17 - Target concentration intervention

Question 1

What are the 3 ways to dose

Answer 1

Population

• same dose for everyone
• convenient and often used in adults
• works most of the time except for those at the extreme ends of the CL frequency distribution
• on average get well treated

Group

• same dose for similar group i.e. weight, Clcr, genotype
• predict the dose based on predictable features

Individual

• dose is determined by the individual response
• i.e. observe response like BP, INR, blood conc (NOT an outcome - marker for effect)
• widely used when the response is easily measured

Question 2

Therapeutic Drug monitoring?

Answer 2

TDM

- therapeutic range with suboptimal borders of the range i.e. ineffective or toxic but if within this range then ok

Question 3

Target Concentration Intervention?

Answer 3

TCI

• SINGLE target not a range
• science based method that uses PK and PD principals to identify how patients are different and uses PK guided dose indiviudalisation to achieve a precise therapeutic target
• improves clinical outcome and is cost effective

Better than the range as there is a continuous relationship between concentration and effect