Clinical Chem 2- Exam 3

Front 1

Amniocentesis is performed by an _____ with the aid of an ultrasound.

Back 1

obstetrician

Front 2

Amniocentesis is performed between ____ and ____ weeks of gestation.

Back 2

14 and 38

Front 3

What is the name of a procedure in which a needle is inserted through the mother's uterine and abdominal walls into a pocket of amniotic fluid in the amniotic sac.

Back 3

amniocentesis

Front 4

___ mL of amniotic fluid is aspirated during amniocentesis.

Back 4

15

Front 5

What color should amniotic fluid be during the 1st and 2nd trimester?

Back 5

yellow and clear

Front 6

what color should amniotic fluid be during the 3rd trimester and what will it be like at birth?

Back 6

3rd trimester= colorless
Turbid at birth

Front 7

What can alter the babies amniotic fluid during maturation?

Back 7

Urination- increases urea, uric acid and creatinine.
Breathing- pulmonary lipids.
Protein from fetal GI tract, skin and respiratory tract.
Hormones

Front 8

What is the final volume of amniotic fluid at term?

Back 8

300-1500 mL

Front 9

What is the term used to describe low volume of amniotic fluid?

Back 9

oligohydraminos
(baby is not as productive)

Front 10

What is the term used to describe excessive volume of amniotic fluid?

Back 10

polyhydraminos
(maternal diabetes or twins)

Front 11

Intrauterine hemolysis is monitored by ____.

Back 11

AF A450

Front 12

What are the causes of intrauterine hemolysis?
(Erythroblastosis fetalis or HDN)

Back 12

ABO incompatibility
Fetal anemia--->Elevated unconjugated bilirubin

Front 13

What are the sample interfering substances associated with amniotic fluid analysis?

Back 13

hemolysis
meconium- (a lot of bilirubin in feces: causes false positive)
vernix- (does not interfere, you can centrifuge and remove. Do not need to reject)

Front 14

In the bishop assessment of fetal prognosis: Zone 1 is?

Back 14

Normally ok- observation only

Front 15

In the bishop assessment of fetal prognosis: Zone 2 is?

Back 15

mild to moderate intrauterine hemolysis- intrauterine transfuison

Front 16

In the bishop assessment of fetal prognosis: Zone 3 is?

Back 16

severe with immediate delivery needed. Very high risk for kernicterus.

Front 17

At birth, lungs must shift from bing _____ to becoming a _____.

Back 17

fluid filled
gas exchange system

Front 18

___ is a type of phospholipid, full of saturated fatty acids (phosphotidylcholine= lecithin, sphingomyelin, phosphotidylinositol).

Back 18

surfacant

Front 19

Surfacant is formed by _____ and lines the alveolar epithelium.

Back 19

type 2 pnemocytes

Front 20

Type ____ pneumocytes are equipped for gas exchange.

Back 20

1

Front 21

Surfacant maintains lung function by ________ and _______ needed to distend lungs. (surface tension of alveolar wall)

Back 21

maintaining alveolar stability
reducing pressure

Front 22

Delivery before 34 weeks can result in ____.

Back 22

RDS- Respiratory Distress Syndrome

Front 23

A collapsed alveoli restricts gas exchange which leads to?

Back 23

respiratory acidosis and hypoxia which leads to RDS

Front 24

_______ is caused by the inability of immature lungs to produce pulmonary surfactant.

Back 24

RDS- Respiratory Distress Syndrome

Front 25

Fetal lung maturity (FLM) is ____ proportional to gestational age.

Back 25

inversely

Front 26

___ can be given to delay birth when preterm labor is indicated.

Back 26

cortisol- helps to produce suracant

Front 27

____ is a condition of pregnant women marked by water retention, high blood pressure and protein in the urine.

Back 27

Pre-eclampsia

Front 28

You cannot give a ___ or a mother that is in ____ cortisol.

Back 28

diabetic patient or pre-eclampsia

Front 29

What is a type of screening tests for fetal lung maturity?

Back 29

foam stability index (FSI) or shake test

Front 30

What is the confirmatory test for fetal lung maturity?

Back 30

L/S ratio

Front 31

In the L/S ratio test you compare the amount of ___ to the amount of ___ in amniotic fluid in order to determine whether the type II pneumocytes have begun to secrete surfactant.

