Endocrinology and toxicology

These act in conjunction with nervous systems to maintain a state in the body which functions optimally and is disease free.

Hormones

These are chemical substances produced and secreted into the blood by an organ or tissue, and has a specific effect on target tissue.

Hormones

Hormones affect the body as a _______.

Whole

What are the three chemical types of hormones?

SteroidsProteinAmine

Steroid hormones are produced in what three places?

Adrenal glandGonadsPlacenta

These are lipid soluble hormones synthesized from cholesterol

Steroidal hormones

What is the plasma half life of steroidal hormones?

60-100min

What are the two types of protein hormones?

Peptide hormonesGlycoprotein hormones

These hormones are synthesized as prohormones.

Peptide hormones

These hormones are composed of alpha- and beta- chains.

Glycoprotein hormones

These are water soluble hormones that are produced, then stored and released as needed.

Protein hormones

These hormones have properties intermediate to steroids and proteins.

Amines

These amines behave like protein hormones.

EpinephrineNoepinephrine

Thes amines behave like steroid hormones

Thyroxine(T4)Tiiodothyronine(T3)

These hormones are thought to produce effects via interaction with receptor on outer surface of cell membranes.

Protein hormones

This acts a second messenger by translating hormone binding into cellular action

(cAMP)

Cellular action in protein hormones ceases rapidly after loss of _______.

Stimulus

These hormones pass through cell membrane and interact with an intracellular receptor.

Steroid hormones

This is the portion of the brain located in walls and floor of third ventricle, directly above pituitary gland.

Hypothalamus

What are five hypothalamus associated disorders?

TumorsInflammatory/degenerative processesCongenital problemsGrowth failure in emotionally deprived childrenAnorexia nervosa

This protein hormone is produced by the anterior pituitary gland and is involved in cell division, protein synthesis, and bone growth.

Growth hormone (GH)

What are three conditions that would cause a decrease in adult growth hormone?

Decreased muscle massIncreased body fatDecreased bone density (osteoporosis)

This protein hormone is produced in the anterior pituitary gland and is involved in milk production.

Prolactin (PRL)

After delivery prolactin levels can reach what levels?

200-300 ng/mL

This peptide hormone is produced in the posterior pituitary and stimulates water reabsorption by kidneys.

ADH (vasopressin)

This peptide hormone is produced in the posterior pituitary and stimulates uterine muscle contraction.

Oxytocin

To produce these two hormones the thyroid gland actively acquires iodine.

Triiodothyronine (T3)Thyroxine (T4)

These two amide hormones are produced in the thyroid. They stimulate O2 consumption and metabolic rate in tissue.

Triiodothyronine (T3)Thyroxine (T4)

This peptide hormone is produced in the thyroid and lowers blood calcium levels.

Calcitonin

What is the most useful test for assessing thyroid function?

TSH

Serum total T3, rT3, and T4 levels are usually measured by which two assays.

Radioimmunoassay (RIA)Chemiluminometric assay

When the eyes protrude because of edema in eye socket tissues in cases of hyperthyroidism or Graves´┐Ż disease it is called what?

Exophthalmic goiter

How many parathyroid glands do most people have?

Four

This peptide hormone is produced in the Parathyroid and raises blood calcium levels.

PTH

These are paired organs located atop upper pole of each kidney.

Adrenal glands

This part of the adrenal gland is linked to sympathetic nervous system.

Adrenal medulla

This part of the adrenal gland is composed of three layers each responsible for different hormones.

Adrenal cortex

These amine hormones are produced in the adrenal medulla and are released in emergency situations.

EpinephrineNorepinephrine

This steroid hormone is produced in the adrenal cortex; it raises blood glucose levels and stimulates the breakdown of protein.

Cortisol

This steroid hormone is produced in the adrenal cortex; it is used to reabsorb sodium and excrete potassium.

Aldosterone

This steroid hormone is produced in the adrenal cortex; it stimulates reproductive organs and brings about sex characteristics.

