CHEM07 - TDM and Toxicology

Home > Preview

The flashcards below were created by user victimsofadown on FreezingBlue Flashcards.


  1. Acetaminophen toxicity will manifest primarily as

    A) liver failure.
    B) CNS disturbances.
    C) respiratory depression.
    D) renal failure.
    A) liver failure.
    (this multiple choice question has been scrambled)
  2. The theophylline analog that may be monitored in the treatment of neonatal apnea is

    A) caffeine
    B) NAPA
    C) theobromine
    D) hypoxanthine
    A) caffeine
    (this multiple choice question has been scrambled)
  3. A patient who overdosed on digoxin was given Digibind. The physician ordered a stat digoxin level 1 hour later. Which of the following is the most appropriate response?

    A) perform the digoxin after treatment with heterophile blocking reagent.
    B) perform the digoxin.
    C) inform the physician that a digoxin concentration cannot be accurately determined.
    D) recommend a digitoxin level also.
    C) inform the physician that a digoxin concentration cannot be accurately determined.
    (this multiple choice question has been scrambled)
  4. The blood concentration of the drug reflects its concentration at its target receptor:

    1. Immediately after ingestion/infusion
    2. At least two hours after ingestion/infusion
    3. After distribution is complete.
    4. Just before the next dose

    A)  and 4
    B) 2, 3, and 4
    C) 3
    D) 4
    E) 1 and 4
    F) 2
    G) 1, 2, 3, and 4
    E) 1 and 4
    (this multiple choice question has been scrambled)
  5. The site in the body where most drug metabolism occurs is the

    A) kidney
    B) intestine
    C) liver
    D) stomach
    C) liver
    (this multiple choice question has been scrambled)
  6. The best time to collect a sample for therapeutic monitoring of most oral drugs is

    A) one hour after the dose.
    B) immediately before the next dose.
    C) one half hour after the dose.
    D) two hours after the dose.
    B) immediately before the next dose.
    (this multiple choice question has been scrambled)
  7. For which of the following metals should all children be tested by age 6?

    A) iron
    B) mercury
    C) lead
    D) arsenic
    E) copper
    C) lead
    (this multiple choice question has been scrambled)
  8. As a rule of thumb, the steady state concentration of a drug is achieved after how many half lives?

    A) 2
    B) 4-5
    C) steady state achievement depends upon patient weight.
    D) steady state is achieved after the first day.
    E) 3-4
    B) 4-5
    (this multiple choice question has been scrambled)
  9. The specimen of choice for monitoring levels of the immunosuppressant drugs cyclosporine, tacrolimus andsirolimus is

    A) whole blood
    B) plasma
    C) urine
    D) serum
    A) whole blood
    (this multiple choice question has been scrambled)
  10. A drug known to increase the metabolism of many other drugs is

    A) theophylline.
    B) lithium.
    C) phenobarbital.
    D) digoxin.
    C) phenobarbital
    (this multiple choice question has been scrambled)
  11. The fraction of a dose that reaches the bloodstream is known as a drug's

    A) volume of distribution.
    B) dose response.
    C) absorptivity.
    D) bioavailability.
    D) bioavailability.
    (this multiple choice question has been scrambled)
  12. The halflifeof a drug is 4 hours. If the initial concentration is 100 mcg/mL, in three halflivesthe expected drug concentration would be

    A) 13 ug/mL
    B) 25 ug/mL
    C) Cannot determine from available information
    D) 40 ug/mL
    E) 88 ug/mL
    A) 13 ug/mL
    (this multiple choice question has been scrambled)
  13. When testing for therapeutic drugs, steady state refers to

    A) the time when the derivative of drug concentration vs time = zero.
    B) the time after a dose when the drug concentration is most stable.
    C) the time before a dose when the drug concentration is changing the least.
    D) the time when net drug administered is equal to net drug eliminated
    D) the time when net drug administered is equal to net drug eliminated
    (this multiple choice question has been scrambled)
  14. The legal limit for ethanol (ETOH) while driving in California is

