In this document, there is all the information about TDM and its relation with pharmacogenetics and pharmacokinetics
TDM can be looked at as a new area in pharmacokinetics that will lead to better patient's outcomes.
Hope you enjoy it.
Therapeutic drug monitoring (TDM) is the clinical practice of measuring specific drug at designated intervals to maintain a constant concentration in a patients blood stream, thereby optimizing individual dosage regimen.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in patients to optimize dosing for efficacy and safety. TDM is useful for drugs with unpredictable relationships between dose and concentration, narrow therapeutic windows, or other pharmacokinetic factors. Key steps in TDM include deciding when to measure drug levels, collecting samples at appropriate times, measuring concentrations, interpreting results based on therapeutic ranges, and adjusting treatment accordingly. TDM aims to individualize drug therapy by achieving target concentrations for each patient.
Therapeutic drug monitoring (TDM) refers to measuring drug concentrations in plasma or blood to individualize drug dosing to maintain concentrations within a target therapeutic range. The goal of TDM is to achieve the desired beneficial effects of a drug while minimizing adverse effects. TDM is useful for drugs with a narrow therapeutic index, high inter-individual variability in drug handling, or where the relationship between concentration and response is well established. The timing of sample collection and analytical methodology used to measure drug concentrations are important considerations for effective TDM.
This document provides information on therapeutic drug monitoring, including sample information required for accurate interpretation and therapeutic ranges for various drugs. It discusses therapeutic drug monitoring for anti-seizure drugs like carbamazepine and valproic acid, cardiac drugs like digoxin and lidocaine, aminoglycoside antibiotics like amikacin and gentamicin, lithium for bipolar disorder, methotrexate for cancer treatment, theophylline, immunosuppressants for transplant patients like cyclosporine and tacrolimus, and various sample collection and testing methods. The goal of therapeutic drug monitoring is to ensure drug levels are within therapeutic ranges to achieve efficacy while avoiding toxicity.
Therapeutic drug monitoring involves measuring drug concentrations in plasma to optimize efficacy and avoid toxicity. It aims to individualize dosing by maintaining drug levels within a target range. Some key points are:
- TDM is indicated for drugs with a narrow therapeutic index, significant pharmacokinetic variability between patients, and a clear relationship between plasma concentrations and clinical effects.
- It involves measuring drug levels, clinical interpretation considering various factors like pharmacokinetics, sampling time, drug history and clinical condition.
- Timing of plasma samples is important to obtain at steady state or just before the next dose to guide dosing adjustments.
Therapeutic drug monitoring and shortcoming in tanzaniaPaul Mwasapi
Therapeutic drug monitoring (TDM) measures drug concentrations in patients' blood to optimize dosages. TDM is indicated for drugs with narrow therapeutic windows or variability. Common drugs monitored include aminoglycosides, antiepileptics, lithium, and digoxin. Interpretation of results considers compliance, interactions, and pharmacokinetics. TDM is underused in Tanzania due to lack of awareness, resources, and expertise, though it can improve outcomes and safety. The take-home message is that TDM ensures therapy effectiveness and safety by avoiding under- or overdosing.
Therapeutic drug monitoring involves measuring drug concentrations in the body to aid in drug therapy management. It helps clinicians individualize treatment regimens by maintaining drug levels within the therapeutic range to provide effective and safe care. TDM is especially useful for drugs with a narrow therapeutic index, variable metabolism between patients, or those where toxicity is difficult to detect clinically. The TDM process involves deciding when to test, collecting patient information and samples, analyzing drug concentrations using various laboratory techniques, and adjusting treatment based on the results.
This document discusses therapeutic drug monitoring (TDM) and provides examples of aminoglycosides (gentamicin and vancomycin), phenytoin, and digoxin. It defines TDM as measuring specific drug concentrations to maintain constant levels. TDM is indicated to monitor compliance, individualize therapy, diagnose under treatment, avoid toxicity, and detect drug interactions. Drugs suitable for TDM have a narrow therapeutic index, pharmacokinetic variability, a relationship between concentrations and effects, and available assays. The document provides dosing and interpretation guidelines for each drug's TDM.
Therapeutic drug monitoring (TDM) is the clinical practice of measuring specific drug at designated intervals to maintain a constant concentration in a patients blood stream, thereby optimizing individual dosage regimen.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in patients to optimize dosing for efficacy and safety. TDM is useful for drugs with unpredictable relationships between dose and concentration, narrow therapeutic windows, or other pharmacokinetic factors. Key steps in TDM include deciding when to measure drug levels, collecting samples at appropriate times, measuring concentrations, interpreting results based on therapeutic ranges, and adjusting treatment accordingly. TDM aims to individualize drug therapy by achieving target concentrations for each patient.
Therapeutic drug monitoring (TDM) refers to measuring drug concentrations in plasma or blood to individualize drug dosing to maintain concentrations within a target therapeutic range. The goal of TDM is to achieve the desired beneficial effects of a drug while minimizing adverse effects. TDM is useful for drugs with a narrow therapeutic index, high inter-individual variability in drug handling, or where the relationship between concentration and response is well established. The timing of sample collection and analytical methodology used to measure drug concentrations are important considerations for effective TDM.
