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What is the therapeutic range for the drug mentioned?
What is the therapeutic range for the drug mentioned?
Ventricular fibrillation results in a slow and regular heartbeat.
Ventricular fibrillation results in a slow and regular heartbeat.
False
What is a major toxic effect of aminoglycosides?
What is a major toxic effect of aminoglycosides?
Nephrotoxicity and ototoxicity
Match the antibiotic with its associated toxic range:
Match the antibiotic with its associated toxic range:
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The half-life of the drug is approximately ______ hours.
The half-life of the drug is approximately ______ hours.
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What is the normal range for blood pH?
What is the normal range for blood pH?
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Bicarbonate acts as a weak acid in the bicarbonate-carbonic acid buffer system.
Bicarbonate acts as a weak acid in the bicarbonate-carbonic acid buffer system.
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What is the principal mammalian buffer system?
What is the principal mammalian buffer system?
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Normal ionized bicarbonate (HCO3) levels range from _____ mmol/L.
Normal ionized bicarbonate (HCO3) levels range from _____ mmol/L.
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Which compound readily dissociates into H2O and CO2 once it reaches the blood circulation?
Which compound readily dissociates into H2O and CO2 once it reaches the blood circulation?
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Match the components of the bicarbonate-carbonic acid buffer system with their descriptions:
Match the components of the bicarbonate-carbonic acid buffer system with their descriptions:
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The normal range for carbonic acid concentrations in blood is 1.05 – 1.45 mmol/L.
The normal range for carbonic acid concentrations in blood is 1.05 – 1.45 mmol/L.
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What is measured to determine blood pH in relation to bicarbonate?
What is measured to determine blood pH in relation to bicarbonate?
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What is the therapeutic range for digoxin levels?
What is the therapeutic range for digoxin levels?
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Alpha blockers promote constriction of the arterioles.
Alpha blockers promote constriction of the arterioles.
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Name one major side effect of alpha blockers related to blood pressure.
Name one major side effect of alpha blockers related to blood pressure.
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What condition can be treated with propranolol due to its effect on thyroid hormones?
What condition can be treated with propranolol due to its effect on thyroid hormones?
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Propranolol is primarily used in the treatment of _______ and hypertension.
Propranolol is primarily used in the treatment of _______ and hypertension.
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Match the following medications with their trade names:
Match the following medications with their trade names:
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What are the effects of alpha-blocking drugs?
What are the effects of alpha-blocking drugs?
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What is the primary therapeutic level for cyclosporine and tacrolimus?
What is the primary therapeutic level for cyclosporine and tacrolimus?
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What phenomenon occurs during Raynaud's type episodes?
What phenomenon occurs during Raynaud's type episodes?
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Leflunomide is used for the treatment of rheumatoid arthritis and does not affect lymphocyte proliferation.
Leflunomide is used for the treatment of rheumatoid arthritis and does not affect lymphocyte proliferation.
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Name one side effect of cyclosporine and tacrolimus.
Name one side effect of cyclosporine and tacrolimus.
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The half-life of cyclosporine and tacrolimus is _____ hours.
The half-life of cyclosporine and tacrolimus is _____ hours.
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Which of the following is a toxic effect associated with methotrexate at levels greater than 30 mg/dL?
Which of the following is a toxic effect associated with methotrexate at levels greater than 30 mg/dL?
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Match the following drugs to their uses or properties:
Match the following drugs to their uses or properties:
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Reye Syndrome commonly occurs without a previous viral infection.
Reye Syndrome commonly occurs without a previous viral infection.
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What does the term 'anti-neoplastic' refer to?
What does the term 'anti-neoplastic' refer to?
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Which of the following is NOT an adverse effect of neuroleptics?
Which of the following is NOT an adverse effect of neuroleptics?
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Leucovorin is used to enhance the effects of methotrexate.
Leucovorin is used to enhance the effects of methotrexate.
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What is the maximum daily dose of acetaminophen?
What is the maximum daily dose of acetaminophen?
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Methotrexate inhibits DNA synthesis by blocking _____.
Methotrexate inhibits DNA synthesis by blocking _____.
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What is the half-life range of acetaminophen?
What is the half-life range of acetaminophen?
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Match the following drugs with their classifications:
Match the following drugs with their classifications:
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Trough concentrations are drawn right after administering the next dose.
Trough concentrations are drawn right after administering the next dose.
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What are the metabolite conjugates produced by the liver when acetaminophen is processed?
What are the metabolite conjugates produced by the liver when acetaminophen is processed?
