Medical Technology Board Examination Review Notes Must Know (Rodriguez) 6

Therapeutic Drug Monitoring
Mixed function oxidase (MFO) system	Biochemical pathway responsible for the greatest portion of drug metabolism
Intravenous route	100% bioavailability
Liberation	Drug à Release
Absorption	Drug à Blood (most: by passive diffusion)
Distribution	Drug à Tissues
Metabolism	Drug à Chemical modification
Excretion	Drug à metabolites à excreted
Bioavailable fraction (f)	Fraction of the dose that reaches the blood
Vd of a drug	Dilution of the drug after it has been distributed in the body
First-pass hepatic metabolism	Drugs à Liver à Decreased bioavailability
First order elimination	Linear relationship bet. the amt. of drug eliminated per hour and the blood level of drug
Pharmacodynamics	Relationship bet. drug concentration at the target site and response of the tissues
Pharmacokinetics	Relationship bet. drug dose and drug blood level
Pharmacogenomics	Study of genes that affect the performance of a drug in an individual
Therapeutic index	Ratio bet. the minimum toxic and maximum therapeutic serum conc.
Trough concentration	Lowest concentration of a drug obtained in the dosing interval Drawn immediately (or 30 mins) before the next dose
Peak concentration	Highest concentration of a drug obtained in the dosing interval Drawn one hour after an orally administered dose (except digoxin)
Cardioactive Drugs
Class I	Rapid Na+ channel blockers (Procainamide, Lidocaine, Quinidine)
Class II	Beta receptor blockers (Propanolol)
Class III	K+ channel blockers (Amiodarone)
Class IV	Ca2+ channel blockers (Verapamil)
Digoxin	Tx: CHF
Lidocaine (Xylocaine)	Local anesthetic 1’ product of hepatic metabolism: MEGX (monoethylglycinexylidide)
Quinidine	Common formulations: Quinidine sulfate and Quinidine gluconate
Procainamide (Pronestyl)	Hepatic metabolite: NAPA (N-acetylprocainamide) Toxic effect: reversible lupus-like syndrome
Disopyramide	Substitute for quinidine Anticholinergic effects
Propanolol	Tx: angina pectoris
Amiodarone (Cordarone)	Iodine-containing drug
Verapamil	Tx: angina, hypertension, supraventricular arrhythmias
Antibiotics
Aminoglycosides	Tx: Gram (-) bacterial infections Nephrotoxic and ototoxic
Vancomycin	Tx: Gram (+) cocci and bacilli Toxic effects: “Red man syndrome” Nephrotoxic and ototoxic
Antiepileptic Drugs
Phenobarbital	Long acting barbiturate Enhances bilirubin metabolism Inactive proform: Primidone
Phenytoin (Dilantin)	Injectable proform: fosphenytoin
Valproic acid (Depakene)	Tx: petit mal and grand mal
Carbamazepine (Tegretol)	Tx: grand mal
Ethosuximide (Zarontin)	Drug of choice for controlling petit mal seizure
Gabapentin (Neurontin)	Similar to neurotransmitter GABA
Others (Antiepileptic)	Topiramate Lamotrigine (Lamictal) Felbamate
Psychoactive Drugs
Lithium	Tx: Bipolar disorders (Manic depression)
Tricyclic antidepressantas (TCA)	Imipramine Amitriptyline Doxepin Nortriptyline Tradazone
	Major metabolite: Desipramine
Fluoxetine (Prozac)	Blocks reuptake of serotonin Tx: Obsessive-compulsive disorders
Bronchodilator
Theophylline	Tx: Asthma and other COPD
Anti-inflammatory and Analgesic Drugs
Salicylates/Aspirin (Acetylsalicylic acid)	Antiplatelet (inhibits cyclooxygenase) Method: Trinder assay
Acetaminophen (Tylenol)	Hepatotoxic
Ibuprofen	Lower risk of toxicity than salicylates and acetaminophen
Neuroleptics (Antipsychotic major tranquilizers)
Neuroleptics	Block the action of dopamine and serotonin Tx: Schizophrenia 2 classes: -Phenothiazines (chlorpromazine) -Butyrophenones (haloperidol) Examples: -Risperdal -Olonzapine (Zyprexa) -Quetiapine (Seroquel) -Aripiprazole (Abilify)
Immunosuppressants	Cyclosporine Tacrolimus (FK-506) Rapamycin (Sirolimus) Mycophenolate mofetil Lefluamide
Chemotherapeutic agents	Busulfan Methotrexate
Toxicology
Toxic Agents
Alcohols (%w/v)	Common CNS depressants
0.01-0.05	No obvious impairment, some changes observable on performance testing
0.03-0.12	Mild euphoria, decr. inhibitions, some impairment of motor skills
0.09-0.25	Decr. inhibitions, loss of critical judgment, memory impairment, decr. rxn time
0.18-0.30	Mental confusion, dizziness, strongly impaired motor skills (slurred speech)