This document provides information on therapeutic drug monitoring, including sample information required for accurate interpretation and therapeutic ranges for various drugs. It discusses therapeutic drug monitoring for anti-seizure drugs like carbamazepine and valproic acid, cardiac drugs like digoxin and lidocaine, aminoglycoside antibiotics like amikacin and gentamicin, lithium for bipolar disorder, methotrexate for cancer treatment, theophylline, immunosuppressants for transplant patients like cyclosporine and tacrolimus, and various sample collection and testing methods. The goal of therapeutic drug monitoring is to ensure drug levels are within therapeutic ranges to achieve efficacy while avoiding toxicity.
Therapeutic drug monitoring involves measuring drug concentrations in plasma to optimize efficacy and avoid toxicity. It aims to individualize dosing by maintaining drug levels within a target range. Some key points are:
- TDM is indicated for drugs with a narrow therapeutic index, significant pharmacokinetic variability between patients, and a clear relationship between plasma concentrations and clinical effects.
- It involves measuring drug levels, clinical interpretation considering various factors like pharmacokinetics, sampling time, drug history and clinical condition.
- Timing of plasma samples is important to obtain at steady state or just before the next dose to guide dosing adjustments.
Therapeutic drug monitoring and shortcoming in tanzaniaPaul Mwasapi
Therapeutic drug monitoring (TDM) measures drug concentrations in patients' blood to optimize dosages. TDM is indicated for drugs with narrow therapeutic windows or variability. Common drugs monitored include aminoglycosides, antiepileptics, lithium, and digoxin. Interpretation of results considers compliance, interactions, and pharmacokinetics. TDM is underused in Tanzania due to lack of awareness, resources, and expertise, though it can improve outcomes and safety. The take-home message is that TDM ensures therapy effectiveness and safety by avoiding under- or overdosing.
Therapeutic drug monitoring involves measuring drug concentrations in the body to aid in drug therapy management. It helps clinicians individualize treatment regimens by maintaining drug levels within the therapeutic range to provide effective and safe care. TDM is especially useful for drugs with a narrow therapeutic index, variable metabolism between patients, or those where toxicity is difficult to detect clinically. The TDM process involves deciding when to test, collecting patient information and samples, analyzing drug concentrations using various laboratory techniques, and adjusting treatment based on the results.
This document discusses therapeutic drug monitoring (TDM) and provides examples of aminoglycosides (gentamicin and vancomycin), phenytoin, and digoxin. It defines TDM as measuring specific drug concentrations to maintain constant levels. TDM is indicated to monitor compliance, individualize therapy, diagnose under treatment, avoid toxicity, and detect drug interactions. Drugs suitable for TDM have a narrow therapeutic index, pharmacokinetic variability, a relationship between concentrations and effects, and available assays. The document provides dosing and interpretation guidelines for each drug's TDM.
Indications for therapeutic drug monitoringChandra Lekha
TDM Indications ('why do it'):
Drug assays are costly, so the reason for monitoring and the additional information to be gained (if any) should be carefully considered.
For some drugs, therapeutic drug monitoring helps to increase efficacy (vancomycin), to decrease toxicity (paracetamol) and to assist diagnosis (salicylates).
Routine monitoring is not advocated for most drugs.
The appropriate indications for therapeutic drug monitoring (and examples) include:
toxicity
- diagnosing toxicity when the clinical syndrome is undifferentiated (unexplained nausea in a patient taking digoxin)
. avoiding toxicity (aminoglycosides, cyclosporin)
Only clinically meaningful tests should be performed
dosing
- after dose adjustment (usually after reaching a steady state)
- assessment of adequate loading dose (after starting phenytoin treatment)
- dose forecasting to help predict a patient's dose requirements1 (aminoglycosides)
monitoring
- assessing compliance (anticonvulsant concentrations in patients having frequent seizures)
- diagnosing under treatment (particularly important for prophylactic drugs such as anticonvulsants, immunosuppressants)
- diagnosing failed therapy (therapeutic drug monitoring can help distinguish between ineffective drug treatment, non-compliance and adverse effects that mimic the underlying disease).
The target concentration may depend on the indication. For example, the recommended concentration for digoxin depends on whether it is being used to treat atrial fibrillation or congestive heart failure.
an experimentally determined relationship between plasma drug concentration and the pharmacological effect.
• Knowledge of the drug level influences management.
Therapeutic drug monitoring refers to maintaining drug concentrations within a target range by individualizing dosages. It involves measuring serum drug levels and applying pharmacokinetic principles to optimize drug therapy for each patient. Therapeutic drug monitoring is helpful for drugs with marked variability, concentration-dependent effects, a narrow therapeutic index, or when the desired therapeutic effect is difficult to monitor. Commonly monitored drugs include aminoglycosides, antiepileptics, cardioactives, and lithium.