Back 31

Lecithin
Sphingomyelin

Front 32

____ has no surfactant activity and is used to correct for dilutional effect of the volume of amniotic fluid.

Back 32

sphingomyelin

Front 33

In what procedure do you extract lipids, perform TLC and ID lipid spots and measure the density of spots?

Back 33

L/S ratio confirmatory test

Front 34

L/S ratio >2 and PG + means?

Back 34

low risk for RDS

Front 35

L/S ratio <2 or PG negative means?

Back 35

medium risk for RDS

Front 36

L/S ratio <2.0 and PG negative means?

Back 36

high risk for RDS deliver should be delayed if possible.

Front 37

Diabetic mothers are low risk if L/S is ____ and PG is ____.

Back 37

>2.5 and PG positive

Front 38

PG (Phosphytidyl Glycerol) is a ___ immunoassay and if you get a result of ___ there is a low risk for RDS.

Back 38

qualitative
>2mg/L

Front 39

____ is a very specific screening test for fetal lung maturity.

Back 39

amniotic surfactant to albumin ratio

Front 40

amniotic surfactant to albumin ratio is performed on a special _________.

Back 40

fluorescence polarization instrument

Front 41

"Mature fetal lungs" are indicated by values greater than ____ surfactant per gram of albumin.

Back 41

50 mg

Front 42

_____ are the storage form of surfactant and are similar in size to normal platelets.

Back 42

Lamellar bodies

Front 43

The count of what can estimate the amount of surfactant present?

Back 43

lamellar bodies

Front 44

A lamellar body count of _____ is highly predictive of pulmonary maturity.

Back 44

>30,000/ul

Front 45

A lamellar body count of _____ suggests a risk for RDS.

Back 45

<10,000/ul

Front 46

____ forms brain and spinal cord during development.

Back 46

neural tube

Front 47

If the neural tube does not close the ______ occurs.

Back 47

spina bifida (baby's spinal fluid seeps into AF and AF gets absorbed into mom's plasma)

Front 48

_____ is a protrusion of brain through an abnormal opening.

Back 48

encephalocele

Front 49

____ is a condition in which the fetus does not develop a cerebrum.

Back 49

anecepha

Front 50

A ____ in AFP is a preliminary indicator of open neural tube defect and must be followed by ultrasound and AFAFP.

Back 50

increase

Front 51

____ is the most significant protein found in the second trimester fetus.

Back 51

Alpha fetoprotein (AFP)

Front 52

What is a transport protein produced by the fetal liver with a function similar to that of albumin?

Back 52

AFP

Front 53

What binds and transports substances that are not very water soluble such as steroid hormones, vitamins, lipids and bilirubin?

Back 53

AFP

Front 54

What is found in AF and maternal circulation only in small amounts under normal circumstances due to its large molecular weight and inability to diffuse readily to maternal circulation from the veto-placental circulation?

Back 54

AFP

Front 55

Low AFP is associated with what?

Back 55

down syndrome

Front 56

Amniotic fluid AFP can only be measured between ____ and ___ week of pregnancy.

Back 56

15th to 21st

Front 57

What is amniotic fluid AFP reported in?

Back 57

MOM- multiples of median (how many times normal)

Front 58

Normal AFP is what?

Back 58

<2.0 MOM

Front 59

To calculate MOM units?

Back 59

specimen AFP/median AFP for gestational age

Front 60

____ is a congenital disorder of the autosomal chromosome 21 with either trisomy or three copies of the long arm.

Back 60

down syndrome

Front 61

Labs:
decreased MSAFP
decreased unconjugated estriol
increased hCG

Back 61

down syndrome

Front 62

What is the definitive test for down syndrome?

Back 62

fetal karyotyping

Front 63

_____, an extra copy of chromosome 18, results in open neural tube defects and death of the infant within a few months.

Back 63

trisomy 18

Front 64

Fetal karyotyping is the definitive test for down syndrome and will differentiate trisomy ___ from ___.

Back 64

21 from 18

Front 65

___ is formed between the amniotic sac and the uterine wall.

Back 65

fibronectin

Front 66

negative fibronectin means?

Back 66

delivery is very unlikely for the next 2 weeks

Front 67

positive fibronectin means?

