(8) TDM & Toxicology
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What is therapeutic drug monitoring?
A process of determining the quantity of a therapeutic drug required to produce a predetermined desirable effect.
Define the following term: Half-life.
Time required for the concentration of a drug to be decreased by half.
Define the following term: Steady State.
Reached when the amount of drug in the dose given is sufficient only to replace the amount of drug eliminated since the last dose. Can be measured after 5 drug half-lives because then the blood will have reached 97% of the steady state.
Define the following term: Compartment
Specific place in the body where a drug is present (e.g. plasma, tissue).
Define the following term: First Order Kinetics
Rate of metabolism is dependent on the concentration of the substrate.
Define the following term: Peak Concentration
Highest concentration of drug is measured in the blood. Collection time varies based on the absorption of the drug.
Define the following term: Therapeutic Range
Concentrations between the minimum effective concentration and the minimum toxic concentration.
Define the following term: Trough Concentration
Lowest concentration of a drug measured in the blood. Collection is usually immediately prior to the administration of the next dose.
Name the five-step process that takes place when a therapeutic agent is administered to a patient.
• Liberation - release of the drug • Absorption - drug taken into the body enters the blood • Distribution - drug must be translocated to its site of action • Metabolism (biotransformation) - occurs mainly in the liver. Unmetabolized drug is a parent compound, products of metabolism are metabolites • Excretion - if drug is water-soluble or can be rendered water soluble through metabolism, it is eliminated through the urine
What is the normal therapeutic range and the classification of the following drug: Theophylline
10 - 20 ug/mL Bronchodilator
What is the normal therapeutic range and the classification of the following drug: Quinidine
2 - 5 ug/mL Anti-arrhythmic
What is the normal therapeutic range and the classification of the following drug: Acetaminophen
10 - 30 ug/mL Analgesic
What is the normal therapeutic range and the classification of the following drug: Phenytoin
10 - 20 ug/mL Anticonvulsants
What is the normal therapeutic range and the classification of the following drug: Lithium
0.5 - 1.5 mEq/L Psychotropic
What is the normal therapeutic range and the classification of the following drug: Gentamicin
Peak: 5.8 - ug/mL Trough: 1 - 2 ug/mL Aminoglycosides
What is the normal therapeutic range and the classification of the following drug: Digoxin
0.8 - 2.0 ng/mL Anti-arrhythmics
What is the normal therapeutic range and the classification of the following drug: Phenobarbital
15 - 40 ug/mL Anticonvulsants
What is the normal therapeutic range and the classification of the following drug: Primidone
5 - 12 ug/mL Anticonvulsants
What is the normal therapeutic range and the classification of the following drug: Tobramycin
Peak: 5 - 8 ug/mL Trough: 1 - 12 ug/mL Aminoglycosides
What is the normal therapeutic range and the classification of the following drug: Procainamide
4 - 10 ug/mL Anti-arrhythmics
What is the normal therapeutic range and the classification of the following drug: Carbamazepine
4 - 12 ug/mL Anticonvulsants
What is the normal therapeutic range and the classification of the following drug: Valproic Acid
50 - 100 ug/mL Anticonvulsants
What plant is digoxin derived from?
The foxglove plant (Digitalis lanata or purpurea)
What are the toxic effects of digoxin?
It effects cellular potassium transport, resulting in bradycardia, followed by arrhythmia, coma, and death.