Therapeutic Drug Monitoring

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Author:
ncrook
ID:
209497
Filename:
Therapeutic Drug Monitoring
Updated:
2013-05-05 22:47:39
Tags:
Cardioactive Antibiotic Antiepileptic Antipsychotic Bronchodilator Immunosuppressive Antineoplastic
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Cardioactive, Antibiotic, Antiepileptic, Antipsychotic, Bronchodilator, Immunosuppressive, Antineoplastic
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  1. What is the purpose of therapeutic drug monitoring?
    To establish maximum benefits with minimal toxic effects for drugs whose correlation with dosage, effect, or toxicity is not clear
  2. Name the most common routes of drug administration
    • Oral
    • IV
    • IM
    • SC (subcutaneous)
  3. What is the term for the drug concentration that produces benefits?
    Therapuetic range
  4. What happens in to all drugs that are absorbed from the GI tract?
    All drugs must go through the liver before entering the general circulation
  5. How do most drugs circulate in the blood?
    Bound to plasma proteins
  6. What do acidic drugs primarily bind to?
    Albumin
  7. What do basic drugs primarily bind to?
    Alpha1-acid glycoprotein (AAG)
  8. Which drugs can interact with target sites and produce a response?
    Only free drugs
  9. In most TDM assays, what is quantified, the free or total drug concentration?
    Quantification of the total drug
  10. In general, how are drugs eliminated from the circulation?
    Through hepatic metabolic processes and renal filtration
  11. Approximately how many doses need to be given before a steady state of a peak and trough levels can be assessed?
    Approximately 7 doses
  12. What is the function of digoxin?
    Cardiac glycoside used to treat congestive heart failure
  13. What is the therapeutic range of digoxin?
    0.8-2.0 ng/mL
  14. What is the function of lidocaine?
    Antiarrhythmic drug used to treat ventricular arrhythmia and prevent ventricular fibrillation
  15. What is the therapeutic range of lidocaine?
    1.5-4.0 micro-gram/mL
  16. What happens when toxicity of lidocaine occurs?
    • 4-8: CNS depression
    • >8: seizures and severe hypotension
  17. What is the function of quinidine?
    Antiarrhythmic drug used to treat cardiac arrhythmia
  18. What is the therapeutic range of quinidine?
    2-5 micro-gram/mL
  19. What is the function of procainamide?
    Antiarrhythmic drug used to treat cardiac arrhythmia
  20. What is the therapeutic range of procainamide?
    4-8 micro-gram/mL
  21. What is the function of aminoglycosides?
    Used to treat infections caused by gram negative bacteria
  22. What is included in the aminoglycosides?
    • Gentamicin
    • Tobramycin
    • Kanamycin
    • Amikacin
  23. What is associated with the toxicity of aminoglycosides?
    • Nephrotoxicity
    • Ototoxicity
  24. What is the function of vancomycin?
    Used to treat infections caused by gram positive bacteria
  25. What is associated with the toxicity of vancomycin?
    • Nephrotoxicity
    • Ototoxicity
    • "Red-man syndrome" (erythemic flushing of extremities
  26. What is the function of phenobarbital?
    Slow acting barbituate used to control seizures
  27. What is associated with toxicity of phenobarbital?
    • Drowsiness
    • Depression
    • Fatigue
    • Altered mental ability
  28. What is the therapeutic range of phenobarbital?
    15-40 micro-gram/mL
  29. What is the function of phenytoin?
    Used to control seizures and to keep the brain from swelling and injuring tissue during brain traumas
  30. What is associated with toxicity of phenytoin?
    Seizures
  31. What is the therapeutic range of the total and free serum levels of phenytoin?
    • Total serum level: 10-20 micro-gram/mL
    • Free serum level: 1-2 micro-gram/mL
  32. What is the function of valproic acid?
    Used to control seizures
  33. What is the therapeutic range of valproic acid?
    50-100 micro-gram/mL
  34. What is the function of carbamazepine?
    Used to control seizures
  35. What is the therapeutic range of carbamazepine?
    4-12 micro-gram/mL
  36. What is the function of lithium?
    Used to treat manic depression
  37. What is the therapeutic range of lithium?
    1.0-1.2 mmol/L
  38. What is the function of tricyclic antidepressants (TCAs)?
    Used in cases of depression, insomnia, extreme apathy, and loss of libido?
  39. What is included in tricyclic antidepressants (TCAs)?
    • Amitriptyline
    • Imipramine
    • Doxepin
  40. What is the the therapeutic range of amitriptyline?
    120-150 ng/mL
  41. What is the therapeutic range of imipramine?
    150-300 ng/mL
  42. What is the therapeutic range of nortriptyline?
    50-150 ng/mL
  43. What is the therapeutic range of desipramine?
    150-300 ng/mL
  44. What is the function of theophylline?
    Used to treat asthma and other chronic obstructive pulmonary disorders (COPD)
  45. What is the therapeutic range of theophylline?
    10-20 micro-gram/mL
  46. What is the function of cyclosporine?
    Used to suppress transplant rejections and graft-versus-host disease
  47. What is the therapeutic range of cyclosporine?
    • Range differs depending on the organ being transplanted
    • Liver, pancreas, and heart: 200-350 ng/mL
    • Renal: 100-300 ng/mL
  48. What is the function of tacrolimus (prograf)?
    • Used to suppress transplant rejections and graft-versus-host disease
    • Potency far exceeds cyclosporine by a factor of 100
  49. Which drug is preferred for the use to suppress transplant rejections and graft-versus-host disease?
    • Tacrolimus (prograf)
    • Because potency far exceed cyclosporine by a factor of 100
  50. What is the therapeutic range of tacrolimus (prograf)?
    10-15 ng/mL
  51. What is the function of sirolimus (rapamune)?
    Used to suppress transplant rejections and graft-versus-host disease
  52. What is the therapeutic range of sirolimus (rapamune)?
    4-12 ng/mL
  53. What is the function of methotrexate?
    Used to destroy neoplastic cells
  54. What refers to the administration of leucovorin to offset the effect of methotrexate in an attempt to prevent cytotoxicity of normal cells?
    Leucovorin rescue
  55. What is the therapeutic monitoring of of methotrexate?
    • High dose therapy generally exceeds 50 mg/m2
    • Serum levels are monitored at 24, 48, and 72 hrs after drug administration
  56. Name some antibiotics that are monitored for therapeutic levels
    • Amikacin
    • Chloramphenicol
    • Dibekacin
    • Gentamicin
    • Kanamycin
    • Netilmicin
    • Streptomycin
    • Tobramycin
    • Vancomycin
  57. Name some antineoplastics that are monitored for therapeutic levels
    Methotrexate
  58. Name some cardiac glycosides that are monitored for therapeutic levels
    • Digitoxin
    • Digoxin
  59. Name some anticonvulsants that are monitored for therapeutic levels
    • Carbamezepine (Tegretol)
    • Ethosuximide
    • Phenobarbital
    • Phenytoin (Dilantin)
    • Primidone
    • Valproic Acid
  60. Name some antiarrhythmics that are monitored for therapeutic levels
    • Disopyramide
    • Flecainide
    • Lidocaine
    • Procainamide
    • N-Acetylprocainamide
    • Propanolol
    • Tocainide

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