Sex hormones

This syndrome can be caused by and adrenal cortex tumor.

Cushing syndrome

Hormonal secretions by the anterior pituitary are all _______ hormones.

Protein

This peptide hormone is produced by the anterior pituitary; it stimulates the adrenal cortex.

Adrenocorticotropic hormone (ACTH)

This protein hormone is produced in the anterior pituitary; it is involved in cell division, protein synthesis, and bone growth.

Growth hormone

This protein hormone is produced in the anterior pituitary; it is involved in milk secretion.

Prolactin (PRL)

These glycoproteins are produced in the anterior pituitary; they are involved in egg and sperm production.

Gonadotropics (FSH, LH)

This glycoprotein is produced in the anterior pituitary; it stimulates the thyroid.

Thyroid stimulating hormone (TSH)

Pituitary tumors cause ________ secretion.

Increased

Where are the Islets of Langerhans located?

Pancreas

What are the three cell types in the Islet of Langerhans and what do they secrete.

Alpha- secrete glucagonBeta- secrete insulinDelta- secrete somatostatin

This protein hormone is produced in the pancreas and lowers blood glucose levels.

Insulin

This protein hormone is produced in the pancreas and raises blood glucose levels.

Glucagon

These steroid hormones are produced in the ovaries and stimulate female sex characteristics.

Estrogens Progesterone

What hormones does the placenta secrete?

EstrogenProgesteroneWide variety of protein hormones

This steroid hormone is secreted by the testes and stimulates male sex characteristics.

Androgens (testosterone)

This classic hormone methodology is cumbersome and expensive; it requires a host organism.

Bioassay

If the binding reagent is an antibody, the assay is ___________.

Immunoassay

If the binding reagent is a transport protein, the assay may be called _____________.

Competitive protein binding assay

If the binding reagent is a receptor, the assay is ________.

Receptor assay

What is the simplest way to identify an assay?

By the label used

What is the most commonly used immunoassay?

ELISA

This type of immunoassay utilizes radio-labeled hormone as tagged hormone.

RIA

In this immunoassay, the antibody is labeled instead of hormone.

IRMA

In this immunoassay, enzyme tag is used vice radioactive label.

ELISA

What are the two purposes of drug monitoring?

ID non-complianceAscertain effectiveness of dosage

What are the four general processes that a body has to handle a foreign compound?

AbsorptionDistributionMetabolismExcretion

What are the three routes for absorption?

OrallyRectallyParenterally (IV, IM)

What are two factors for optimum utilization in absorption?

Route of administrationIs drug utilized as is or as metabolite

Body interprets drug as __________.

Foreign material

Insoluble drugs are converted to soluble by what organ?

Liver

Under normal renal performance, most drugs and their metabolites are excreted in ______ via the ______.

UrineKidneys

________ have little capacity to eliminate drugs.

Neonates

This will affect drug disposition due to hormonal changes and increased fluid volume.

Pregnancy

What are three diseases that can affect drug disposition?

Hepatic functionCardiac capacityRenal function

What admin data is needed for drug testing procedures (5)?

Pt name, SSN, DOB, sexDate/time of last doseDate/time of collectionAmount of last doseName of drug Pt diagnosis

What are three appropriate samples for drug testing?

Non-hemolyzed serumNon-hemolyzed plasma (red/dark blue top)Urine

This is collected prior to dose when drug concentrations are lower.

Trough

This is collected after dose (60 min) when drug concentrations are higher.

Peak

How long after a dose is a sample collected for peak testing?

60 min

Most drugs/metabolites are stable for several days at what temperature?

Room temp

This methodology detects a wide variety of drugs.

Thin layer chromatography (TLC)

This methodology is better for ID of drugs than TLC.

Gas Chromatography (GC)

This methodology measures drugs simultaneously.

HPLC

This is the method of choice for drug testing.

