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Quantitative Chemical Analysis8th EditionDaniel C. Harris 921 solutions All of these options: Therapeutic drug monitoring is necessary for drugs that have a narrow therapeutic index. Individual differences alter pharmacokinetics, causing lack of correlation between dose and drug blood level. These include age, diet, ingestion with or without food, genetic factors, exercise, smoking, pregnancy, metabolism of other drugs, protein binding, and disease states. Creatinine 5 mg/dL Approximately 5 per 1,000 urine samples received for DAU testing have been adulterated by either dilution, substitution, or addition of substances such as glutaraldehyde that interfere with testing. The majority of these situations can be detected by determining temperature (90°F-100°F) pH (4.5-8.0), specific gravity (1.003-1.019), and creatinine (≥20 mg/dL). All of the values listed are within the limits of an acceptable sample with the exception of creatinine. Dry reagent strips are available that test for pH, specific gravity, creatinine, nitrite, peroxide, pyridinium, and glutaraldehyde. Whole blood Lead accumulates in RBCs, bones, and neural tissues, and whole blood, hair, and urine are suitable for demonstrating lead toxicity. Greatest sensitivity is obtained by using whole blood, which can detect exposure over time. Because lead is rapidly eliminated from plasma, serum or plasma should not be used to test for lead exposure. Lead binds to sulfhydryl groups of proteins such as delta-aminolevulinic acid (∆-ALA) dehydratase and ferrochelatase and interferes with heme synthesis. This results in increased free erythrocyte protoporphyrin, erythrocyte zinc protoporphyrin, urinary coproporphyrin III, and δ aminolevulinic acid, which are also useful markers for lead poisoning. When screening for lead poisoning in children, the method of choice is graphite furnace atomic absorption spectrophotometry or inductively coupled plasma mass spectroscopy because they offer the best analytical sensitivity. The CDC cutoff for normal lead in children is less than 5.0 μg/dL. When is the best time to collect samples for a trough?The trough level is the lowest concentration in the patient's bloodstream, therefore, the specimen should be collected just prior to administration of the drug.
What is the optimum time for the nurse to obtain the trough level?When a trough is drawn, the provider is examining what the concentration of a certain medication is at its lowest therapeutic level. This is typically done 30 minutes before the next dose is scheduled to be administered. This is important when measuring therapeutic levels.
What is generally the optimal time to collect a sample for a peak drug level?To assess peak levels, the time for drawing depends on the route of administration: Oral: One hour after drug is taken (assumes a half-life of > two hours) IV: 15-30 minutes after injection/infusion. Intramuscular (IM): 30 minutes - one hour after injection.
What is trough level monitoring?In medicine and pharmacology, a trough level or trough concentration (Ctrough) is the concentration reached by a drug immediately before the next dose is administered, often used in therapeutic drug monitoring.
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