Buffer Systems in Mammals
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Questions and Answers

What is the therapeutic range for the drug mentioned?

  • 150-500 ng/ml
  • 100-450 ng/ml
  • 80-400 ng/ml (correct)
  • 50-300 ng/ml

    • Ventricular fibrillation results in a slow and regular heartbeat.

    False

    What is a major toxic effect of aminoglycosides?

    Nephrotoxicity and ototoxicity

    Match the antibiotic with its associated toxic range:

    <p>Amikacin = &gt;30 ug/ml Gentamicin = 12-15 ug/ml Vancomycin = Not specified Kanamycin = &gt;30 ug/ml</p> Signup and view all the answers

    The half-life of the drug is approximately ______ hours.

    <p>2-3</p> Signup and view all the answers

    What is the normal range for blood pH?

    <p>7.35 - 7.45</p> Signup and view all the answers

    Bicarbonate acts as a weak acid in the bicarbonate-carbonic acid buffer system.

    <p>False</p> Signup and view all the answers

    What is the principal mammalian buffer system?

    <p>Bicarbonate-carbonic acid buffer system</p> Signup and view all the answers

    Normal ionized bicarbonate (HCO3) levels range from _____ mmol/L.

    <p>21 - 28</p> Signup and view all the answers

    Which compound readily dissociates into H2O and CO2 once it reaches the blood circulation?

    <p>Carbonic acid</p> Signup and view all the answers

    Match the components of the bicarbonate-carbonic acid buffer system with their descriptions:

    <p>Bicarbonate = Conjugate base Carbonic Acid = Weak acid Ionized Bicarbonate = Measured to determine pH CO2 = Higher concentration than HCO3 in blood</p> Signup and view all the answers

    The normal range for carbonic acid concentrations in blood is 1.05 – 1.45 mmol/L.

    <p>True</p> Signup and view all the answers

    What is measured to determine blood pH in relation to bicarbonate?

    <p>Ionized bicarbonate (HCO3)</p> Signup and view all the answers

    What is the therapeutic range for digoxin levels?

    <p>50-100 ng/ml</p> Signup and view all the answers

    Alpha blockers promote constriction of the arterioles.

    <p>False</p> Signup and view all the answers

    Name one major side effect of alpha blockers related to blood pressure.

    <p>Orthostatic hypotension</p> Signup and view all the answers

    What condition can be treated with propranolol due to its effect on thyroid hormones?

    <p>Thyrotoxicosis</p> Signup and view all the answers

    Propranolol is primarily used in the treatment of _______ and hypertension.

    <p>angina pectoris</p> Signup and view all the answers

    Match the following medications with their trade names:

    <p>Doxazosin = Cardura Prazosin = Minipress Terazosin = Hytrin</p> Signup and view all the answers

    What are the effects of alpha-blocking drugs?

    <p>Lower high blood pressure and reduce heart workload</p> Signup and view all the answers

    What is the primary therapeutic level for cyclosporine and tacrolimus?

    <p>5 mg/dL</p> Signup and view all the answers

    What phenomenon occurs during Raynaud's type episodes?

    <p>Insufficient blood supply causing color changes</p> Signup and view all the answers

    Leflunomide is used for the treatment of rheumatoid arthritis and does not affect lymphocyte proliferation.

    <p>False</p> Signup and view all the answers

    Name one side effect of cyclosporine and tacrolimus.

    <p>GI disturbances</p> Signup and view all the answers

    The half-life of cyclosporine and tacrolimus is _____ hours.

    <p>17</p> Signup and view all the answers

    Which of the following is a toxic effect associated with methotrexate at levels greater than 30 mg/dL?

    <p>Reye Syndrome</p> Signup and view all the answers

    Match the following drugs to their uses or properties:

    <p>Cyclosporine = Decreases renal allograft rejection Leflunomide = Treatment of rheumatoid arthritis Methotrexate = Immunosuppressive agent Trinder assay = Uses ferric nitrate for testing</p> Signup and view all the answers

    Reye Syndrome commonly occurs without a previous viral infection.

    <p>False</p> Signup and view all the answers

    What does the term 'anti-neoplastic' refer to?

    <p>Drugs that prevent or inhibit the development of tumors.</p> Signup and view all the answers

    Which of the following is NOT an adverse effect of neuroleptics?

    <p>Skin rash</p> Signup and view all the answers

    Leucovorin is used to enhance the effects of methotrexate.

    <p>False</p> Signup and view all the answers

    What is the maximum daily dose of acetaminophen?

    <p>4 grams</p> Signup and view all the answers

    Methotrexate inhibits DNA synthesis by blocking _____.

    <p>dihydrofolate reductase</p> Signup and view all the answers

    What is the half-life range of acetaminophen?

    <p>5-9 hours</p> Signup and view all the answers

    Match the following drugs with their classifications:

    <p>Risperdal = Neuroleptic (antipsychotic) Chlorpromazine = Phenothiazine Haloperidol = Butyrophenone Aripiprazole = Neuroleptic (antipsychotic)</p> Signup and view all the answers

    Trough concentrations are drawn right after administering the next dose.

    <p>False</p> Signup and view all the answers

    What are the metabolite conjugates produced by the liver when acetaminophen is processed?

    <p>Glucuronide and Sulfate</p> Signup and view all the answers

    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
      • 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
    • 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.

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