Therapeutic drug monitoring (TDM) is a process in clinical pharmacology which specializes in measuring the concentration of certain drugs in the body fluids and clinically interpreting it to obtain useful and often lifesaving information. It is defined as “the use of drug concentration measurements in body fluids as an aid to the management of drug therapy for the cure, alleviation or prevention of disease”. TDM is done only for a few selected drugs with a narrow therapeutic range where the challenge is to avoid both sub-therapeutic and overtly toxic doses.
Therapeutic drug monitoring (TDM) refers to measuring drug concentrations in biological fluids to optimize a patient's drug therapy. It is used to minimize toxicity and ensure appropriate dosing. Factors like dosage, interactions, disease states, and individual metabolism can impact drug levels and should be considered when interpreting TDM results.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in a patient's blood to optimize drug therapy and avoid toxicity. The key objectives of TDM are to achieve the desired pharmacological effects of a drug quickly without side effects. It benefits patients medically by improving outcomes and financially by reducing costs from unnecessary hospital stays or treatment of drug-related toxicity. TDM is particularly useful for drugs with a narrow therapeutic index, those showing concentration-dependent effects, and those affected by individual patient factors like metabolism or other diseases. Common indications are lithium, digoxin, phenytoin, and antibiotics.
Gentamicin is an aminoglycoside antibiotic commonly used to treat infections caused by Pseudomonas aeruginosa. It has a narrow therapeutic window, and therapeutic drug monitoring (TDM) of peak and trough plasma levels is essential to avoid toxic side effects of nephrotoxicity and ototoxicity. Gentamicin's volume of distribution is low and it is eliminated renally without metabolism. Dosing is based on creatinine clearance and body weight, with peak levels below 12 mg/L and trough levels below 2 mg/L for multiple daily doses, while once daily dosing requires different monitoring approaches.
Therapeutic drug monitoring (TDM) involves analyzing drug concentrations in blood to ensure dosage is therapeutic and not toxic. TDM is indicated when the therapeutic index is narrow, drug effects vary between patients, or changes in a patient's condition could affect drug levels. Common drugs monitored include cardiac medications, antibiotics, antiepileptics, psychotherapeutics, and immunosuppressants. Factors like absorption, distribution, metabolism, and excretion influence circulating drug concentrations.
This document discusses therapeutic drug monitoring (TDM), which is defined as pragmatically manipulating a drug's dose based on plasma concentration measurements to optimize efficacy, avoid toxicity, and detect noncompliance. TDM involves measuring drug concentrations, clinical interpretation based on pharmacokinetics and patient history/condition, and aims to individualize dosing by maintaining drug levels within a target range. It indicates TDM is best for drugs with a narrow therapeutic range, significant pharmacokinetic variability between patients, and an established relationship between plasma concentrations and clinical effects.
1) Therapeutic drug monitoring (TDM) involves measuring drug concentrations in the blood to help individualize and optimize drug therapy.
2) TDM is useful when there is a narrow therapeutic range, high inter-individual variability in drug response, or when the clinical effects are not readily observable.
3) The TDM process involves requesting the test with relevant clinical information, collecting a blood sample, measuring drug concentrations using validated analytical methods, interpreting the results in the clinical context, and adjusting drug dosages based on the findings to improve therapeutic outcomes.
This document discusses therapeutic drug monitoring (TDM), which uses drug concentration measurements to help manage patients receiving drug therapy. TDM aims to attain safe and effective drug concentrations within the therapeutic range to optimize treatment. It coordinates various medical fields and removes empirical approaches. The document outlines drugs that commonly require TDM due to pharmacokinetic variability and concentration-dependent effects. It also discusses the TDM process, including deciding when to monitor, collecting patient information, measuring drug levels using various laboratory techniques, and using results to guide dosing adjustments. TDM provides benefits like side effect monitoring, shorter hospital stays, and better disease control through individualized dosing.
This document discusses therapeutic drug monitoring (TDM), including its definition, introduction, criteria for when it is useful/unnecessary, and process. TDM involves measuring drug concentrations in blood/plasma to help adjust dosages to a desired therapeutic range. It is especially useful for drugs with a narrow therapeutic index or large interindividual variability. The TDM process involves collecting a biological sample at steady state, requesting a lab analysis, the lab measuring the drug level using an appropriate analytical technique, communicating the results along with the therapeutic range, and the clinician interpreting the level based on dosage and patient factors. Commonly monitored drugs and some problems with TDM services are also mentioned.
No, therapeutic drug monitoring generally requires taking blood samples in order to directly measure drug concentrations in plasma or serum. While some alternative samples like saliva or other biologic fluids may provide indirect information in some cases, a direct correlation to blood levels is needed for accurate therapeutic drug monitoring in most situations.
TDM is the clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patient's bloodstream, thereby optimizing individual dosage regimens. The process of TDM is predicated on the assumption that there is a definable relationship between dose and plasma or blood drug concentration, and between concentration and therapeutic effects.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in blood to optimize drug efficacy and avoid toxicity. TDM is clinically important for drugs with a narrow therapeutic window, such as anticonvulsants, cardioactive drugs, theophylline, immunosuppressants, antidepressants, and some antibiotics. Altered pharmacokinetics in disease states can be identified through TDM, allowing dosage adjustments to properly manage patients and avoid adverse reactions. TDM is performed by collecting a blood sample at an appropriate time relative to drug dosing and measuring drug concentrations, which are interpreted based on the therapeutic range for that drug.
