Chemistry Internship Study Questions Section 2

In general, when should peak TDM levels be drawn?
1 Hour after dose
In general, when should trough TDM levels be drawn?
Just before the next dose
When should digoxin peak levels be drawn and why?
8 hours after dose;
It takes that long for serum/tissue to reach equilibrium
Define half life
Time it takes for the concentration of a drug to decrease by 1/2
What is meant by “steady state” drug?
Amount drug excreted = Amount of drug absorbed
How many drug doses are required to reach steady state?
5-7 doses
List 3 factors that may affect drug metabolism
Age, Renal Function, Heart, GI or Liver Disease, Genetic Factors
Why are the first-pass metabolite(s) of some drugs as well as the parent drug BOTH measured?
Both forms are physiologically active
Can you list 2 drugs that fit into the first-pass category?
Primadone & phenobarbital;
Procainamide & NAPA
Why is protein quantitation necessary in some patients receiving therapeutic drugs?
Protein levels affect the amount of bound and free drug. The free form is physiologically active. Decreased Protein levels will result in more free drug.
Why must SST (serum separator tubes) be avoided when testing for some therapeutic drugs?
SS may absorb some drugs causing Falsely Decreased levels.
List the common use for the following:

Lithium

Bi-Polar Disorder
List the common use for the following:

Methotrexate

Cancer
List the common use for the following:

Primadone

Seizures
List the common use for the following:

Valproic Acid

Anti-convulsant
List some of the more commonly used cardioactive drugs
Digoxin, quinidine, procainamide
What is the general function of aminoglycosides, vancomycin, and chloramphenicol?
Antibiotics
What are some of the serious toxic effects of aminoglycosides, vancomycin, and chloramphenicol?
Ototoxicity & Renal Damage
What is the common brand name for phenytoin?
Dilantin
What is Phenytoin/Dilantin used for?
Control Seizures and Epilepsy
In what general group of drugs are Demerol & Codeine?
Opiates
In what general group of drugs are Librium & Valium?
Psychotropic
List 2 commonly used immunosuppressive drugs that are used on organ transplant patients to suppress host vs graft disease.
Cyclosporin & Tacrolimus (FK 506)
Why should thalidomide NOT be given to younger women?
Devastating Birth Defects
What organ is most susceptible to the toxic effects of the following:

Acetaminophen

Liver
What organ is most susceptible to the toxic effects of the following:

Salicylate

CNS
What organ is most susceptible to the toxic effects of the following:

Ibuprofen

Kidneys
What is the LEGAL limit for Blood Alcohol in Arkansas?
0.08% / 80 mg/dL
What is the CRITICAL Value for Blood Alcohol?
>350 mg/dL
What precaution should be made when drawing blood for an alcohol level?
AVOID Alcohol Swabs
In what type of tube should a Blood Alcohol be collected?
Light Green
– May vary though
What should a Chain of Custody be initiated in regards to drug or alcohol analysis?
If there could be ANY Legal Ramifications such as law suits or worker’s compensation.
How would delta osmolality levels be affected in cases of alcohol toxicity?
>10
What urinalysis finding is associated with ethylene glycol poisoning?
Calcium Oxalate Crystals
What are the most common testing methods used to screen for drugs of abuse?
FPIA, EMIT, TLC
What is considered to be the “gold standard” technique for drug confirmation?
Gas Chromatography Mass Spectrometry (GC Mass Spec)
What is the formula for Delta Osmolality?
Measured – Calculated
What is the formula for Osmolality?
2(Na) + (GLU/20) + (BUN/3)
x

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