    A) 0.10% in whole blood.
    B) 0.08% in serum or plasma.
    C) 0.10% in serum or plasma.
    D) 0.08% in any blood sample.
    E) 0.10% in any blood sample.
    F) 0.08% in whole blood.
    F) 0.08% in whole blood.
    (this multiple choice question has been scrambled)
  15. The metabolite THCCOOHcan be detected by immunoassay for several days after the use of

    A) marijuana.
    B) methamphetamine.
    C) cocaine.
    D) heroin.
    A) marijuana.
    (this multiple choice question has been scrambled)
  16. The most sensitive and specific method for identifying drugs of abuse is

    A) monoclonal immunoassay.
    B) GC mass spectrometry (GCMS).
    C) HPLC.
    D) gas liquid chromatography (GC).
    B) GC mass spectrometry (GCMS).
    (this multiple choice question has been scrambled)
  17. When receiving a assay request for the drug on the left, which drug on the right should also be measured?

    +Gentamicin
    +Primidone
    +Procainamide

    -Digoxin
    -Phenytoin
    -Phenobarbital
    -Tobramycin
    -No other drug need be measured
    -Amikacin
    -NAPA
    • Getamicin: No other drug need be measured
    • Primidone: Phenobarbital
    • Procainamide: NAPA
  18. What is occurring in phase I metabolism of a therapeutic drug?

    A) Conjugation to a different moiety
    B) First pass metabolism
    C) Elimination
    D) Chemical modification such as hydrolysis or oxidation
    D) Chemical modification such as hydrolysis or oxidation
    (this multiple choice question has been scrambled)
  19. The group of enzymes that are particularly involved in phase I metabolism of drugs is

    A) methyltransferases.
    B) xenobiotases.
    C) cytochrome P450.
    D) glucuronyl transferases.
    C) cytochrome P450.
    (this multiple choice question has been scrambled)
  20. All of the following are antiepileptic (anticonvulsant) drugs EXCEPT

    A) carbamazepine.
    B) phenytoin.
    C) valproic acid.
    D) procainamide.
    D) procainamide.
    (this multiple choice question has been scrambled)
  21. The drug most suited for measurement of the free fraction in appropriate circumstances is

    A) phenytoin.
    B) gentamicin.
    C) vancomycin
    D) caffeine
    A) phenytoin.
    (this multiple choice question has been scrambled)
  22. The most common method of measuring ethanol in clinical laboratories is

    A) LC MS/MS.
    B) gas liquid chromatography.
    C) GCMS.
    D) enzymatic assay using ADH.
    D) enzymatic assay using ADH.
    (this multiple choice question has been scrambled)
  23. A 56 y.o. female patient has a digoxin measured stat just prior to his 11:00 am doctor's appointment. The result is 6.2 ng/mL (ther. range 0.82.0)and when you call this critical value, the physician responds that the patient is only taking a very low dose every morning and the EKG he just took shows no signs of digoxin toxicity. What is the most likely cause of this discrepancy?

    A) DLIS
    B) laboratory error
    C) incomplete distribution
    D) concurrent DigiFab therapy
    C) incomplete distribution
    (this multiple choice question has been scrambled)
  24. A mass spectrum is a plot of

    A) abundance vs time.
    B) m/z vs time.
    C) m/z vs abundance
    D) mass vs time.
    C) m/z vs abundance
    (this multiple choice question has been scrambled)
  25. A homeless man is taken to the ED with profound "inebriation", hyperventilation and a fruity odor on his breath. Stat glucose is 176 mg/dL and BHB (beta hydroxybutyrate)is normal. Urinalysis is normal except for trace glucose and 1+ ketones. Osmolal gap is elevated. Which test would you recommend to a physician?