Therapeutic drug monitoring (TDM) involves measuring the plasma concentration of a drug to guide dosing for individual patients. TDM is primarily used for drugs with a narrow therapeutic index or steep dose-response curves to maximize efficacy and minimize toxicity. Common drugs monitored include digoxin, lithium, theophylline, phenytoin, and gentamicin. TDM helps optimize dosing, identifies non-compliance or toxicity, and facilitates dose adjustments based on concentration levels.
Therapeutic drug monitoring (TDM) of drugs used in seizure disordersAbel C. Mathew
Therapeutic drug monitoring (TDM) of drugs used in seizure disorders- Phenytoin, Valproic acid, Carbamazepine are major drugs used in epilepsy disorders. These drug need TDM to ensure their proper usage.
TDM is increasingly being used in clinical practice in order to improve the therapeutic outcome and reducing the toxicity in HIV infection.
The use of TDM requires certain criteria in order to interpret the plasma concentrations appropriately.
Therapeutic drug monitoring PHARMACY sAA.pptssuser497f37
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in a patient's blood to optimize drug dosing and ensure concentrations are within a therapeutic range. TDM is useful for drugs with a narrow therapeutic index that can be toxic above the upper limit or ineffective below the lower limit. It helps individualize treatment regimens and assess efficacy and safety. Common drugs monitored include antiepileptics, antiarrhythmics, antibiotics, and immunosuppressants. Interpretation of levels considers pharmacokinetic and pharmacodynamic factors as well as clinical information to guide dosing adjustments. TDM provides insights to improve patient outcomes by achieving maximum benefit while minimizing toxicity risks.
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
Indications for therapeutic drug monitoringChandra Lekha
TDM Indications ('why do it'):
Drug assays are costly, so the reason for monitoring and the additional information to be gained (if any) should be carefully considered.
For some drugs, therapeutic drug monitoring helps to increase efficacy (vancomycin), to decrease toxicity (paracetamol) and to assist diagnosis (salicylates).
Routine monitoring is not advocated for most drugs.
The appropriate indications for therapeutic drug monitoring (and examples) include:
toxicity
- diagnosing toxicity when the clinical syndrome is undifferentiated (unexplained nausea in a patient taking digoxin)
. avoiding toxicity (aminoglycosides, cyclosporin)
Only clinically meaningful tests should be performed
dosing
- after dose adjustment (usually after reaching a steady state)
- assessment of adequate loading dose (after starting phenytoin treatment)
- dose forecasting to help predict a patient's dose requirements1 (aminoglycosides)
monitoring
- assessing compliance (anticonvulsant concentrations in patients having frequent seizures)
- diagnosing under treatment (particularly important for prophylactic drugs such as anticonvulsants, immunosuppressants)
- diagnosing failed therapy (therapeutic drug monitoring can help distinguish between ineffective drug treatment, non-compliance and adverse effects that mimic the underlying disease).
The target concentration may depend on the indication. For example, the recommended concentration for digoxin depends on whether it is being used to treat atrial fibrillation or congestive heart failure.
an experimentally determined relationship between plasma drug concentration and the pharmacological effect.
• Knowledge of the drug level influences management.
Therapeutic drug monitoring refers to maintaining drug concentrations within a target range by individualizing dosages. It involves measuring serum drug levels and applying pharmacokinetic principles to optimize drug therapy for each patient. Therapeutic drug monitoring is helpful for drugs with marked variability, concentration-dependent effects, a narrow therapeutic index, or when the desired therapeutic effect is difficult to monitor. Commonly monitored drugs include aminoglycosides, antiepileptics, cardioactives, and lithium.
Therapeutic drug monitoring (TDM) is a process in clinical pharmacology which specializes in measuring the concentration of certain drugs in the body fluids and clinically interpreting it to obtain useful and often lifesaving information. It is defined as “the use of drug concentration measurements in body fluids as an aid to the management of drug therapy for the cure, alleviation or prevention of disease”. TDM is done only for a few selected drugs with a narrow therapeutic range where the challenge is to avoid both sub-therapeutic and overtly toxic doses.
Therapeutic drug monitoring (TDM) refers to measuring drug concentrations in biological fluids to optimize a patient's drug therapy. It is used to minimize toxicity and ensure appropriate dosing. Factors like dosage, interactions, disease states, and individual metabolism can impact drug levels and should be considered when interpreting TDM results.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in a patient's blood to optimize drug therapy and avoid toxicity. The key objectives of TDM are to achieve the desired pharmacological effects of a drug quickly without side effects. It benefits patients medically by improving outcomes and financially by reducing costs from unnecessary hospital stays or treatment of drug-related toxicity. TDM is particularly useful for drugs with a narrow therapeutic index, those showing concentration-dependent effects, and those affected by individual patient factors like metabolism or other diseases. Common indications are lithium, digoxin, phenytoin, and antibiotics.
