Exam 3 Chemistry

Front 1

The science of analyzing body fluids to determine concentration of a prescribed drug present at a particular time correlating the concentration of the drug with its effect on the patient

Back 1

Therapeutic drug monitoring

Front 2

When to monitor drugs

Back 2

1. Consequences of over/under dosing are serious

2. Narrow well defined range with only a small difference between therapeutic and toxic

3. Plasma drug levels are not predictable from dosage alone

4. Non compliant patient

5. Disease alters drug utilization

6. Drug interactions

Front 3

Schedule I drugs

Back 3

• Heroin
• LSD
• Marijuana

Front 4

Metabolite metabolized in Heroin

Back 4

Morphine in urine

Front 5

Metabolite metabolized in LSD

Back 5

LSD or nor-LSD in urine

Front 6

Metabolite metabolized in Marijuana

Back 6

Delta 9 THC in urine

Front 7

Schedule II drugs

Back 7

• Cocaine
  
• Meth
• Morphine
• PCP
• Oxycodone (Percodan)

Front 8

Metabolite measures in Concaine

Back 8

Benzoylecgonine in urine

Front 9

Metabolite measures in meth

Back 9

amphetamines

Front 10

Metabolite measured in morphine

Back 10

morphine

Front 11

metabolite measured in oxycodone (percodan)

Back 11

oxymorphone

Front 12

metabolite measured in PCP

Back 12

phencyclidine

Front 13

Schedule III drugs

Back 13

barbiturates

Front 14

Metabolite measured in barbituates

Back 14

barbituates

Front 15

Barbituates

Back 15

can fatally depress breathing

Front 16

Opiates

Back 16

Morphine and Oxycodone

Front 17

Schedule IV drugs

Back 17

• Darvon, valium

Front 18

Metabolite measured in darvon, valium

Back 18

barbiturates

Front 19

Therapeutic drugs: cardiac

Back 19

• glycosides: digoxin, digitoxin
• beta blockers: lopressor
• Antidysrrythmics: lidocaine, procainamide, and quinidine

Front 20

Glycosides; digoxin, digitoxin

Back 20

increases strength of heart contraction

Front 21

Beta blockers; lopressor

Back 21

decreases blood pressure and heart rate

Front 22

Antidysrrythmic: lidocaine, procainamide, quinidine

Back 22

keeps heart stable

Front 23

metabolite measured in antidysrrythmic

Back 23

procainamide becomes NAPA which is also an antidysrrhytmic drug

Front 24

Anticonvulsants

Back 24

• Phenytoin (Dilantin)
• Phenobarbital
• Primidone
• Carbamazapine, benzodiazapine (tegretol)

Front 25

Phenobarbital

Back 25

calms electrical storm

Front 26

Primidone

Back 26

calms electrical storm

Front 27

Metabolite measured in primidone

Back 27

becomes phenobarbital

Front 28

Carbamazapine, benzodiazapine

Back 28

anticonvulsants

Front 29

Bronchodilators

Back 29

• Albuterol
• Theophylline

Front 30

Albuterol

Back 30

long acting

Front 31

Theophylline

Back 31

shorter acting

Front 32

Metabolite measured in theophylline

Back 32

caffeine

Front 33

Tricyclics (antidepressants)

Back 33

• Imipramine, amitryptiline, doxepen, lithium

Front 34

Imipramine, amitryptiline, doxepen, lithium

Back 34

stabilize moods used for bipolar patients

Front 35

Metabolites measured in imipramine

Back 35

disipramine

Front 36

Metabolites measured in amitryptiline

Back 36

nortriptyline

Front 37

metabolites measured in doxepen

Back 37

nordoxepen

Front 38

Antipsychotic

Back 38

Chlozapine, Haloperidol

Front 39

Chlozapine, Haloperidol

Back 39

treats schizophrenic patients

Front 40

Antineoplastic

Back 40

methotrexate, cisplaten

Front 41

methotrexate, cisplaten is given to

Back 41

cancer patients

Front 42

what drugs need sheilded from light

Back 42

methotrexate

Front 43

Immunosuppresants

Back 43

Cyclosporine, tacrolimus

Front 44

Effectiveness of a drug over a population (responder/nonresponder) differences related to genetic polymorphisms of enzymes in cytochrome P450 pathway

