Therapeutic_Drug_Monitoring

Therapeutic_Drug_Monitoring - Therapeutic Drug Monitoring...

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Therapeutic Drug Monitoring Roger L. Bertholf, Ph.D. Shands Jacksonville Medical Center
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Why monitor plasma drug concentrations? Avert toxicity Optimize dose/therapeutic response Detect changes in pharmacokinetics Monitor compliance
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First Principle of TDM “Knowledge of serum concentrations is most helpful when the drug in question requires individualized dosing for optimal efficacy and more routine measures of therapeutic success are unavailable.” From W. J. Taylor and A. L. Finn (eds.) Individualizing Drug Therapy, 1981
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Therapeutic Index Plasma drug concentration Toxic Sub-therapeutic Therapeutic range Toxicity
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Therapeutic Index High therapeutic index NSAIDs Aspirin Tylenol Ibuprofen Sedative/hypnotics Benzodiazepines Most antibiotics Beta-blockers Low therapeutic index Lithium Neuroleptics Phenytoin Phenobarbital Some antibiotics Gent/Vanco/Amikacin Digoxin Immunosuppressives
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Introduction to Pharmacokinetics What are pharmacokinetics? The study of the absorption, distribution, and elimination of drugs Pharmacodynamics is the study of drug effects Most drugs exert their effect at tissue receptors , but we measure drug concentration in plasma .
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Two Compartment Model Blood Tissue Absorption Elimination K a K d K -d K e
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Drug absorption Route Oral Intravenous Intramuscular/subcutaneous Dermal Inhaled/intranasal Slow/sustained release
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Rate of drug absorption IV 2245 Inhaled > Intramuscular > Oral > Dermal seconds hours minutes
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First-pass metabolism Prodrug Active drug or Active drug Inactive metabolite or Lipid soluble drug Water soluble drug
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Two Compartment Model Blood Tissue Absorption Elimination k a k d k -d k e
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Distribution ( α ) phase Once drug is absorbed into the blood, it
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Therapeutic_Drug_Monitoring - Therapeutic Drug Monitoring...

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