Pharmacy Practice Essay

390 words - 2 pages

PHAR6113 – Pharmacokinetics
Lecture 2 – Therapeutic Drug Monitoring
Therapeutic Range
• The range at which a drug is achieving a desired response and minimal adverse effects
• The intention in clinical practice is to maintain plasma drug concentrations within this range
• A drug with a narrow therapeutic index is one that has a narrow range between toxic and ineffective concentrations

Therapeutic Drug Monitoring (TDM)
• Therapeutic drug monitoring is the clinical practice of measuring specific drugs at designated levels to maintain a constant concentration in a patient’s bloodstream, thereby optimizing individual dosage regiments
• TDM begins when the drug is first prescribed, and involves determining an initial dosage regimen ...view middle of the document...

g. genetics)
• Disease states (e.g. renal or hepatic insufficiency) or physiological states (e.g. extremes of age or obesity) that alter absorption, distribution or elimination.
• Drug interactions
• Age – whether the person has developed tolerance/susceptibility over time
• Compliance – whether they consistently take the drug
• Physiology – size, build, metabolic rate etc
Candidates for Therapeutic Drug Monitoring
• A drug is a good candidate for therapeutic drug monitoring if it exhibits the following characteristics:
- Good correlation between plasma drug concentration and pharmacological effect
- Therapeutic range determined and narrow therapeutic index
- Large inter-individual variation in pharmacokinetics (between patients)
- Toxic effects are dramatic (easily measureable)
- Desired therapeutic effect is difficult to monitor
Limitations of Therapeutic Drug Monitoring
• No well-defined therapeutic range
• Pharmacologically active metabolites and these not measured
• Toxic effects may occur unexpectedly at low concentrations as well as high concentrations
• No significant consequences associated with high or low levels
Example – Phenytoin
• Originally prescribed 300mg daily – monitoring found there to be a 10 fold variation amongst patients
• Large inter-individual variation in pharmacokinetics
• Pharmacological effect not easily quantified
• Therapeutic range well established
• Non-linear pharmacokinetics

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