Back 67

deliveries are imminent

Front 68

A chemical is considered a drug if:

Back 68

It is selective as to its site of action or target.
It is reversible in its action.
It produces a therapeutic or toxic effect.

Front 69

_____ are prescribed drugs that produce a healing or curative effect when an undesirable physiological or psychological condition is present.

Back 69

therapeutic drugs
(aspirin)

Front 70

What is the process of measuring the actual concentration of prescribed drug that is circulating in plasma or serum?

Back 70

TDM
Therapeutic drug monitoring

Front 71

Why do we monitor therapeutic drugs?

Back 71

To guard against overdoes or underdose.
To check for compliance.

Front 72

What is the lowest concentration of a drug that will produce the desired response?

Back 72

MEC
Minimum effective concentration

Front 73

What is the lowest concentration of a drug that will produce an adverse response?

Back 73

MTC
Minimum toxic concentration

Front 74

What is the equation for therapeutic index (TI)?

Back 74

MTC(maximum toxic concentration + MEC(minimum effective concentration)

Front 75

___ TI is good and ___ TI is dangerous.

Back 75

High
Low

Front 76

In most cases, ____ concentration reflects tissue concentration.

Back 76

plasma

Front 77

Usually, Peak or maximum blood concentration of a drug measured in blood occurs _____ hours after an oral dose.

Back 77

1/2-2 hours

Front 78

___ of a drug measured in blood is the most reliable indicator of appropriateness of dosage.

Back 78

Trough (lowest concentration)

Front 79

___ takes >8 hours to equilibrate with tissues. It is the exception to the usual peak at 1/2-2 hours.

Back 79

DIgoxin

Front 80

At ______, peak concentration of a drug is below MTC and trough concentration of a drug is above MEC within therapeutic window.

Back 80

steady state

Front 81

If constant dose of a drug is given once every half life, steady state concentration is achieved after ______.

Back 81

5-7 doses

Front 82

_____ is the route that the drug follows from its initial exposure to body to production of phamacologic response.

Back 82

drug disposition

Front 83

What are the five steps in drug disposition?

Back 83

1. Must see drug administration (IV, oral, etc).
2. Absorption
3. Distribution
4. Biotransformation
5. Excretion

Front 84

Intestinal blood goes through portal vein to liver which is in charge of removing _____.

Back 84

xenobiotics
(drugs must pass through intestinal lining into blood stream)

Front 85

What is it called when the drug on its first pass through the liver immediately after absorption is substantially metabolized and eliminated?

Back 85

first pass effect

Front 86

What are the five factors that affect absorption?

Back 86

1. Blood flow to absorption site.
2. Drug formulation.
3. Polarity.
4. Molecular weight of the drug.
5. Nature of the membranes to be crossed.

Front 87

Factors that effect degree of distribution are:

Back 87

pH of the physiological environment.
Degree to which the drug binds to plasma proteins.

Front 88

Only ____ drugs are lipid soluble.

Back 88

nonionized

Front 89

___ equation describes proportion of drug in the absorbable nonionized form.

Back 89

HH

Front 90

pH= pK + log [nonionized form:base] / [ionized form:acid]

Back 90

for weakly basic drugs

Front 91

pH= pK + log [ionized form] / [nonionized form]

Back 91

for weakly basic drugs

Front 92

when _____, both ionized and nonionized drug is present in equal amounts.

Back 92

pH=pK

Front 93

What is a proton donor?

Back 93

acid

Front 94

What is a proton acceptor?

Back 94

base

Front 95

for acidic drugs if pH>pK, drug exists in ____ form.

Back 95

ionizable

Front 96

for acidic drugs if pH<pK, drug exists in ___ form.

Back 96

nonionizable.

Front 97

for basic drugs if pH>pK, drug exists in ____ form.

Back 97

nonionizable

Front 98

for basic drugs if pH<pK, drug exists in ___ form.

Back 98

ionizable

Front 99

Why are acidic drugs absorbed more easily?

Back 99

because the gut has an acidic environment

Front 100

what do acidic drugs attach to?

Back 100

albumin

Front 101

what do basic drugs attach to?

Back 101

alpha-1-glycoprotein

Front 102

only ___ drugs attach to the target organ receptors and cause the pharmacological effect.