Gentamicin is an aminoglycoside antibiotic commonly used to treat infections caused by Pseudomonas aeruginosa. It has a narrow therapeutic window, and therapeutic drug monitoring (TDM) of peak and trough plasma levels is essential to avoid toxic side effects of nephrotoxicity and ototoxicity. Gentamicin's volume of distribution is low and it is eliminated renally without metabolism. Dosing is based on creatinine clearance and body weight, with peak levels below 12 mg/L and trough levels below 2 mg/L for multiple daily doses, while once daily dosing requires different monitoring approaches.
Therapeutic drug monitoring (TDM) involves analyzing drug concentrations in blood to ensure dosage is therapeutic and not toxic. TDM is indicated when the therapeutic index is narrow, drug effects vary between patients, or changes in a patient's condition could affect drug levels. Common drugs monitored include cardiac medications, antibiotics, antiepileptics, psychotherapeutics, and immunosuppressants. Factors like absorption, distribution, metabolism, and excretion influence circulating drug concentrations.
This document discusses therapeutic drug monitoring (TDM), which is defined as pragmatically manipulating a drug's dose based on plasma concentration measurements to optimize efficacy, avoid toxicity, and detect noncompliance. TDM involves measuring drug concentrations, clinical interpretation based on pharmacokinetics and patient history/condition, and aims to individualize dosing by maintaining drug levels within a target range. It indicates TDM is best for drugs with a narrow therapeutic range, significant pharmacokinetic variability between patients, and an established relationship between plasma concentrations and clinical effects.
1) Therapeutic drug monitoring (TDM) involves measuring drug concentrations in the blood to help individualize and optimize drug therapy.
2) TDM is useful when there is a narrow therapeutic range, high inter-individual variability in drug response, or when the clinical effects are not readily observable.
3) The TDM process involves requesting the test with relevant clinical information, collecting a blood sample, measuring drug concentrations using validated analytical methods, interpreting the results in the clinical context, and adjusting drug dosages based on the findings to improve therapeutic outcomes.
This document discusses therapeutic drug monitoring (TDM), which uses drug concentration measurements to help manage patients receiving drug therapy. TDM aims to attain safe and effective drug concentrations within the therapeutic range to optimize treatment. It coordinates various medical fields and removes empirical approaches. The document outlines drugs that commonly require TDM due to pharmacokinetic variability and concentration-dependent effects. It also discusses the TDM process, including deciding when to monitor, collecting patient information, measuring drug levels using various laboratory techniques, and using results to guide dosing adjustments. TDM provides benefits like side effect monitoring, shorter hospital stays, and better disease control through individualized dosing.
This document discusses therapeutic drug monitoring (TDM), including its definition, introduction, criteria for when it is useful/unnecessary, and process. TDM involves measuring drug concentrations in blood/plasma to help adjust dosages to a desired therapeutic range. It is especially useful for drugs with a narrow therapeutic index or large interindividual variability. The TDM process involves collecting a biological sample at steady state, requesting a lab analysis, the lab measuring the drug level using an appropriate analytical technique, communicating the results along with the therapeutic range, and the clinician interpreting the level based on dosage and patient factors. Commonly monitored drugs and some problems with TDM services are also mentioned.
No, therapeutic drug monitoring generally requires taking blood samples in order to directly measure drug concentrations in plasma or serum. While some alternative samples like saliva or other biologic fluids may provide indirect information in some cases, a direct correlation to blood levels is needed for accurate therapeutic drug monitoring in most situations.
TDM is the clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patient's bloodstream, thereby optimizing individual dosage regimens. The process of TDM is predicated on the assumption that there is a definable relationship between dose and plasma or blood drug concentration, and between concentration and therapeutic effects.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in blood to optimize drug efficacy and avoid toxicity. TDM is clinically important for drugs with a narrow therapeutic window, such as anticonvulsants, cardioactive drugs, theophylline, immunosuppressants, antidepressants, and some antibiotics. Altered pharmacokinetics in disease states can be identified through TDM, allowing dosage adjustments to properly manage patients and avoid adverse reactions. TDM is performed by collecting a blood sample at an appropriate time relative to drug dosing and measuring drug concentrations, which are interpreted based on the therapeutic range for that drug.
Therapeutic drug monitoring (TDM) involves measuring the plasma concentration of a drug to guide dosing for individual patients. TDM is primarily used for drugs with a narrow therapeutic index or steep dose-response curves to maximize efficacy and minimize toxicity. Common drugs monitored include digoxin, lithium, theophylline, phenytoin, and gentamicin. TDM helps optimize dosing, identifies non-compliance or toxicity, and facilitates dose adjustments based on concentration levels.
Therapeutic drug monitoring (TDM) of drugs used in seizure disordersAbel C. Mathew
Therapeutic drug monitoring (TDM) of drugs used in seizure disorders- Phenytoin, Valproic acid, Carbamazepine are major drugs used in epilepsy disorders. These drug need TDM to ensure their proper usage.
TDM is increasingly being used in clinical practice in order to improve the therapeutic outcome and reducing the toxicity in HIV infection.
