1.47: Therapeutic Drug Monitoring
- Page ID
- 125361
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- At the end of __ half lives a steady state level of drug is reached with multiple dosing. At the end of this period therapeutic monitoring for maintenance therapy can be initiated:
- one
- two
- three
- four
- five
Use the following Key to answer Questions 2-16.
- 1, 2, and 3 are correct
- 1 and 3 are correct
- 2 and 4 are correct
- 4 only is correct
- all are correct
- Pharmacokinetics is the quantitative study of drug distribution in the body. It permits the user:
- to mathematically describe the fate of a drug after administration
- to compare drugs and dosage forms
- to predict blood levels
- to mathematically describe the kinetic (movement) of pharmacological agents through tissue
- The principle(s) which underlie monitoring of drugs in patients is/are:
- increasing drug concentrations are more effective
- the blood levels are inversely related to the clinical effects
- drug receptors have a variable response to drug and the ratio of drug/ receptor must be measured
- there is a relationship between clinical effects and drug concentration in plasma
- The therapeutic index is defined as:
- the concentration of drug in plasma which optimizes therapy
- the amount of reduction of pathologic symptoms obtained by use of a specific drug
- the ranking of the effect of the drug versus other drugs for the same disease
- the ratio between the average toxic dose and the average therapeutic dose
- The LADME system to describe drug disposition includes consideration and measurement of which of the following processing:
- absorption
- metabolism
- liberation
- elimination
- Absorption of drug takes place when the drug is given:
- extravascularly
- intravascularly
- orally
- intravenously
- Mechanisms of absorption include:
- passive diffusion
- active transport
- facilitated transport
- convective transport
- Once drug molecules are absorbed, they distribute within the bloodstream and can:
- be confined to the blood space
- leave the bloodstream to enter other extravascular fluids
- migrate into various tissues or organs
- semilogarithmically be related to dose
- Biotransformation is the process of converting the parent drug to one or more metabolites. Which of the following, statements is/are true?
- the metabolites are usually more polar
- usually metabolism takes place in the liver and kidney
- metabolites are usually less active than parent drug
- usually metabolites can form prodrug and be effective at receptors
- The most prominent physiologic factor(s) which influence drug disposition include(s):
- body weight
- age
- temperature
- gastric emptying time
- The most important pathological factors which influence drug disposition are:
- renal impairment
- liver impairment
- gastrointestinal diseases
- cancer metastasis
- Which liberation factor(s) affect(s) the blood level curves after oral dosage of a drug:
- size of liberation
- rate of liberation
- gastric emptying
- extent of liberation
- High levels of drug in serum or plasma are usually associated with:
- shock
- intensity of clinical effectiveness
- low therapeutic index
- toxicity
- The rationale for using blood levels as indicators of clinical response is based on the following assumptions:
- For those receptors interacting with drugs, the concentration at the receptors determines pharmacologic effect.
- It is not possible to sample at the site of action (biophase).
- Blood and serum are the fluids closest in equilibrium to the biophase.
- Blood, serum and plasma are the transport systems by which drug reaches the receptor.
- Therapeutic drug monitoring is usually NOT performed when:
- blood level is not related directly to clinical response
- liver impairment is present and the patient is on drugs eliminated by hepatic metabolism
- clinical or pharmacological response is easily and accurately measured
- the drug is used as a prophylactic
- Most drugs are administered:
- as a single dose
- in a series of doses
- at the time of diagnosis
- at specified interval
- Answer
-
- d (p. 1079, 1085)
- a (p. 1081)
- d (p. 1087-1088)
- d (p. 1074, 1086)
- e (p. 1075-1076)
- b (p. 1076)
- e (p. 1076)
- a (p. 1076)
- a (p. 1076)
- e (p. 1076-1077)
- a (p. 1077)
- c (p. 1077)
- d (p. 1079)
- a (p. 1087-1089)
- b (p. 1079)
- c (p. 1079)