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Lab Drug Monitoring

MLT Therapeutic Drug Monitoring

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