Exam 4 Chemistry Review/Study Questions Part 6

When is the Therapeutic Window?
Drug level is high enough to work, but not so high as to cause toxicity
When is considered a narrow therapeutic window?
When a drug’s therapeutic and toxic concentrations are very close
When are peak levels reached?
after absorption and distribution,
generally 1 hour after a dose
When are trough levels reached?
when the drug is at its lowest concentration, just before a dose
True or False:
Each dose is additive to what remains from the previous dose
True
Generally, When is a Steady State Reached?
By the end of 5-7 doses
Define Steady State
When the amount of drug = the amount of drug eliminated
TDM Specimen Collection – When will you draw the Peak?
draw 1 hour after an oral dose of drug
TDM Specimen Collection – When will you draw the Trough?
draw right before the next dose is given
True or False:
With TDM Specimen Collection you should avoid serum separator tubes
True
What should you do to TDM samples that have been drawn through an IV line used to administer drugs?
Reject
What Age Group will Utilize drugs at 2X adult level based on body weight?
2-10
Higher GFR & Higher Protein Levels are tied to what group?
Pregnancy
List 3 Cardioactive Drugs
Digoxin
Quinidine
Procainamide
Name 2 Antibiotics
Aminoglycosides
Vancomycin
When should you collect a peak for Digoxin?
8-10 hours after oral dose
For What type of MO are aminoglycosides given?
Resistant Gram-Negative Bacteria
For What type of MO is Vancomycin given?
Gram-Positive Bacteria
With which Antibiotic are the following consistent with:
Gentamicin, tobramycin, amikacin, kanamycin.
IV or IM only
Aminoglycosides
With which Antibiotic is the following consistent with:
Red Man Syndrome
Vancomycin
True or False:
Both Aminoglycosides & Vancomycin can cause renal damage and irreversible hearing impairment
True
Name the 4 First Generation Anti-Epileptic Drugs (Anti-seizure/Anti-convulsant)
Phenobarbital
Phenytoin
Valproic Acid
Carbamazepine
Which First Generation Anti-Epileptic Drug is consistent with the following:
the administered
“proform”. After ingestion, it
converts to phenobarbital. Both drugs should be assayed.
Peaks at 10 hours
Phenobarbital
Which First Generation Anti-Epileptic Drug is consistent with the following:
oxicity includes seizures.
Up to 97% is protein-bound, so labs may assay both total and Free dilantin
Phenytoin
What is a side effect of Phenytoin?
Gingival Hyperplasia
Which First Generation Anti-Epileptic Drug is consistent with the following:
Toxicity includes pancreatitis & hallucinations
Valproic Acid
Which First Generation Anti-Epileptic Drug is consistent with the following:
Tegretol
Serious toxicity = leukopenia and aplastic anemia
Carbamazepine
List 2 Psychoactive Drugs
Lithium
Tricyclic Antidepressants
List 3 Immunosuppressives
Cyclosporine
Tacrolimus
Thalidomide
What Psychoactive Drug is consistent with the following:
Manic-depressive disorders.
Toxicity = lethargy, apathy
Lithium
What Psychoactive Drug is consistent with the following:
Depression, insomnia.
Effects not evident for 2-4 weeks
Tricyclic Antidepressants
Many Tricyclic Antidepressants are being replaced with what due to fewer side effects?
SSRIs
What Immunosuppressive Drug is consistent with the following:
To suppress host-versus-graft rejection of transplanted Organs
Cyclosporine
What Immunosuppressive Drug is consistent with the following:
FK506
100 x more potent than cyclosporine
Tacrolimus
What Immunosuppressive Drug is consistent with the following:
Serious birth defects 1956-1961
Multiple myeloma treatment prior to b.marrow transplant
Thalidomide
What is the Antineoplactic Drug that was discussed in lecture?
Methotrexate
True or False:
Antineoplactics are usually given as a single IV dose & TDM is NOT very affective for most
True
What Antineoplastic Inhibits DNA?
Methotrexate
What Antineoplastic is connected with Leukemia, Lymphomas, and other cancers?
Methotrexate
What else is Methotrexate used to treat?
RA and psoriasis
Methotrexate Toxicity =
Bone Marrow Suppression
What is the primary cause of toxicity in patients taking therapeutic drugs?
Noncompliance
Drugs exist in two forms in the circulation. Describe these 2 forms and explain which is pharmacologically active
Protein-bound and free (free form is active)
What is “first pass” metabolism?
Drugs absorbed by the GI tract are first routed through the liver before entering the circulation. This may cause some metabolic changed to the drug.
If a patient had a serum drug level at 8:00 of 100 ng/mL, and the t1/2 is 1 hour, what will the serum concentration be at 10:00?
25 ng/mL
List 4 physical changes which affect drug metabolism in an elderly patient
GFR, proteins, cardiac output and liver function are all reduced
To which drug is primidone the proform?
Phenobarbital
For which drugs should a peak level be drawn 8-10 hours after an oral dose?
Digoxin & phenobarb
Why should SST (serum separator tubes) be avoided?
Some drugs may be absorbed by the gel, causing a falsely decreased level of drug
Who are the most common victims of poisoning?
Age 15-30, suicides and ODs
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