0.27-0.40	Unable to stand/walk, vomiting, impaired consciousness
0.35-0.50	Coma and possible death
≥0.10	Presumptive evidence of driving under influence of alcohol
Ethanol (Grain alcohol)	Most common abused drug Ethanol à Acetic acid Major metabolic pathway: Ethanol ------(Alcohol Dehydrogenase)------> Acetaldehyde Testing: Use benzalkonium chloride as antiseptic
Methanol (Wood alcohol)	Cause blindness Methanol à Formaldehyde à Formic acid (liver)
Isopropanol (Rubbing alcohol)	Liver metabolism: Isopropanol à Acetone
Ethylene glycol (1,2-ethanediol)	Antifreezing agent Ethylene glycol à Oxalic acid and glycolic acid (+) Monohydrate calcium oxalate crystals
Carbon Monoxide	Colorless, odorless, tasteless gas Has 210x greater affinity than O2 for Hgb “Cherry-red” color of the face and blood Specimen: EDTA whole blood Method: Co-oximetry  (HbCO measurement)
Cyanide	Binds to iron (ferric and ferrous) containing substances like hemoglobin and cytochrome oxidase “Odor of bitter almonds” Antidote: Sodium thiosulfate, amyl and sodium nitrite
Arsenic	“Odor of garlic” “Metallic taste” Hair and nails: “Mees lines” Method: Reinsch test (Flat black)
Cadmium	Significant environmental pollutant (+) GGT in urine sample
Lead	Blocks D-ALA synthase and Ferrocheletase “Wrist drop or Foot drop” manifestation Tx: EDTA and dimercaptosuccinic acid (DMA) – remove lead áFree erythrocyte protoporphyrin (+) Basophilic stippling (course)
Mercury	Amalgamate: mix or merge w/ other substances Specimen: -Whole blood (organic mercury) -Urine (inorganic mercury) Method: Reinsch test (Silvery gray)
Drugs of Abuse
Opiates	Morphine Codeine Heroin Methadone
Tranquilizers	Diazepam (Valium) Oxazepam
Barbiturates: Sedative Hypnotics	Phenobarbital Pentobarbital Amobarbital
Dopaminergic pathway stimulants	Cocaine Benzoylecgonine Amphetamine
Hallucinogens	Phencyclidine Lysergic acid diethylamide Tetrahydrocannabinol Methaqualone
Amphetamines	Increase mental alertness (“Uppers”) MDMA (methylenedioxymethamphetamine) = ecstasy Methamphetamine  HCl = shabu
Annabolic steroids	Improves athletic performance by increasing muscle mass
Cannabinoids	Marijuana and hashish
Tetrahydrocannabinol (THC)	Psycoactive substance of marijuana Urinary metabolite: 11-nor-deltatetrahydrocannabinol (THC-COOH)
Cocaine (Crack)	Alkaloid salt Admin: Insufflation of IV or by inhalation/snorting Derived from coca plant (erythroxylon) Cardiac toxicity Prozac: inhibit the action of cocaine Urine metabolite: benzoylecgonine
Opiates	From opium poppy Heroin Morphine Codeine Methadone Major metabolites: N-acetylmorphine (heroin) and morphine Antagonist: Nalaxone (Narcan)
Phencyclidine (Angel dust or angel hair)	Hallucinogen Admin: Ingestion or inhalation Major metabolite: Phencyclidine HCl
Sedative hypnotics	Barbiturates (Secobarbital, pentobarbital, Phenobarbital) Benzodiazopines: Diazepam (Valium), Lorazepam (Ativan), Chlordiazepoxide (Librium) Major metabolite (barbiturates): Secobarbial
Lysergic acid diethylamide (LSD, Lysergide)	“Undulating vision” “Bad trip” – panic reactions
Methaqualone (Quaalude)	Pyramidal signs (Hypertonicity, hyperreflexia, myoclonus)
Vitamins
Vitamins	Water soluble: B1, B2, B3, B5, B6, B9, B12, Biotin, C, Carnitine Fat soluble: A, D, E, K
Vitamin A	CN: Retinol Def: Night blindness
Vitamin E	CN: Tocopherol Def: Mild hemolytic anemia, RBC fragility
Vitamin D2 Vitamin D3	CN: Ergocalciferol, Cholecalciferol (D2), 1,25-dihydroxycholecalciferol (D3) Def: Rickets (young), Osteomalacia (adult)
Vitamin K	CN: Phylloquinones, Menaquinones Def: Hemorrhage
Vitamin B1	CN: Thiamine Def: Beriberi, Wernicke-Korsakoff syndrome
Vitamin B2	CN: Riboflavin Def: Angular stomatitis, dermatitis, photophobia
Vitamin B3	CN: Niacin/Niacinamide/Nicotinic acid/Nicotinamide Def: Pellagra (dermatitis, disorientation, weight loss)
Vitamin B5	CN: Panthotenic acid Def: Depressed immune system, muscle weakness
Vitamin B6	CN: Pyridoxine, Pyridoxal Def: Facial seborrhea
Vitamin B9	CN: Folic acid, Pteroylglutamic acid Def: Megaloblastic anemia
Vitamin B12	CN: Cyanocobalamin Def: Megaloblastic anemia, neurologic abnormalities
Vitamin C	CN: Ascorbic acid Def: Scurvy
Biotin	Def: Dermatitis
Carnitine	Def: Muscle weakness, fatigue