    A) Serum ethanol
    B) Serum glucagon
    C) Serum volatiles
    D) None, this is clearly DKA
    E) Serum ethylene glycol
    C) Serum volatiles
    (this multiple choice question has been scrambled)
  26. Ethylene glycol ingestion might be accompanied by all of the following EXCEPT

    A) rbcs in urine.
    B) metabolic acidosis.
    C) elevated acetone.
    D) calcium oxalate crystals in urine.
    C) elevated acetone.
    (this multiple choice question has been scrambled)
  27. The following drugs all have somewhat specific "antidotes" that can minimize toxicity EXCEPT

    A) acetaminophen.
    B) ethylene glycol.
    C) ethanol.
    D) methanol.
    C) ethanol.
    (this multiple choice question has been scrambled)
  28. You are called to court to testify about a sample drawn in the ED from a driver involved in a collision. The serum alcohol was 86 mg/dL. The prosecution says this proves the driver was legally drunk. The defense counters with one of the following arguments. Which is the most defensible from a laboratory point of view?

    A) The sample tested was serum, so the results do not correspond to legal definitions of DUI.
    B) The alcohol dehydrogenase assay used by the lab is not specific enough for forensic testing. They should use GCMS.
    C) The sample was collected after disinfection of the blood draw site with an alcohol swab. The contamination raised the apparent alcohol level.
    D) The laboratory does not follow chain of custody procedures, so we know nothing about the identity or integrity of the sample they tested.
    A) The sample tested was serum, so the results do not correspond to legal definitions of DUI.
    (this multiple choice question has been scrambled)
  29. Doubling the dose of a drug that follows "saturation" kinetics might lead to

    A) no change in steady state drug levels
    B) an approximate 3367%increase in steady state drug levels.
    C) an approximate doubling of steady state drug levels.
    D) a quadrupling of steady state drug levels.
    D) a quadrupling of steady state drug levels.
    (this multiple choice question has been scrambled)
  30. A concurrently administered drug that might affect drug levels of gentamicin is

    A) valproic acid.
    B) vancomycin.
    C) phenobarbital.
    D) carbenicillin.
    D) carbenicillin.
    (this multiple choice question has been scrambled)
  31. A potential interferent in digoxin immunoassays in pregnant women and newborns is

    A) DHEA
    B) DMSO
    C) DLIS
    D) DigiFab
    C) DLIS
    (this multiple choice question has been scrambled)
  32. The drug whose dosing would most likely need adjustment in a patient with renal disease is

    A) theophylline.
    B) carbamazepine.
    C) gentamicin.
    D) phenytoin.
    C) gentamicin.
    (this multiple choice question has been scrambled)
  33. +Methemoglobin
    +Methemoglobin samples
    +Carboxyhemoglobin
    +Carboxyhemoglobin samples

    -is hemoglobin with Fe3+.
    -is hemoglobin complexed with carbon dioxide.
    -is hemoglobin complexed with carbon monoxide.
    -are unstable and should be iced or analyzed w/in 30 minutes.
    -are unstable and should be iced
    -must be collected anaerobically.
    -are stable and can be analyzed rou栱nely.
    • Methemoglobin: is hemoglobin with Fe3+.
    • Methemoglobin samples: are unstable and should be iced or analyzed w/in 30 minutes.
    • Carboxyhemoglobin: is hemoglobin complexed with carbon monoxide.
    • Carboxyhemoglobin samples: are stable and can be analyzed routinely.
  34. are stable and can be analyzed routinely.