The use of TDM requires certain criteria in order to interpret the plasma concentrations appropriately.
Therapeutic drug monitoring PHARMACY sAA.pptssuser497f37
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in a patient's blood to optimize drug dosing and ensure concentrations are within a therapeutic range. TDM is useful for drugs with a narrow therapeutic index that can be toxic above the upper limit or ineffective below the lower limit. It helps individualize treatment regimens and assess efficacy and safety. Common drugs monitored include antiepileptics, antiarrhythmics, antibiotics, and immunosuppressants. Interpretation of levels considers pharmacokinetic and pharmacodynamic factors as well as clinical information to guide dosing adjustments. TDM provides insights to improve patient outcomes by achieving maximum benefit while minimizing toxicity risks.
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
Therapeutic drug monitoring (TDM) measures drug levels in the blood to ensure drug amounts are safe and effective for each patient. TDM is useful when there is significant variability between patients in how drugs are absorbed, distributed, metabolized and excreted. This variability can lead to differences in drug concentrations and effects. TDM helps optimize dosing to maintain drug levels within a therapeutic range and avoid toxicity. Factors like genetics, organ function, drug interactions and adherence impact drug levels and thus TDM is recommended for certain drug classes like antibiotics, anti-seizure drugs, and immunosuppressants.
Therapeutic drug monitoring (TDM) refers to maintaining drug concentrations within a target therapeutic range to individualize dosage for patients. TDM grew from recognizing some drugs have a narrow range between toxicity and ineffectiveness. TDM is used for drugs with a close relationship between plasma levels and effects like antiepileptics, antibiotics, and immunosuppressants. The goal of TDM is to maximize efficacy while minimizing adverse reactions by achieving and maintaining target concentrations through dosage adjustments based on laboratory drug level measurements.
Therapeutic drug monitoring (TDM) aims to optimize drug therapy by maintaining serum concentrations within a therapeutic range. TDM involves monitoring drug and metabolite levels in plasma/serum to individualize dosage regimens. It is useful for drugs with a narrow therapeutic index, large inter-individual variability in metabolism, or where concentrations correlate with response/toxicity. Common drugs monitored include antiarrhythmics, mood stabilizers, immunosuppressants, antibiotics, and anticonvulsants. The TDM process involves developing plasma concentration-time profiles, interpreting levels based on dosage and clinical factors, and adjusting dosages when needed.
Toxicology screening and therapeutic drug monitoring (an introduction) Hossamaldin Alzawawi
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in patients to optimize drug therapy and avoid toxicity. TDM emerged in the 1960s with pharmacokinetic studies linking drug levels to outcomes. Pioneers in the 1970s demonstrated that constructing therapeutic ranges could reduce adverse reactions to drugs like digoxin. TDM utilizes pharmacokinetics and pharmacodynamics to assess medication efficacy and safety. It aims to individualize treatment and tailor it to each patient's needs. Factors like genetics, disease states, and drug interactions cause vast inter-patient variability in how drugs are absorbed, distributed, and eliminated.
Role of toxicological analysis in therapeutic monitoringMysm Al-khattab
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in a patient's blood or plasma to guide dosage adjustments. TDM aims to maximize drug effectiveness while minimizing toxicity. It is necessary for drugs with a narrow therapeutic index, significant interpatient variability, or those where concentrations correlate with effects/side effects. Common techniques for TDM include immunoassays, chromatography, and analyzing samples like plasma, serum, or whole blood. Proper TDM helped optimize immunosuppressant dosing for a transplant patient also taking antiretrovirals by detecting and addressing a drug interaction that increased toxicity risks.
The document discusses therapeutic drug monitoring (TDM), including its need, indications, factors affecting results and interpretation, common drug classes monitored, and technologies used. TDM is needed because some drugs have a narrow therapeutic range, and monitoring helps ensure concentrations remain in the therapeutic window to maximize efficacy and minimize toxicity. Factors like dosage, sampling time, and patient characteristics can affect results. Technologies include HPLC, GC/MS, immunoassays like EMIT, and chemiluminescence to accurately measure drug levels.
Pharmacogenomics is the study of how genetic variations affect individual responses to drugs. It examines genomic loci and biological pathways to determine variability in drug metabolism and effects. Pharmacogenetics focuses on clinical effects of single gene variants. Pharmacogenomics can improve drug safety, efficacy and discovery by tailoring treatments based on a person's genetics. It allows optimization of drug metabolism and dosing based on an individual's genetic profile. Variations in genes that encode drug targets, metabolizing enzymes, transporters and those associated with adverse drug reactions can impact drug responses. Pharmacogenomics aims to incorporate genetic insights to develop safer and more effective precision medicines.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in patients' blood to optimize drug therapy. TDM is useful for drugs with a narrow therapeutic index, high inter-individual variability, or when the relationship between concentration and clinical effects is well established. The TDM process includes requesting the test with relevant clinical information, collecting a proper blood sample, measuring drug levels in the laboratory, interpreting the results clinically, and adjusting drug dosing regimen accordingly to maintain concentrations within the therapeutic range. TDM aims to maximize drug effectiveness while minimizing toxicity.
