilators-Theophylline -absorption rates: what are the peaks with and without food | with 3-5 without 2 |
| Bronchodilators-Theophylline -half lives of children/smokers & normal adults | children/smokers 3-4 hrs normal adults 9hrs |
| Bronchodilators-Theophylline -clearance is _____ dependent | dose |
| Bronchodilators-Theophylline-Clearance -level >20 mg/ml: small increases in dose gives _____ in serum | disproportionate increase in serum |
| Bronchodilators-Theophylline -Optimal levels | 15 mg/ml |
| Bronchodilators-Theophylline -what is a minor metabolite? | Caffenine |
| Cardioactive -what two drugs need to be measure at the same time for cardio issues? | Procainamid & N-acetylprocainamide (NAPA) |
| Cardioactive--NAPA -accumulates in PTs with... | impaired renal function |
| Cardioactive--NAPA + Procainamide -should not exceed ____mg/ml | 30 mg/ml |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -which drug inhibits membrane Na-K-ATPase? | Digoxin |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin absorption is variable and influenced by | dietary factors GI motility Formulation of drug |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin half life in plasma | 38 hrs in average adult |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin is measured by | immunoassays to determine total concentration in serum |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin: increased sensitivity seen in (x3) | Hypokalemia Hypercalcemia Hypomagnesemia |
| Cardioactive drugs requiring TDM-Antiarrhytmics -what three types? (QPD) | Quinidine Procainamide Disopyramide |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin: peak levels in plasma and tissues | plasma: 2-3hrs after ingestion tissues: 6-10 hrs |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin: tissue levels correlate with ___ & ____ values | therapeutic and toxic values |
| Cardioactive drugs requiring TDM-Cardiac Glycosides -Digoxin: what two things may give similar clinical symptoms | toxicity & under treatment |
| Cardiac Drugs -what has a high degree of first-pass hepatic metabolism that results in widely variable bioavailability for individuals? | Propranolol (Inderal) |
| Cardiac Drugs -only given by IM or IV b/c undergoes first pass hepatic metabolism when given orally | Lidocaine |
| Cardiac Drugs-Lidocaine -two metabolites that can be toxic | monoethylglycinexylidide (MEGX) glycinexylidide (GX) |
| Cardiac Drugs-Lidocaine -testing in early therapy for adequate concentration is done _____ min after loading dose | 30 min |
| Cardiac Drugs--Lidocaine -if no loading dose is used, ____hrs after start of therapy | 5-7 hrs |
| Cardiac Drugs-Lidocaine -bound by _____ -increased after_____ & _____ free drug | bound by a-acid-glycoprotein increased after MI & reduces free drug |
| Cardiac Drugs -used to treat rapid & irregular heart beats? | Quinidine |
| Cardiac Drugs-Quinidine -plasma peak reached in how many hrs after oral dose? | 1.5-2hrs |
| Cardiac Drugs-Quinidine -what cross reacts w/ metabolites that gives slightly higher values that GLC? | EMIT & FPIA antibodies |
| Cardiac Drugs-Quinidine -trough specimen usually is used to document what? | adequate dosage |
| Immunosuppressive Drugs -what selectively inhibits proliferation & activation of CD4+ cells? | Cyclosporin A |
| Immunosuppressive Drugs -Cyclosporin A is used to prevent what? | graft vs host rejection in organ transplants |
| Immunosuppressive Drugs -Cyclosporin A inhibits proliferation of lymphocytes while results in.... | the suppression of humoral and cellular immunity |
| Immunosuppressive Drugs-Cyclosporin A -Specimen Requirement - % bound in ____ | Whole Blood 90% bound in RBC |
| Immunosuppressive Drugs-Cyclosporin A -concentration in RBC is _____ dependent in vitro | temperature |
| Immunosuppressive Drugs -what is found in the soil in N.Japan (fungus) | FK 506 aka Tacrolimus |
| Immunosuppressive Drugs -FK506 is _____X more potent than cyclosporin | 100x |
| Immunosuppressive Drugs-FK506 - ____% bound to ____ | 99% bound to albumin |
| Immunosuppressive Drugs-FK506 -what can be caused w/ continual use? | renal failure |
| Immunosuppressive Drugs-FK506 -_____Interference | T-Helper Interference |
Created by:
haley.gooch
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