    A) CO displaces Fe from the heme ring, preventing oxygen binding.
    B) CO binds to the O2 binding site, preventing O2 binding.
    C) CO oxidizes Hgb ferrous ion to ferric ion.
    D) CO dissociates the Hgb tetramers, preventing O2 binding.
    B) CO binds to the O2 binding site, preventing O2 binding.
    (this multiple choice question has been scrambled)
  35. Proper interpretation of serum acetaminophen levels and hepatic necrosis risk require that the sample be drawn

    A) no sooner than four hours after ingestion
    B) as soon as possible after ingestion
    C) within 24 hours of ingestion
    D) within two hours of ingestion
    A) no sooner than four hours after ingestion
    (this multiple choice question has been scrambled)
  36. Definition of a therapeutic range by a laboratory

    A) is determined by transference
    B) uses the central 95% of values from at least 20 patients on the drug
    C) follows CLSI guideline EP 23
    D) uses data from clinical trials
    D) uses data from clinical trials
    (this multiple choice question has been scrambled)
  37. Match the following:

    +what the body does to a drug
    +what a drug does to the body

    -pharmacokinetics
    -pharmacognosy
    -pharmaceutics
    -pharmacodynamics
    • what the body does to a drug: pharmacokinetics
    • what a drug does to the body: pharmacodynamics
  38. The type of drug administration that shows the MOST variability among patients is:

    A) intravenous
    B) subcutaneous
    C) intramuscular
    D) oral
    D) oral
    (this multiple choice question has been scrambled)
  39. The drug mentioned in class as a potential candidate for dosing decisions made on pharmacogenetics is

    A) ketoconazole
    B) warfarin
    C) primidone
    D) diazepam
    B) warfarin
    (this multiple choice question has been scrambled)
  40. The drug for which peak levels would be most useful is

    A) vancomycin
    B) digoxin
    C) caffeine
    D) phenobarbital
    A) vancomycin
    (this multiple choice question has been scrambled)
  41. Monitoring of which of the following psychotropic drugs (or drug classes) is most appropriate and common.

    A) benzodiazepines (e.g., diazepam or Xanax)
    B) none need be or are commonly monitored
    C) lithium
    D) tricyclic antidepressants
    E) SSRI's (e.g., Prozac, etc)
    C) lithium
    (this multiple choice question has been scrambled)
  42. Iron was recommended to be available stat, ideally with TIBC. Which of the following results would be the most concerning in a presumed iron ingestion (all units are mcg/dL)?

    A) None are concerning
    B) Cannot determine without knowing transferrin saturation
    C) Fe 400, TIBC 450
    D) Fe 300, TIBC 400
    E) Fe 300, TIBC 250
    E) Fe 300, TIBC 250
    (this multiple choice question has been scrambled)
  43. Determination of carboxyhemoglobin in the clinical laboratory would be most commonly performed in which lab section?

    A) blood gases
    B) electrophoresis
    C) toxicology
    D) hematology
    E) automated chemistry
    A) blood gases
    (this multiple choice question has been scrambled)
  44. For the following ingestions, what compound would provide the most concerning toxicity?

    +ethanol
    +ethylene glycol
    +isopropanol
    +methanol

    -glyoxal
    -ethanol
    -methyl formate
    -isopropanol
    -oxalic acid
    -acetaldehyde
    -formaldehyde
    -acetone
    • ethanol: ethanol
    • ethylene glycol: oxalic acid
    • isopropanol: isopropanol
    • methanol: formaldehyde
  45. Ingestion of poppy seed bagels might give a positive immunoassay reaction for urinary

    A) THC (cannabinoids)
    B) cocaine (metabolite)
    C) opiates
    D) PCP
    C) opiates
    (this multiple choice question has been scrambled)
  46. Most reference laboratories require that samples for TDM NOT be collected in

    A) gel barrier tubes
    B) green top tubes (heparin)
    C) capillary tubes
    D) red top tubes (no anticoagulant)
    A) gel barrier tubes
    (this multiple choice question has been scrambled)

Card Set Information

Author:
victimsofadown
ID:
327343
Filename:
CHEM07 - TDM and Toxicology
Updated:
2017-01-12 01:36:18
Tags:
CHEM07 TDM Toxicology
Folders:
TESTS,CHEM
Description:
CHEM07 - TDM and Toxicology
Show Answers:

Home > Flashcards > Print Preview