1.47: Therapeutic Drug Monitoring

1. 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:
   1. one
   2. two
   3. three
   4. four
   5. five

Use the following Key to answer Questions 2-16.

1. 1, 2, and 3 are correct
2. 1 and 3 are correct
3. 2 and 4 are correct
4. 4 only is correct
5. all are correct

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

Answer

1. d (p. 1079, 1085)
2. a (p. 1081)
3. d (p. 1087-1088)
4. d (p. 1074, 1086)
5. e (p. 1075-1076)
6. b (p. 1076)
7. e (p. 1076)
8. a (p. 1076)
9. a (p. 1076)
10. e (p. 1076-1077)
11. a (p. 1077)
12. c (p. 1077)
13. d (p. 1079)
14. a (p. 1087-1089)
15. b (p. 1079)
16. c (p. 1079)