Back 44

Pharmacogenomics

Front 45

Lowest concentration to produce a desired effect

Back 45

MEC

Front 46

Lowest concentration to produce toxic effects

Back 46

MTC

Front 47

Max concentration of drug in the blood

Back 47

Peak

Front 48

Lowest concentration in the blood

Back 48

through

Front 49

drug absorbed/distributed equals amount metabolized and excreted equivalent amount of drugs that enter and leave the body

Back 49

Steady state

Front 50

How many doses to reach steady state

Back 50

4-7

Front 51

Time between doses

Back 51

dosing interval

Front 52

percent of drug taken that is systemically absorbed and reaches the site of action

Back 52

bioavailability

Front 53

Amount of drug in the body to be reduced to 1/2

Back 53

1/2 life

Front 54

Sum of all procedures in the body to completely eliminate the drug from the body

Back 54

total plasma clearance

Front 55

any product of metabolism as in the derivative of a drug

Back 55

metabolite

Front 56

When to measure the peak/max drug

Back 56

• Oral:1 hour after ingestion
  
• IV: 30 min
• 1hr 30min IM

Front 57

When to measure the trough/lowest

Back 57

right before new dose is given

Front 58

The therapeutic dose is

Back 58

the ratio of MTC to MEC

Front 59

When to increase dosing

Back 59

in renal/hepatic disease to reduce drug elimination

Front 60

100% bio availability

Back 60

IV

Front 61

Acid drug is bound to

Back 61

albumin

Front 62

Basic drug is bound to

Back 62

alpha1-acid glycoprotein

Front 63

What produces therapeutic response

Back 63

free fraction

Front 64

Primary site of drug metabolism

Back 64

liver (first pass effect causes rapid metabolism) increased H20 solubility

Front 65

Lipid soluble drugs

Back 65

Non ionized

Front 66

What type of drug crosses the cell membrane

Back 66

non ionized

Front 67

Drug metabolism assays measure

Back 67

total drug

Front 68

Water soluble protein

Back 68

excreted by kidneys; bile, feces, saliva, air, and breast milk

Front 69

Metabolized drugs: not active form; except

Back 69

Primidone, Procainamide, Theophylline, TCAs

Front 70

Formula to calculate to drug clearance

Back 70

V=D/c

Front 71

polar hydrophilic drugs

Back 71

small V

Front 72

Clearance is a

Back 72

first order kinetics

Front 73

Higher Concentration of drugs

Back 73

• Patient non compliance
• Decrease total clearance
• Increase protein binding
• Increase bioavailability

Front 74

Lower concentration of drugs

Back 74

• Patient non compliance
  
• Increase total clearance
• Decrease protein binding
• Decrease bioavailability

Front 75

Drug elimination calculations

Back 75

C=Ce^kt

Front 76

The study of poisons, substances, and their effect on the human body (50% suicide/ 30% accidental)

Back 76

toxicology

Front 77

Gases

Back 77

CO

Front 78

CO

Back 78

odorless/colorless/tasteless

Front 79

What is dichloromethane is converted to

Back 79

CO in body

Front 80

CO found as carboxyhemoglobin the absorbance is

Back 80

higher (@1-5% Hb)

Front 81

Fraction of poisoning that are CO

Back 81

1/3

Front 82

Blood sample for CO

Back 82

Whole blood (EDTA)

Front 83

Method for testing CO

Back 83

scanning spectrophotometer (555nm to 541nm)

Front 84

Treat CO

Back 84

give 100% O2/hyperbaric chamber

CO-oximeter

Front 85

Volatiles

Back 85

• Ethanol
• Isopropanol
• Methanol
• Ethylene glycol

Front 86

Ethanol is absorbed by

Back 86

gastric mucosa

Front 87

CO metabolized by the

Back 87

liver into acetaldehyde (toxic) to acetic acid to kreb cycle

Front 88

Tests for Ethanol

Back 88

• Use alcohol dehydrogenase (NAD as cofactor)
• Gas chromatography
• Osmolar gap

Front 89

Osmolar gap

Back 89

2(Na)+Glu/20+Bun/3

Front 90

Isopropanol converts to

Back 90

acetone 240mL fatal

no metabolic acidosis

Front 91

Methanol converts to

Back 91

formaldehydge to formic acid "wood alcohol"