Therapeutic Drug Monitoring (TDM) is important tool to identify the drug concentration for their therapeutic range to minimize unwanted effects of particular drugs
Therapeutic drug monitoring (TDM) involves measuring drug levels in a patient's blood or plasma to ensure concentrations remain within a therapeutic range. TDM is useful for drugs with a narrow therapeutic window, high individual variability in effects, or when clinical effects are difficult to observe. Factors like dosage, sampling time, drug interactions, and individual physiology can impact drug levels and require monitoring to optimize treatment and avoid toxicity. Common methods to measure drug concentrations include chromatography techniques coupled with mass spectrometry, as well as various immunoassays.
This document discusses therapeutic drug monitoring (TDM), which refers to measuring drug concentrations in biological fluids to optimize drug therapy. TDM aims to maintain drug levels within the therapeutic window to maximize efficacy and minimize toxicity. It is useful for drugs with a narrow therapeutic index, large inter-individual variability, or in patients with organ dysfunction. Common drugs monitored include digoxin, aminoglycosides, phenytoin, and lithium. Factors like absorption, distribution, metabolism, excretion, drug interactions, and compliance can impact drug levels and require consideration during TDM interpretation. The document outlines the need, suitable/unsuitable drugs, therapeutic ranges, testing methods, and factors affecting TDM.
This document discusses the basic principles of therapeutic drug monitoring (TDM). It provides 3 key points:
1. TDM is a team effort that involves measuring drug concentrations in serum/blood, interpreting the results based on pharmacokinetics and the patient's clinical condition, and adjusting the drug regimen accordingly.
2. For optimal TDM, blood samples should be taken at steady state and appropriate times in relation to the last dose, analytical techniques should be sensitive enough to measure drug levels, and clinical information is needed to interpret results.
3. Factors like disease states, age, pregnancy, and drug interactions can impact drug levels and must be considered when interpreting results, along with the patient's clinical response
This document summarizes a seminar on pharmacogenomics and its promise for personalized medicine. Pharmacogenomics uses DNA analysis to target drugs to specific patient populations based on their genetic makeup. It aims to increase drug safety and efficacy by individualizing treatment. Recent research has applied pharmacogenomic approaches to develop personalized therapies for conditions like HIV, cancer, cardiovascular disease, and depression. While pharmacogenomics faces scientific hurdles, it has the potential to enhance drug discovery, development, and outcomes by identifying genetic factors influencing drug targets and individual responses.
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Pharmacogenetics and pharmacogenomics is an upcoming branch in therapeutics. Various pharmacogenomic tests are currently available to aid in actual clinical practice. It has shown to have promising results in personalized medicine It is my attempt to compile the basic concepts from various books, articles, and online journals. Please feel free to comment.
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2. Therapeutic Drug Monitoring (TDM)
INTRODUCTION
TDM is the clinical practice of measuring specific drugs at designated intervals to
maintain a constant concentration in a patient’s blood stream, thereby optimizing
individual dosage regimens.
It is used to monitor drugs with low therapeutic window.
Drugs that marked pharmacokinetic (PK) variability.
Drugs which target concentrations are difficult to monitor.
Drugs known to cause adverse reactions.
TDM was introduced to the clinical practice in the 1960s with the publication of initial PK
studies linking mathematical theories to patient outcomes. It was primary focused on the
adverse effects and the demonstration of therapeutic ranges; in order to reduce the
toxicity of drugs such as phenytoin (anti-epileptic), digoxin (cardiac glycoside) and
theophylline (CNS stimulant) can be reduced.
By combining the knowledge of pharmaceutics, PK and pharmacodynamics PD; TDM
enabled the assessment of the efficacy and safety of a particular medication in a variety of
clinical settings.
We can consider this science as a part of the clinical PK
monitoring, where drug concentration-response is being
analyzed and studied using and a whole PK map is made
using analytical technology and computerization; The
more recent explosion of pharmacogenetic and
pharmacogenomics (PG) research has been fueled by the
huge amount of genetic data generated by the Human
Genome Project (HGP), recent advancements in gene chip
technology have ushered in a new era of gene-based
medicinal and drug therapies.
3. WHICH DRUGS?
When a drug has the ability to cause immediate effects such as blood pressure changes,
cholesterol changes and even pain then TDM is highly recommended.
Not all drugs MUST perform these studies, only if they had the following points.
1. Narrow therapeutic window.
2. Significant PK variability.
3. Reasonable relationship between
plasma concentration and clinical
effects.
4. Established target concentration
range.
5. Availability of cost-efficient drug
easily.
Since drug assay are expensive and costly, if the manufacturer decides to do the TDM
studies they should gain knowledge about
how to increase the therapeutic dose,
decreasing the toxicity and to assist the
candidate in diagnosis.
Examples on drugs that are therapeutically
monitored are Anti-epileptics
(Carbamazepine, valproate, phenobarbital
and phenytoin), Immunosuppressant
(Cyclosporine, sirolimus and tacrolimus),
Cardiac medications (Quinidine, digoxin
and procainamide) and finally antibiotics
and in particular antiviral agents which
will be focusing on in this article.
