{"id":980,"date":"2020-02-18T11:26:06","date_gmt":"2020-02-18T05:56:06","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=980"},"modified":"2020-02-18T11:26:06","modified_gmt":"2020-02-18T05:56:06","slug":"therapeutic-drug-monitoring","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/therapeutic-drug-monitoring\/","title":{"rendered":"Therapeutic Drug Monitoring"},"content":{"rendered":"\n
Therapeutic Drug Monitoring<\/strong><\/p>\n\n\n\n TDM will be useful if :<\/strong><\/p>\n\n\n\n 1) Narrow therapeutic range<\/p>\n\n\n\n 2) Direct relationship between the drug or drug metabolite levels in plasma and the pharmacological or toxic effects<\/p>\n\n\n\n 3) Therapeutic effect cannot be readily assessed by the clinical observation<\/p>\n\n\n\n 4) Large individual variability in steady state plasma concentration exists at any given dose<\/p>\n\n\n\n 5) Appropriate analytic techniques available to determine the drug and metabolite levels.<\/p>\n\n\n\n Indication of TDM:<\/strong><\/p>\n\n\n\n Steady State<\/u><\/em><\/strong>\u2013 Equilibrium between the amount of drug given and the amount eliminated over the dosing interval.<\/p>\n\n\n\n Trough<\/u><\/em><\/strong>–<\/strong> Lowest drug concentration during a dosing interval when drug is given intermittently.<\/p>\n\n\n\n Peak<\/u><\/em><\/strong>–<\/strong> Highest serum drug concentration that occurs following a single dose or at steady state within a dosing interval.<\/p>\n\n\n\n Laboratory Investigations & TDM<\/strong><\/p>\n\n\n\n Associated investigations help to detect factors which may elevate toxicity. \u2026 t3\/T4 why??<\/p>\n\n\n\n Drugs for TDM<\/strong><\/p>\n\n\n\nClass of Drug<\/td> Examples<\/td><\/tr> -Cardiac Drugs<\/td> Digoxin, Amiodarone<\/td><\/tr> -Anti Epileptic Agents<\/td> Phenytoin, Carbamazepine, Valproic Acid<\/td><\/tr> -Antibiotics<\/td> Gentamycin, Vancomycin<\/td><\/tr> -Antidepressants & Antipsychotics<\/td> Lithium, Tricyclic Antidepressants<\/td><\/tr> -Analgesics<\/td> Acetaminophen, Aspirin<\/td><\/tr> -Anti-cancer Drugs<\/td> Methotrexate<\/td><\/tr> -Bronchodilators<\/td> Theophylline<\/td><\/tr> -Immunosuppressant<\/td> Cyclosporine<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n Drug<\/strong><\/td> Therapeutic Range<\/strong><\/td><\/tr> Digoxin<\/td> 0.8-2 ug\/L<\/td><\/tr> Lithium – Acute Mania – Maintenance<\/td> 0.8-1.2 mmol\/L 0.4-1.0 mmol\/L<\/td><\/tr> Phenytoin<\/td> 10-20 mg\/L<\/td><\/tr> Sodium Valproate<\/td> 50-100 mg\/L<\/td><\/tr> Carbamazepine<\/td> 5-12 mg\/L<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n