Metabolic acidosis

20-30mL fatal

Front 92

Ethylene glycol converts to

Back 92

oxalate and hippuric acid

Front 93

Huffing

Back 93

difluoroethane, freon: GC

Front 94

Corrosives cause

Back 94

Metabolic acidosis and alkalosis

Front 95

Cyanide

Back 95

Corrosive

Binds heme iron and cytochrome oxidase

Front 96

Cyanide symptoms

Back 96

headaches, dizziness, respiratory depression, seizure, coma, and death

Front 97

Metals

Back 97

• Lead
• arsenic
  
• Cadmium
• Mercury

Front 98

Lead

Back 98

Metal

• toxicity: behavioral encephalopathy >100 ug/dL
• atomic absorption
• zinc protoporphrin

Front 99

Arsenic

Back 99

High affinity binding to thio groups

Front 100

Cadmium

Back 100

paint used in electroplating protein binding accumulate: renal tubular necrosis

Front 101

Mercury

Back 101

Protein binding/inhibits many enzymes

neurologic/renal dysfunction

Front 102

Pesticides

Back 102

• 50% organophosphates and carbamates
• inhibit acetylcholinesterases which neutralize acetylcholinesterases

Front 103

How to measure pesticides

Back 103

Pseudocholinesterase

Front 104

Salicylates is

Back 104

aspirin

Front 105

Salicylate overdose starts as

Back 105

respiratory alkalosis (increase water loss) then metabolic acidosis

Front 106

Treat salicylates

Back 106

ionized to bicarbonate infusions (7.6-8.0)

Front 107

Acetaminophen

Back 107

Tylenol

Front 108

Acetaminophen is converted to

Back 108

glucuronide in the liver and sulfate conjugate

Front 109

What to monitor in acetaminophen

Back 109

creatinine and prothrombin before and after

Front 110

How to treat with acetaminophen overdose

Back 110

oral activated charcoal and hydrate w/ hypoglycemia

Front 111

Acetaminophen exposure

Back 111

64%

Front 112

Acetaminophen falaties

Back 112

62%

Front 113

Mechanism acetaminophen

Back 113

liver toxicity

Front 114

Determine acetaminophen

Back 114

Rumack-Matthew

Front 115

Aspirin Exposure

Back 115

17%

Front 116

Aspirin Fatalities

Back 116

34%

Front 117

Mechanism Aspirin

Back 117

Acid-Base Imbalance

Front 118

Determine aspirin

Back 118

Done monogram

Front 119

Treat aspirin

Back 119

activated charcoal, bicarbonate infusions, for acid-base imbalance

Front 120

Ibuprofen exposure

Back 120

19%

Front 121

Ibuprofen fatalities

Back 121

4%

Front 122

Mechanisms of Ibuprofen overdose

Back 122

fatality to oliguric renal failure

GI bleeding mixed acid-base balance

Front 123

Determine Ibuprofen

Back 123

Nomogram Hall et al

Front 124

Treat Ibuprofen

Back 124

Activated charcoal bicarb infusion or dialysis; supportive measures

Front 125

Toxi-lab

Back 125

TLC

Front 126

Drug Screening

Back 126

Immunoassay

Front 127

Reference method of drug screening

Back 127

GC

Front 128

No antidote to over dose

Back 128

Amphetamines

Front 129

Treat barbituates

Back 129

Supportive therapy, urinary alkalinization (prevents barbituates reabsroption)

Front 130

Benzos treat alcohol withdraw

Back 130

mix with alcohol very toxic

Front 131

Adluterants interfer with

Back 131

immunoassays

Front 132

NIDA-5

Back 132

1. amphetamine/methamphetamine

2. cannabinoids

3. Cocaine

4. Opiates

5. PCP

Front 133

Confrim drugs

Back 133

GC/MS

Front 134

Prostate cancer

Back 134

Incidence: 29%

Death- 9%

Front 135

Lung Cancer

Back 135

Incidence: 15%

Death: 31/26%

Front 136

Colorectal cancer

Back 136

Incidence: 10/11%

Death 9/10%

Front 137

Breast Cancer

Back 137

Incidence: 26%

Death: 15%

Front 138

Single, original transformed cell, lose of regulatory function, proliferative eventually invade (metastases) normal tissues