Figure 2 shows the process of reaching a
dosage decision with TDM.
FIGURE 1
FIGURE 2
4. GENICTIC FACTOR AND TDM
As cleared in the above figure, genetic variation contributes to the phenotype of drug
response. Despite the mind-blowing breakthrough in PG research; not all drugs require
PG test before being prescribed.
The rationale behind PGs is to deal with gene encoding drug transporters, drug
metabolizing enzymes and drug targets; which then predict the usefulness of a particular
drug by increasing the number of responders and decreasing the adverse drug reactions
(ADRs)
For example; CYP (P450) family is a group of enzymes that are responsible for most
phase I metabolism
CYP2C9, CYP2C19 and CYP2D6 are subtypes that mediate 40% of the metabolism
of the drugs on the market; so any mutations on their encoding gene may lead to
abolished, altered, reduced or increased metabolizing activity.
Which resulted in four major phenotypes
FIGURE 3
5. TDM FOR ANTIVIRAL DRUGS
poor
metabolisers
PMs
Intermediate
metabolizers
IMs
Extensive
metabolizers
EMs
Ultrarapid
metabolizers
UMs
Lack the functional enzyme
Carry more than two functional
gene copies
Two normal alleles
Heterozygous for a defect
allele
FIGURE 4
Figure 4 shows the pathophysiological changes associated with infection
6. Initial adequate anti-infection therapy is associated with significant improvement in the
patient’s outcome for severely ill ones. TDM may be assisted to overcome this problem.
Drug Absorption
Abs. od drugs is expected to be lower due to decreased gut
motility,poor blood perfusion to the GIT and finally decreased
blood flow to the peripherals
Volume of Distribution
Pathogens are known to produce endotoxins that stimulate
the production of immunomediators, and that leads to
maldistributionand increased capillary permeability; fluid
will shift to the interstatial spaces
Protein Binding
The free drug is the active drug, 40% of patients with infections
develop hypoalbuminemia; which increases the the action of the
drug plus its availability for elimination
Clearance
Due to fluid buildup and the use of vasoactive agents and the
underlying infectionresponse; blood flow to major organs will
increase thus increasing the renal clearance. untill myocardium
deppressionoccurs and cause acute kidney injury AKI
MIC
Minimun concentration of a drug that can inhibit the growth
of the pathogens at 24-hour intervals. As MIC decreases the
suscptibility increases
Extracorporeal Clearance
Renal Replacementtherapy (RRTs)that are given during AKI to
avoid further complication.For hydrophilicdrugs (with low Vd and
high CL) RRTs will extent the elimination.unlike the lipophilicdrugs
that are not affected by RRTs
Acyclovir
There is no clinical evidence between the
plasma concentration of the drug and its
efficacy, although when Cp increases it lead to
serious toxicity that includes neurotoxicity
Hydrophilicagent, with low Vd and high Cl
rate. RRTs will extent its eliminationrate
Bioanalyticalassays that were carried on
acyclovir include HPLC-UV and LC-MS/MS
analysis
Dosing is highly dependent on creatinin
clearance
Oseltamivir
There is no relationship between oseltamivir and
its active metabolite to the pharmacological
response
There is an association between AUC and the
efficacy against the Influnza virus
Although it is a hydrophilic drug which means that when
given with RRTs it will increase its Vd and decreases the
Cl
Bioanalyticalassays that were carried on oseltamivir
include HPLC-UV and LC-MS/MS analysis
7. CONCLUSION
TDM of anti-infections is of increasing interest for optimizing treatment of infections in critically ill
patients.
For many anti-infections, especially the hydrophilic agents, there is strong evidence of altered PK in
critically ill patients.
Many studies have described a higher apparent Vd and a great effect of augmented or decreased renal
clearance on concentrations of renally cleared compounds in critically ill patients.
These data indicate that TDM could be useful in order to optimize treatment in this patient group.
A simple, precise, and rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been developed and
validated for the simultaneous determination of oseltamivir and oseltamivir carboxylate, a neuraminidase inhibitor, using their
deuterated analogs as internal standards (ISs).
The method involved solid-phase extraction of the analytes and ISs from 200 μL human plasma with no reconstitution and drying
steps.
The chromatographic separation was achieved on a Symmetry C18 column using 10 mM ammonium formate and acetonitrile as
the mobile phase in a run time of 2.0 min.
Quantitation of analytes and ISs were done by multiple reaction monitoring on a triple quadrupole mass spectrometer in the positive
ionization mode.
The linearity of the method was established in the concentration range of 0.5–200 ng/mL and 2.0–800 ng/mL for oseltamivir and
oseltamivir carboxylate respectively. The mean extraction recovery for oseltamivir (94.4%) and oseltamivir carboxylate (92.7%) from
spiked plasma samples was consistent and reproducible.
The application of this method was demonstrated by a bioequivalence study in 42 healthy Indian subjects with 75 mg oseltamivir
phosphate capsules. The assay reproducibility was established by reanalysis of 151 incurred subject samples
FIGURE 5