Back 102

free (non protein bound)

Front 103

What is the major site of drug biotransormation or metabolism?

Back 103

the liver

Front 104

What are the three ways in which metabolism may effect the drug?

Back 104

1. Increase activity
2. Decrease activity
3. No effect on activity

Front 105

Reactions metabolize lipophilic drugs to more polar forms to facilitate renal excretion. Which phase of biotransformation is this?

Back 105

phase 1

Front 106

Phase 1 of biotransformation is accomplished by ________ processes.

Back 106

oxidative or reductive

Front 107

Cytochrome ____ enzymes on mcrosomal membranes undergo redox reactions that inactivate drugs.

Back 107

P-450

Front 108

Metabolic products of biotransformation are _____ active.

Back 108

biologically

Front 109

Reactions involve conjugation of drugs with compounds such as glutathione, glucuronic acid, sulfate and phosphate. What phase of biotransformation is this?

Back 109

phase 2

Front 110

____ is the rate of metabolism is dependent on concentration of the substrate.

Back 110

first order kinetics

Front 111

As long as the concentration of the drug is within the capacity of the detox/conjugation reactions then removal rate is ___ order.

Back 111

first

Front 112

If drug concentration exceeds these capacities then removal rate becomes ___ order.

Back 112

zero

Front 113

Clearance rate of drug depends on ______ and ____.

Back 113

volume of distribution (VD) and Half life

Front 114

VD=

Back 114

VD= does administered / immediate plasma concentration

t1/2= (0.693) / K elimination

Front 115

drug clearance =

Back 115

VD x K elimination

Front 116

TDM is measured using?

Back 116

EIA
FPIA
gas chromatography
HPLC
Calorimetric methods

Front 117

___ is a major cardiac glycoside derived from the digitalis plant. It improves cardiac contractility by altering force of contraction.

Back 117

Digoxin

Front 118

Half life of digoxin is?

Back 118

38 hours, wait 8 hours before monitoring.

Front 119

___ is an antiarryhthmic drug that treats irregular heartbeat.

Back 119

lidocaine
(AMI patients)

Front 120

___ is an antiarryhthmic drug that is metabolized in liver to form an active metabolite, NAPA, that produces the same effect as the parent drug.

Back 120

Procainamide

Front 121

___ antiarryhthmic myocardial depressant that lowers the heart's ability to conduct current.

Back 121

quinidine

Front 122

____ is a group of chemically related antibiotics that treat gram negative bacterial infections.

Back 122

aminoglycosides
(gentamicin, tobramycin, amikacin, and kanamycin)

Front 123

___ is a glycopeptide antibiotic effective agains gram positive coccie and bacilli.

Back 123

vancomycin

Front 124

Phenobarital
Phenytoin (Dilantin)
Valproic acid
Carbamazepine (Tegretol)
Ethosuximide

Back 124

Antiepileptic drugs

Front 125

Lithium
Tricyclin antidepressants
doxepin
imiipramine

Back 125

psychoactive drugs

Front 126

Theophylline

Back 126

brochodialtors

Front 127

cyclosporine
tacrolimus

Back 127

immunosuppressive drugs

Front 128

___ is the study of toxic drugs or poisons.

Back 128

toxicology

Front 129

___ ia any substance that causes a harmful effect upon sufficient exposure.

Back 129

toxicant

Front 130

Exposure to toxins is ___% suicidal, ___ % accidental and ___% homicide or occupational exposure.

Back 130

50
30
20

Front 131

What is the relative term used to compare harmful effects of one substance from another?

Back 131

toxicity

Front 132

What are factors that influence toxicity?

Back 132

1. Exposure to variables of toxicant.
2. Nature of toxicant.
3. Biological variables of individual ingesting toxicant.

Front 133

____ is drug transformation by metabolic processes before exerting an effect on the ingestor.

Back 133

toxicokinetics

Front 134

What is the lethal dose average of 6-super toxic?

Back 134

<5mg/kg

Front 135

What is the lethal dose average of 5-extremely toxic?

Back 135

5-50mg/kg

Front 136

What is the lethal dose average of 4-very toxic?

Back 136

50-500 mg/kg

Front 137

What is the lethal dose average of 3-moderately toxic?

