TDM for B Pharm practical-2019
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This presentation was used for practical class of B. Pharmacy students.
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TDM for B Pharm practical-2019
- 1. THERAPEUTIC DRUG MONITORING For B. Pharmacy Dr. Pravin Prasad MBBS, MD Clinical Pharmacology Lecturer, Department of Clinical Pharmacology Mahrajgunj Medical Campus, IOM,TU 8 December 2019 (22 Mangsir 2076), Sunday
- 3. INTRODUCTION Measuring drug concentration Individualizing the dose Drug concentration maintained in target range
- 4. THERAPEUTIC DRUG MONITORING(TDM) DEFINITION Pragmatic manipulation of the dose of a drug using plasma concentration as a guide to optimize its efficacy, to avoid or identify toxicity and to detect or confirm poor compliance
- 5. TDM: WHAT’S INCLUDED? Measuring drug concentration Clinical interpretation Pharmaco kinetics Sampling Time Drug History Clinical Condition
- 6. SOURCES OFVARIATIONS Inter-individual Variation Pharmacokinetic Variability Genetic Polymorphism Pathological and physiological factors Intra-individual Variability Age Weight Pathological Factors Physiological Factors Concomitant medications
- 7. TDM: CRITERIA NarrowTherapeutic Range Significant pharmacokinetic Variability A reasonable Relationship between plasma concentrations and clinical effects Established target concentration range Availability of cost-Effective drug assay WHICH DRUGS? NERVE
- 9. TDM: INDICATIONS Dosing: Post dose adjustment Adequate loading dose? Patient’s dose requirements
- 10. TDM: INDICATIONS Monitoring: Assessing compliance Diagnosing undertreatment Diagnosing failed therapy Q: WHYTDM? A:TDM
- 11. TIMING OF PLASMA SAMPLE At steady state (SS) concentration What is it? Why? Just before the next dose is due What is it? Why? Consider absorption and distribution
- 12. TIMING OF PLASMA SAMPLE Very long half life- Before SS reached To avoid toxicity To ascertain adequate dosing Suspected toxicity due to peak concentrations Method of Monitoring
- 14. INTERPRETINGTDM NUMBER Needs to be individualised Before adjusting dose, ascertain: Sample timing SS reached or not Patient compliance Other causes • Change in electrolytes • Serum albumin concentration • Possible drug interaction • Co-morbidity
- 15. MEASURING AND MONITORING Within a clinically useful timeframe Trained staff Quality assay Units in report Reference values
- 16. LIMITATIONS Limited number of drugs Scientific accuracy Laboratory variability Limited accessibility Validity of suggested target ranges Drugs with active metabolites
- 17. VALUES FROM OUR LABORATORY Drug Normal Range (μg/mL) Phenytoin 10-20 Phenobarbitone 15-40 Paracetamol 10-20 Carbamazepine 4-12
- 18. TDM: CONCLUSION Team work involving clinicians, pharmacologists, paramedical & laboratory staff. Aims at better management of drug therapy by individualization of therapy taking plasma levels of the drug as guide. Before attemptingTDM, its limitations must be kept in mind that only certain drugs fit into the category.
- 19. TDM LAB OFTUTH
- 20. TDM LAB OFTUTH
- 21. TDM LAB OFTUTH
- 24. ANY QUERIES?
Editor's Notes
- Individualization of dosage by maintaining plasma or blood drug concentration within a target range
- 3.Digoxin and hypokalemia 4.PD t1/2 >> PKt1/2 e.g reserpine,MAO(-),vigabatrin,hit and run drugs 5.e.g levodopa ,enalapril 6.antihypertensives,hyperglycemics,oral anticoagulants,diuretics 7.Penicillin
- Provides the clinician with greater insight into the factors determining the patients response to drug therapy. It can help to distinguish a noncompliant patient and a patient who is a true non-responder.