Therapeutic Drug Monitoring
1. Describe first order kinetics.
2. Describe zero order kinetics.
1st order: rate of metabolism is concentration dependent, 1/2 life of drug is always constant.
Zero order: concentration independent. 1/2 life changes with different drug concentrations.
List at least 3 potential uses of Tumor Markers
1. assess risk
2. screen for disease
3. diagnosis of disease
4. monitor disease progression
5. monitor response to therapy
6. assist with cancer staging
What are the 3 function of synovial fluid?
1. Provides nutrients for cartilage
2. Lessons shock of joint compression
3. Lubrication of moving joints
What is the significance of a positive fetal fibronectin?
Values over 50 ng/dl indicate a 2-4X risk for preterm labor
1. What is the significance of elevated adenosine deaminase (ADA) in pleural fluid?
2. What is the significance of elevated amylase in pleural fluid?
1. tuberculosis and/or malignancy
2. pancreatitis, esophageal rupture or malignancy
List at least 4 reasons why TDM is used.
1. When there is wide pharmacokinetic variation (variations in absorption, distribution, metabolism, etc.
2. Drug with narrow therapeutic range
3. Toxic effects difficult to recognize
4. Noncompliance suspected
5. Drug interations suspected
Name 3 exampes of oncofetal antigens
CEA
AFP
POA
TA90
Describe the clinical significance of synovial fluid with the following appearance:
Dark yellow
Red
Green
Milky
Turbid
Dark yellow= inflamation
Red= blood/hemorrhagic arthritis
Green= infection
Milky= crystals
Turbid=debris, WBCs
What is the significance of:
Yellow amniotic fluid
Dark green amniotic fluid
Red (blood streaked) amniotic fluid
Yellow= bilirubin, HDN
Dark green= meconium
Red= intra-amniotic hemorrhage, traumatic tap, trauma
If 4 tubes of CSF are collected, list the number of tube and what department it should be sent to for testing.
1. chem/serology
2. microbiology
3. hematology
4. other additional tests
Name 3 examples of anticonvulsant drugs that are commonly monitored.
1. Phenobarbitol
2. Phenytoin (dilantin)
3. Valproic Acid (depakote)
4. Primidone (Mysoline)
Match the following:
1. CA19-9 a. serotonin metabolite
2. HE4 b. melanoma
3. TA90 c. ovarian cancer
4. PSA d. pancreatic cancer
5. 5HIAA e. prostate cancer
1. d
2. c
3. b
4. e
5. a
1. Describe the appearance of monosodium urate crystals in synovial fluid.
2. How does MSU appear under compensated light (describe orientation and color)?
1. thin and needle-like
2. yellow when parallel to light and blue when perpendicular
What is the expected lab values for the following in Down's syndrome (increased, decreased)
1. AFP
2. unconjugated estriol
3. HCG
1. decreased
2. decreased
3. increased
Explain the benefits of testing CSF lactate in cases of bacterial meningitis.
Useful in monitoring treatment of bacterial meningitis
Levels remain elevated until treatment becomes effective- then fall rapidly
No need to compare to plasma value
List and describe the 4 factors that affect drug concentration.
1. Absorption- process in which drug is administered to the body, speed of absorption is route dependent
2. Distribution-after absorption within the circulation. Travels bound to albumin. Only free drug is active.
3. Metabolism- occurs mostly in the liver*. Parent compound undergoes changes and metabolites are produced
4. Excretion- removal of metabolites via urine. Primary route is the kidney.
What are the 3 methods that can be used to differentiate prostatic cancer from benign prostatic hyperplasia?
1. PSA density
2. PSA velocity
3. PSA ratio (free to total)
1. Describe the appearance of CPPD crystals in synovial fluid.
2. How does CPPD appear under compensated light (describe orientation and color)?
1. thick shorter and square or rhomboid
2. Blue color when parallel to polarizer, yellow when perpendicular
List 3 lab test that evaluate fetal lung maturity in amniotic fluid.
1. L/S ratio
2. PG by agglutination
3. Lamellar body count
4. Foam stability index
5. Surfactant/albumin ratio
Name at least 3 differences between a transudate and exudate.
1. transudates are from a systemic disorder, exudates are from malignancy or inflamation of membranes
2. transudates have lower specific gravity than exudates
3. exudates have more proteins than transudates
4. transudates are often bilateral, exudates are often unilateral
Correctly Match the following:
1. cyclosporine a. gram pos infections
2. lithium b. asthma attacks
3. vancomycin c. renal transplants
4. theophylline d. cardioglycoside
5. digoxin e. bipolar disorder
6. phenytoin f. anti-seizure
1. c
2. e
3. a
4. b
5. d
6. f
What is the expected level of PSA if cancer is present confined to the prostate?
<50 ng/ml
What are the normal synovial fluid values for the following:
Color=
Clarity=
Viscosity=
Leukocyte #=
Protein=
Crystals=
Color= colorless or pale yellow
Clarity= clear
Viscosity= 4-6cm string
Leukocyte count= <200 cells
Protein= <3 g/dl
Crystals= negative
What are the 2 most common phospholipids evaluated in the lab for fetal lung maturity?
Phosphatidylcholine (lecithin) and sphingomyelin
15-45 mg/dl