EIA

This is an effective smooth muscle relaxant that stimulates CNS and increases respiratory rate.

Theophylline

What is the therapeutic and toxic range for Theophylline?

Therapeutic range: 10-20 ug/mLToxic: >25 ug/mL

This drug improves cardiac contractions in CHF, 70% is absorbed orally.

Digoxin

How long after dosing of digoxin should a specimen be collected?

8 hrs after

Digoxin levels may rise ____ ng/mL in first eight hours.

8-10

What are the therapeutic and toxic ranges for digoxin?

Therapeutic: 0.8-2.0 ng/mlToxic : >3 ng/ml

This drug is used to correct ventricular arrhythmias associated with MI, and also digitalis intoxication.

Lidocaine

What is the therapeutic and toxic range for lidocaine?

Therapeutic: 1.5-5.0 ug/mlToxic: .5.0 ug/ml

This drug is used in the treatment and therapy of febrile seizures and neonatal seizures.

Phenobarbital

Which drug is tested based on the angle change of polarized fluorescence emitted by a fluorescent molecule?

Theophylline

What is the therapeutic range for Phenobarbital?

15-40 ug/ml

This is the primary drug in the treatment of absence (petit-mal) and myoclonic seizures.

Valproic acid

What is the therapeutic and toxic range for valproic acid?

Therapeutic: 50-100 ug/mlToxic: >100 ug/ml

This multipurpose antibiotic is quickly diminished due to dose related toxicities primarily aplastic anemia.

Chloramphenicol

What is the therapeutic and toxic range for chloramphenicol?

Therapeutic: 10-20 ug/mlToxic: >25 ug/ml

This antibiotic is effective against GPC/GPR, S. Epi, S. Aureus; it also prevents cell wall synthesis.

Vancomycin

What is the therapeutic range for vancomycin (peak and trough)?

Trough: 5-10 ug/mlPeak: 30-40 ug/ml

What are the toxic ranges for vancomycin (trough and peak)?

Trough: >20 ug/mlPeak: >80 ug/ml

Regular checking of __________ levels is used to alert exposed persons to any change in the level of this essential enzyme before it can cause serious illness.

Cholinesterase

Evaluation of this drug is used secondary to insecticide exposure.

Cholinesterase

What are the specimen requirements for cholinesterase?

Plasma (EDTA)Spate plasma from cell immediately

What is the normal reference value for cholinesterase?

4,000-12,000 U/L

To determine levels of ethanol in blood what is measured?

NADH

What is the methodology for ethanol testing?

Reactive enzyme assay (REA)

Ethanol tests are drawn using what tube?

Sodium fluoride (gray top)

Abuse of this commonly used analgesic leads to respiratory alkalosis.

Salicylate

What is the therapeutic and toxic range for salicylate?

Therapeutic: <30 mg/dLToxic: >30mg/dL

This commonly used analgesic if not taken as directed could cause liver necrosis 3-4 days post OD.

Acetaminophen

The toxic agent in acetaminophen is the __________ not the parent drug.

Metabolie

What is the antidote for acetaminophen overdose?

N-acetylcysteine

What is the therapeutic and toxic range for acetaminophen?

Therapeutic: 10-25 mg/mlToxic: 100-250 mg/ml

What are the four purposes of testing for drugs of abuse?

Pre-employmentRandom testingEmployees exhibiting s/s of abuseForensics

What are the two methods to screen for drugs of abuse?

EIAFPIA

What are the two methods to confirm drugs of abuse?

GCMS

What are the specimen requirements for drugs of abuse?

Urine

What are the initial and confirmatory test levels for marijuana?

Initial: 50 ng/mlConfirmatory: 15 ng/ml

What is the initial and confirmatory test level for cocaine?

Initial: 300 ng/mlConfirmatory: 150 ng/ml

What is the initial and confirmatory test level for opiate metabolite?

Initial: 300 ng/mlConfirmatory: 300 ng/ml