TDM
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Entails analysis, interpretation, and evaluation of drug concentration in serum, plasma, or whole blood samples
THERAPEUTIC DRUG MONITORING
Used to establish maximum benefits with minimal toxic effects for drugs whose correlation with dosage, effect or toxicity is not clear
THERAPEUTIC DRUG MONITORING
T/F TDM is a routine laboratory test
F NOT a routine laboratory test: Majority of drugs available in the market have its standard dosage (established)
Assesses drugs with NARROW THERAPEUTIC INDEX
THERAPEUTIC DRUG MONITORING
MAIN PURPOSE of TDM
• Ensure the drug dosage will produce maximal therapeutic benefit • Identify when the drug is outside the therapeutic range
concentration of drug in the human sample that will produce pharmacologic/therapeutic benefit
Therapeutic range
effect if < TR
inefficacy
effect if > TR
toxicity
therapeutic range of a drug is almost the start of the toxic level (causes adverse effects)
Narrow therapeutic index
dose that provides therapeutic benefits (safe & effective) in most healthy population
STANDARD DOSAGE
T/F Standard dose is used in diseased state
F Not utilized in diseased state (diseased patients have alteration in physiologic condition) – can affect the predicted concentration of the standard dose
What must be done during diseased state to fit the individual needs
dosage regimen by performing TDM
FACTORS AFFECTING CIRCULATING CONCENTRATION OF DRUG
Route of Administration Absorption Drug Distribution Free vs Bound Drug Drug Metabolism Drug Elimination
considered to achieve maximum therapeutic benefit of the drug
Route of Administration
Most direct and effective route of administration with 100% bioavailability
Intravenous (IV)
most common and least invasive route of administration
Oral (GI absorption)
Route of Administration done by Inhalation or skin absorption (transdermal patch)
Transcutaneous
Route of Administration done by rectal delivery and performed if oral delivery is not possible among infants (not all the time)
Suppository
Routes of Drug Administration based on the effectivity in drug delivery or in bioavailability
IV IM SC Transcutaneous Suppository Oral
fraction of administered dose of drug that reaches the site of action or the circulation
Bioavailability
When drugs are absorbed, it can circulate in the blood either as?
free drug or protein-bound drug
active drug which exhibits therapeutic benefit
free / unbound drug
T/F Only free drugs exhibit therapeutic benefit
F Some protein-bound drugs may also exhibit therapeutic benefit.
2 fates of circulating drug
• distributed to the site of action (target of the drug) → shows biologic response • metabolized and eliminated in their metabolite form