55 Questions
Which of the following is the MAIN purpose of therapeutic drug monitoring (TDM)?
To optimize treatment by maintaining drug concentrations within the therapeutic window
A patient is not responding to their current drug therapy as expected. Which of the following is the BEST next step in this situation?
Measure the patient's current drug concentration in the body
Which of the following factors can MOST significantly affect a drug's availability in the body?
The route of drug administration
When is the OPTIMAL time to collect a sample for therapeutic drug monitoring?
At the trough of the drug's concentration in the body
Which of the following is the MAIN factor that determines the duration of action of a drug?
The drug's half-life
What is the main purpose of using the Levey-Jennings chart in quality control?
To identify trends in results
In quality control, what does the term 'shift' refer to?
6 or more results on one side of the mean
What is the purpose of calculating the overall lab performance using the Bias Index Score (BIS) for all analytes?
To evaluate the laboratory's performance across all analytes
Why is the assessment of therapy important when a patient is clinically unstable?
To identify potential drug toxicity
In suspected drug toxicity, what is a common reason for unexpectedly high drug levels?
Complex drug interactions with other medications
Which patient group is specifically mentioned as requiring close monitoring due to both over- and under-nourishment issues?
Obese patients
Which enzyme is considered the most sensitive marker for myocardial infarction?
Troponin
What is the primary cause of myocardial infarction?
Rupture of an atherosclerotic plaque in a coronary artery
Which of the following liver function tests can be used as an indirect marker of atherosclerosis?
Globulins
What is the main difference between creatine kinase (CK) and troponin in the context of myocardial infarction?
Troponin is more sensitive but less specific than CK
Which of the following liver function tests can provide information about the severity of atherosclerosis?
Albumin-globulin (A/G) ratio
What is the main purpose of measuring the LDH isoenzyme pattern in the context of myocardial infarction?
To differentiate between myocardial and liver injury
Which of the following is the primary mechanism of nephrotoxicity caused by aminoglycoside antibiotics?
Altering phospholipid metabolism in renal tubular cells
Which of the following statements about the ototoxicity caused by aminoglycoside antibiotics is correct?
It is caused by the generation of free radicals in the inner ear, leading to damage to sensory cells and neurons.
Which of the following drugs of abuse is commonly measured in urine using gas chromatography/mass spectrometry (GC/MS)?
Cannabinoids
Which of the following statements regarding the misuse of drugs is correct?
Anabolic steroids are commonly misused for performance enhancement in athletic settings.
Which analytical technique is commonly used for the measurement of amphetamines in biological samples?
Both GC and LC can be used
What is the key reason why therapeutic drug monitoring (TDM) is required for aminoglycoside antibiotics?
Aminoglycosides have a narrow therapeutic index and toxicity is a major concern.
Which of the following statements about the pharmacokinetics of aminoglycoside antibiotics is INCORRECT?
Aminoglycosides have a long elimination half-life of approximately 2-3 hours.
Which of the following drug classes is NOT mentioned in the text as requiring therapeutic drug monitoring (TDM)?
Antidepressant drugs
Why is therapeutic drug monitoring important for monitoring digoxin levels?
All of the above
Therapeutic drug monitoring is not necessary for evaluating patient compliance with their medication regimen.
False
Therapeutic drug monitoring is primarily used to assess potential drug interactions.
False
Therapeutic drug monitoring is not required for drugs with a wide therapeutic index.
True
Therapeutic drug monitoring is not necessary for patients with organ damage, such as liver or kidney impairment.
False
Therapeutic drug monitoring is not required for patients who are clinically unstable or have uncompensated cardiac dysfunction.
False
Therapeutic drug monitoring is not necessary for patients with airway disease.
False
Drugs with a narrow therapeutic index require therapeutic drug monitoring (TDM) to avoid toxicity.
True
Aminoglycoside antibiotics are eliminated primarily through hepatic metabolism.
False
Therapeutic drug monitoring is not required for $\text{digoxin}$, as its plasma concentration is predictably related to its effects.
False
Aminoglycoside antibiotics primarily target anaerobic gram-positive bacteria.
False
Phenytoin, an anti-epileptic drug, requires therapeutic drug monitoring due to its linear pharmacokinetics.
False
Aminoglycoside antibiotics have a long elimination half-life of approximately 8-12 hours.
False
Aminoglycoside antibiotics are primarily distributed to the liver via active transport.
False
Ototoxicity caused by aminoglycoside antibiotics is primarily due to the generation of free radicals in the inner ear, leading to damage to sensory cells and neurons.
True
Amphetamines are commonly used clinically for the treatment of narcolepsy and ADHD, and their misuse can lead to an initial feeling of well-being followed by restlessness and possible psychosis.
True
Anabolic steroids are primarily used in clinical settings to increase muscle mass and improve athletic performance.
True
Cocaine is a stimulant drug that can cause a high concentration of free radicals in the body.
False
Creatine kinase (CK) is the most sensitive marker for diagnosing myocardial infarction.
False
Therapeutic drug monitoring (TDM) is not required for opioid analgesics, as they do not require close monitoring.
False
The main purpose of measuring the LDH isoenzyme pattern in the context of myocardial infarction is to determine the severity of atherosclerosis.
False
Aspartate aminotransferase (AST) is a specific marker for liver injury and is not elevated in myocardial infarction.
False
The primary cause of myocardial infarction is the rupture of an atherosclerotic plaque in a coronary artery, leading to thrombus formation and blood flow obstruction.
True
Therapeutic drug monitoring (TDM) is not required for CNS stimulants, as they have a wide therapeutic index and do not require close monitoring.
False
Apolipoprotein B-100 is the smallest single polypeptide chain known.
False
Chylomicrons have high density in plasma due to their nonpolar composition.
False
Insulin resistance primarily affects peripheral tissues like the liver and kidney.
False
Hyperglycemia is characterized by low blood glucose levels.
False
Ketoacidosis is commonly associated with Type 1 Diabetes.
True
UDP-glucuronosyltransferases are involved in the breakdown of cholesterol esters.
False
Study Notes
- Drugs can cause nephrotoxicity by accumulating in renal tubular cells and altering phospholipid metabolism, leading to renal vasoconstriction.
- Ototoxicity from drugs can result in mild reversible hearing loss by generating free radicals in the inner ear, damaging sensory cells and neurons.
- Drugs of abuse like amphetamines, anabolic steroids, and cannabinoids have various clinical applications and effects on the body.
- Therapeutic Drug Monitoring (TDM) involves measuring drug levels in body fluids to optimize treatment and improve patient management.
- Factors affecting drug availability for TDM include the therapeutic window, lag period, duration of action, and the necessity for drug concentration monitoring.
- Drugs like digoxin, quinidine, antibiotics, anti-epileptic drugs, psychoactive drugs, and immunosuppressive drugs require TDM due to their narrow therapeutic indices and potential toxicities.
- Aminoglycoside antibiotics, used to treat bacterial infections, have specific characteristics such as poor oral absorption, wide distribution, and nearly complete excretion through urine.
Learn about the definition, principles, applications, and examples of Therapeutic Drug Monitoring (TDM) in Analytical and Clinical Biochemistry. Understand how TDM helps optimize treatment by measuring drug concentrations in body fluids and its role in patient management.
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