Back 137

0.5-5g/kg (1lb)

Front 138

What is the lethal dose average of 2-slightly toxic?

Back 138

5-15 g/kg (1pint)

Front 139

What is the lethal dose average of 1-practically non toxic?

Back 139

>15g/kg (1quart)

Front 140

-Assume the substance is present
-Need quantitative result
-Invasive (serum)
-Slow TAT
-Metabolites may interfere
-Expensive
-Dynamic tange should include therapeutic range

Back 140

TDM
(therapeutic drug monitoring)

Front 141

-Screen for presence of substance
-Qualitative is sufficient
-Non invasive (urine)
-Fast TAT
-Metabolites can be detected
-Cheap
-Minimum analytical sensitivity=symptomatic

Back 141

Toxicology

Front 142

What is the smallest amount that you can measure called?

Back 142

minimal analytical sensitivity

Front 143

What is the amount of the drug that will provide symptoms called?

Back 143

minimal diagnostic sensitivity

Front 144

___ is the first step of DOA testing?

Back 144

screening

Front 145

What is the most common method of DOA screening?

Back 145

immonassay

Front 146

What are examples of Analgesics?

Back 146

Aspirin and Tylenol
(all pain killers)

Front 147

What are examples of Barbiturates?

Back 147

sedatives

Front 148

What is the active ingredient in Aspirin?

Back 148

Salicylate

Front 149

What are the adverse effects of Aspirin?

Back 149

interference with platelet aggregation and gastrointestinal function

Front 150

What stimulates respiratory center ---> Initial respiratory alkalosis ---> conversion of pyruvate to lactate and breakdown of fatty acids to produce ketoacids ---> metabolic acidosis ??

Back 150

Salicylate overdose

Front 151

In salicylate, serum levels of ____ ug/mL, 6 hours following ingestion is considered toxic and ___ug/mL is lethal.

Back 151

>100
>500

Front 152

What is used for treatment of salicylate overdoes?

Back 152

Neutralization and elimination of excessive acid and maintenance of electrolyte balance.

Front 153

What are the two ways to measure salicylate?

Back 153

1. Trinder rxn- purple color with FeCl3
2. Enzymatic- NADH linked rxn (measure A340)

Front 154

Overdose of Aceaminophen (Tyleonol) causes _____.

Back 154

severe hepatotoxicity

Front 155

What results in hepatocystic necrosis due to inability of liver to adequately conjugate the metabolite of acetaminophen, acetamidoquinone by glutathione?

Back 155

Intoxication of acetaminophen

Front 156

In overdose of Acetaminophen, ____ can be depleted but reactive intermediates continue to be produced.

Back 156

glutathione (GSH pathway is exhausted)

Front 157

What is the antidote for acetaminophen overdose?

Back 157

N-acetylcystein NAC given quickly in small doses.

Front 158

What is a colorless, oderless tasteless gas that causes suffocation, tissue hypoxia and death?

Back 158

carbon monoxide

Front 159

Carbon Monoxide has about ____ times more affinity for hemoglobin than O2.

Back 159

200-500

Front 160

During CO poisoning, hemoglobin cannot adequately exchange ___ for ___ because of the increased amount of CO. This leads to increased COHb and decreased oxyhemoglobin.

Back 160

CO2
O2

Front 161

What is the treatment for CO poisoning?

Back 161

Remove source of CO or victim from source. (O2 mask)

Front 162

What is the most common type of toxic exposure?

Back 162

Ethanol

Front 163

Ethanol is metabolized in the liver by?

Back 163

ethanol+NAD--Alcohol dehydrogenase--->acetaldehyde+NADH

acetaldehyde--ALDH-->acetate

Front 164

____mg/dL of ethanol in blood results in reduced inhibitions, disorientation, and confusion.

Back 164

50-100

Front 165

____mg/dL of ethanol in blood results in progressive impairment of motor abilities.

Back 165

100-200

Front 166

____mg/dL of ethanol in blood is approaching unconsciousness.

Back 166

200-400

Front 167

Is AST greater than/Less than/or equal to ALT in ethanol toxicity?

Back 167

greater than

Front 168

____ is the most toxic alcohol.You treat it by giving the patient ethanol so that the products are less toxic.

Back 168

methanol