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TDM / Toxicology

Define "therapeutic window" The range between the minimum effective concentration and the maximum toxic concentration
Define MEC minimum effective concentration: lowest dosage given to receive results
Define MTC Maximum toxic concentration: The highest dosage possible to give a patient before it causes toxicity
Explain the LADME system The system of changes in drug concentration over time.
What is the "L" in LADME system for? Liberation - Active ingredients are released
What is the "A" in LADME system for? Absorption - drug molecule is taken up into the circulation (or plasma)
What is the "D" in LADME system for? Distribution - distributing active contents to blood and tissues
What is the "M" in LADME system for? Metabolism - biotransformation. the conversion of the parent form into a metabolite
What is the "E" in LADME system for? Elimination - excreted from the body
Describe high performance liquid chromatography The sample is injected into a column full of beads that have reaction sites. The liquid in the column carries the sample through. It is released at different times and this is measured.
Felbamate partial seizures
Gabapentin drug-resistant partial seizures
Lamotrigine binds to GABA receptors
Levetiracetam partial on-set seizures
Oxcarbazepine partial seizures
Phenobarbital Seizures (NOT petite mal)
Phenytoin Seizures
Tiagabine partial seizures
Topiramate Broad Spectrum anti-epileptic
Valproic acid Absence seizures
Digoxin Cardiac contractions
Lidocaine PVC and atrial fibrillation after AMI
Quinidine Tachycardia
Procainamide Tachycardia
Amiodarone Supraventricular and ventricular tachyarrhythmias
Theophyllines Bronchodilators. Relax smooth muscle to relieve or prevent asthma
Aminoglycosides Antibiotics. Prevent protein synthesis of the bacteria
Lithium Anti-psychotic drugs. Manic depressive illnesses
Imiprimine Antidepressants. Endogenous depression
Methotrexate Antimetabolite drugs. Used for ALL in children. Breast, Testicular, Tongue cancers.
Cyclosporine Suppresses host vs. graft rejection
Mycophenolate mofetil (Cellcept) Inhibits IMPDH
5 parameters determined on patients with toxic reactions: - amount of reagent introduced - route of administration - number of doses - time period of administration - lethal dosage
list 5 ways a toxic agent can affect the body - interference of enzyme systems - blockage of Hb/O2 transport interference of general cell function - interference of DNA/RNA synth. - hypersensitivity
Example of a toxin that causes irreversible enzyme inhibition insecticides
Example of a toxin that causes blockage of Hb/O2 transport carbon monoxide
Example of a toxin that causes interference with general function of the cell anesthetics
Example of a toxin that causes inhibition of oxygen transfer cyanide
Example of a toxin that causes interference with DNA and RNA synthesis mustard gas
What are the 7 most commonly ordered drug tests? Volatiles (alcohols) Barbiturates Hypnotics Salicylates Opiates Amphetamines Phenytoin (dialantin)
Barbituates (Phenobarbital, pentobarbital, secobarbital) Depressants
Benzodiazepine (valium, librium) Depressants
Lowers body temperature. Anti-inflammitory. Compound that reduces pain without causing loss of consciousness Analgesics
Narcotics, Salicylates, and Acetominophen Analgesics
What can cause an accidental poisoning in children? Salicylates
Imipramine (trofranil) Tricyclics
LSD, Mescaline Hallucinogens
Amphetamine and Cocaine Stimulants
Very potent toxin. Affects the CNS. Widely abused. No longer used therapeutically Stimulants
Minimal medicinal use for glaucoma and nausea Cannabis
Serum level decreases in 1 day by 10%. Half life is 1 day, 3-5 days in chronic users THC
There are very few _____ on the market for toxins Antidotes
Treatment methods to remove toxins from the body: - Gastric levage. - Skin decontamination - Charcoal to absorb - Increase urine flow - Vomiting
What is the most common of the poisonous gases Carbon monoxide
Which toxic gas is present in fossil fuels and organic fuels? Carbon monoxide
What specimen is used for carbon monoxide testing? Whole blood samples. Determine the % saturation of the hemoglobin by CO
10% CO shortness of breath with vigorous exercise
30% CO irritated. fatigued. headaches.
60-70% CO unconscious. respiratory failure
80% CO rapidly fatal
Colorless gas with the odor of almond Cyanide
Rapidly bound to the heme of hemoglobin causing hypoxia Cyanide
How can levels of Cyanide be measured? ISE and isotopic GC-MS
What is cyanide attracted to? Iron in the ferrous state
Highest blood level of all toxins studied in class: Alcohols
How is a specimen collected for alcohol poisoning? Venapuncture. Do NOT use alcohol wipe to clean
What are the two main alcohols Ethanol and Methanol
Which of the two alcohols is most common? Ethanol
What is the metabolite of ethanol? Alcohol Dehydrogenase
Which alcohol is a contaminant in moonshine? Methanol
How do you treat someone with a methanol toxicity? Give ethanol to saturate the heme molecules
What binds with keratin and will combine with proteins to precipitate the proteins? Arsenic
What is the favorite homicidal poison? Arsenic
What specimen should be used to determine acute arsenic poisoning? urine samples, testing for metabolites
What specimen should be used to determine chronic arsenic poisoning? hair and nail samples
What is one of the most serious metallic poisons? Lead
How are adults exposed to lead? Industry - fumes. Soil
How are children exposed to lead? Ingestion
What does lead inhibit? heme production. increase in ALA
In what settings are drug tests most often performed? ERs, Sports medicine, Insurance Companies, driving fatality investigations, Military, Workplace
How is a specimen collected for a drug test? Very specifically and properly to avoid a lawsuit
Chain of custody of drug test specimen: - monitored - written ID - documentation of transport, storage, and testing
Used to separate a negative from a positive Drug Screen
Performed on all positive screens Drug Confirmatory
Accurate Close to the right answer
Precise Able to reproduce same result
Thin Layer Chromatography Sample preparation is mixed with solvent. Drug goes into solvent to be isolated. Chromatography. Visualization. Interpretation.
What specimens can be used for TLC? Urine, Serum, or Gastric
What is the weakness of TLC? less sensitive and precise. no permanent records.
Immunoassay Different "labels" are used to monitor the presence of drug
What are the strengths of EIA Very specific. Sensitive and accurate. Precision may vary.
How does mass spectrometry identify drugs? Fragmentation of drug by a bombardment of electrons. Shatters molecule in the same pattern every time.
What is the strength of GC-MS? Accurate, precise, sensitive, and specific
What are the weaknesses of GC-MS? Expensive. Labor intensive. Requires special training. Data interpretation is hard. Time consuming. Large analyzer.
What does a "negative" drug screen mean? The levels of the drug may not be in large enough amounts to show up on test
What does a "positive" drug screen mean? Drug or metabolite may be present. Follow up with a confirmation test.
What does a "positive" drug confirmation test mean? The person has recently used drugs. Does NOT show intoxication or impairment. Can not determine if patient is a chronic abuser.
Created by: ashleywest16