Back 138

Clonal theory

Front 139

Phases of Clonal theory

Back 139

• Induction phase
• In situ phase
• invasion phase
• dissemination phase

Front 140

induction phase

Back 140

>30 years or more (3/4 to carcinogens)

Front 141

In situ phase

Back 141

transformed cells develop into cancer, remains localized

Front 142

Invasion pahse

Back 142

penetrates basement membrane moves to blood and lymphatic vessels

Front 143

Dissemination phase

Back 143

1 to 5 years tumor spreads acquire additional bloody supply (angiogenesis)

Front 144

Formation of tumors, occur due to mutation of growth factors, tumore suppressor, cell cycle and oncogenes

Back 144

Tumorgenesis

Front 145

spreading of tumors

Back 145

metastasis

Front 146

expressed during the development of the feetus then re expressed in the tumor

Back 146

oncofetal antigens

Front 147

present in or produced by the tumor/resemble fetal tissue anaplastic with out form, monitor therapy

Back 147

Tumor marker

Front 148

AFP

Back 148

germ cell tumors, liver cancer

Front 149

HCG

Back 149

Germ cell and trophoblastic tumors

Front 150

CEA

Back 150

colorectal, breast lung cancer

Front 151

CA 15-3, 27.29

Back 151

monitor recurrence of breast cnacer

Front 152

Hormone receptors

Back 152

breast cancer therapy

Front 153

CA-125

Back 153

ovarian cancer monitoring

Front 154

Total PSA

Back 154

Screen/monitor prostate cancer (glycoprotein)

4.1-10ng/ml and %PSA <24%

Front 155

Free PSA

Back 155

distinguish prostate cancer from BPH

Front 156

Alkaline phosphatase

Back 156

bone live leukemia (isoenzyme)

Front 157

CK

Back 157

Enzyme

prostatic, lung, breast, colon, ovarian

Front 158

Lactate dehydrogenase

Back 158

Enzyme

2,3, 4 (Lymphoma/leukemia)

5 Liver

Front 159

Hormone tumor marker

Back 159

secreting tumors

neuroblastoma

pituitary/adrenal gland

Front 160

Beta-human chronic gonadotropin+ AFP

Back 160

grem cell tumors

Front 161

Calcitonin

Back 161

thyroid carcinomas

Front 162

Adrenocorticotropin

Back 162

anterior pituitary

>200ng/dL

Front 163

Immunoglobulins

Back 163

Protien

MM

Immunofxation/SPEP

Front 164

Alpha-fetoproteins

Back 164

Protein

(80% liver, raised in heptitis/cirrhosis)

Front 165

CEA

Back 165

Oncofetal Ag

Colorectal adhesion protein

Front 166

CA 15-3, 27.29

Back 166

Carbohydrate Ag or secreted

Front 167

CA 27.29

Back 167

recurrent blood group mucin

Front 168

CA 19-9

Back 168

pancreatic cancer

Front 169

Lewis (=)

Back 169

no CA 19-9

Front 170

excessive marker concentration results in false low

Back 170

hook effect; eliminated by two step immunometric assay

Front 171

Lipemia, hemolysis, ab cross reactivity

Back 171

interferences in immunoassay: two site immunometric

Front 172

circulating Ab against animal immunoglobulin

Back 172

heterophile Ab

Front 173

Suppression of interference

Back 173

Non specific IgG

Front 174

Blood pH

Back 174

7.35-7.45

Front 175

pCO2

Back 175

35-45mmHg

Front 176

pO2

Back 176

85-108 mmHg

Front 177

HCO3

Back 177

22-26mmol/L

Front 178

O2 saturation

Back 178

>95%

Front 179

glass electrode

Back 179

pH

Front 180

severinghous electrode

Back 180

pCO2

H+ ions read