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Study Notes
Buffer Systems
-
Bicarbonate-Carbonic Acid Buffer System
- Principle mammalian buffer system
- Acids combine with Bicarbonates in the blood
- Neutral Salts (Bicarbonate Salts) – conjugate base
- Carbonic Acid (Weak Acid)
- In blood circulation, bicarbonate and carbonic acid exists in 2 different forms:
- Bicarbonate: HCO3-
- Measured to determine pH
- Normal range: 21 - 28 mmol/L (21 - 28 meq/L)
- Carbonic Acid (unstable): H2CO3
- Readily dissociated into H2O and CO2 once it reaches the blood circulation
- This fraction of blood, plasma or serum includes the undissociated carbonic acid and the physically dissolved anhydrous C02
- Bicarbonate: HCO3-
- In blood circulation, CO2 concentration is higher than HCO3, the symbol cdCO2 (conc.of dissolved C02) is frequently used and measured from pCO2 multiplied by the solubility coefficient (0.03) of CO2.
- Normal range: 1.05 –1.45 mmol/L.
Propanol
- Beta receptor blocking drug (Class II)
- Used in the treatment of angina pectoris, hypertension, and coronary artery disease
- Suppresses the conversion of T4 to T3
- Helpful in patients with thyrotoxicosis
- Therapeutic Range: 50-100 ng/ml
- Toxic Effect:
- Hypotension
- Peripheral edema
- Ventricular fibrillation
Alpha Blockers
- Significant effect on the heart function and circulatory system activity
- Alpha receptors normally promote constriction of the arterioles
- Blocking constriction promotes dilation of vessels and lowers blood pressure as well as reducing the heart work in some situations.
- Alpha-blocking drugs also inhibit the actions of one of the adrenal hormones, norepinephrine, that raise blood pressure as part of the fight-or-flight response.
- Generic names (trade names): doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin)
- Effects: Lower high blood pressure and may reduce the heart workload in heart failure.
- Possible side effects:
- Orthostatic hypotension: Drop in blood pressure when a person stands up abruptly
- Dizziness and fainting may occur.
Vancomycin
- Example: Vancomycin HCl
- Glycopeptide - effective against gram (+) cocci and bacilli
- Supplemental therapy with cyclosporine and tacrolimus
- Decreases renal allograft rejection
- Half Life: 17hrs
Leflunamide
- Inhibits lymphocyte proliferation
- For the treatment of rheumatoid arthritis
Anti-Neoplastic
- Drugs to prevent/inhibit the development of neoplasm or tumor
- Therapeutic monitoring is not readily aided by therapeutic monitoring because the correlation between the plasma concentration and therapeutic benefits is hard to establish.
- Varies according to the type of neoplasm the patient has.
Methotrexate
- Example: Otrexup, Rasuvo
- Also an immunosuppressive agent
- Inhibits DNA synthesis in all cells by blocking dihydrofolate reductase
- Leucovorin is used to reverse action of methotrexate
- Methotrexate dose followed by Leucovorin because the neoplastic cell proliferate rapidly.
- The DNA synthesis will be most affecting the anti-neoplastic cell and after inhibition of DNA synthesis, we will be reversing the action thru Leucovorin
- Methotrexate dose followed by Leucovorin because the neoplastic cell proliferate rapidly.
- Half Life: 5-9hrs
- Therapeutic range for trough specimen: 20 mg/ml
- Adverse Effects: Insomnia, tachycardia, seizures, arrhythmias, cardiorespiratory arrest
Phenytoin
- Example: Dilantin
- Anticonvulsant drug that is effective against generalized tonic-clonic seizures
- Works by suppressing repetitive neuronal firing (mainly in the motor cortex of the brain) through blocking sodium channels and reducing calcium influx
- Also works by blocking the release of excitatory neurotransmitters in synapses
- It stabilizes the neuronal membrane by inhibiting the repetitive firing of neurons, which leads to a decrease in the amplitude and frequency of action potentials.
- This helps to prevent seizures by reducing the likelihood of synchronized neuronal activity
- Also known to have antidepressant effects.
- Half Life: 12 - 42 hours
- Not fully absorbed from the GIT
- IV administered
Neuroleptics (Antipsychotic Major Tranquilizer)
- Examples: Risperdal, Olonzapine ( Zyprexa), Quetiapine ( seroquel), Aripiprazole (abilify)
- Block the action of dopamine and serotonin in the limbic system.
- 2 classes:
- Phenothiazines (chlorpromazine)
- Butyrophenones (haloperidol)
- Toxic effects: cholestasis, orthostatic hypotension, aplastic anemia, muscle rigidity
Sample Collection
- Serum or plasma – specimen of choice
- Timing of specimen collection: Single most important factor in TDM
- Trough concentrations: Drawn right before the next dose.
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Description
Explore the Bicarbonate-Carbonic Acid Buffer System, which is the principal buffer system in mammalian blood. This quiz covers how acids combine with bicarbonates and the roles of carbonic acid in regulating blood pH levels. Test your understanding of these essential biochemical processes.
