Drug Monitoring Flashcards
Advantages
-Nonadherence can be identified
-Variations in drug-disposition patterns
-Altered drug utilization
-Compensation for an altered state
-Drug interactions
Phenytoin
Exhibits saturated kinetics so TDM necessary
Theophylline
-PK is age dependent
-Phenytoin and phenobarbital increase theophylline clearance 2 fold
-OD tx with charcoal and hemodialysis
CHAPP
Valproic Acid (depa)
-Increases GABA
-Half life varies with age, duration, liver function
-Rapid and complete absorption
Phenobarbital
-Hyperpolarizes GABA(A) receptor
-Slow and complete absorption
Primidone
-Phenobarbital contributes to effect
-Rapid and complete absorption
-Phenobarbital is active metabolite and the dose is titrated to obtain therapeutic conc of phenobarbital
CPR
Carbamazepine
-Slow and erratic absorption
-Carb-10-11-epox accumulates in children
-Highly protein bound
SPEC
Ethosuximide
-Readily absorbed from GI tract
Digoxin
-Variably absorbed
-25% protein bound
-Serum drawn as a trough (8 hr post dose)
Procainamide
-Fast acetylators form more NAPA which accumulates in plasma
-NAPA also accumulates in RF
NAPA in FARF
Aminoglycosides
-Poorly abs orally
-Peak for therapeutic response, trough for toxicity
Cyclosporine
-Highly variable abs
-Whole blood conc correlates well with IS/tox
Vancomycin
-Trough 10-20
-AUC 400-600
-90% renal exc
Sirolimus
-AE: pneumocystis carinii infection
-Excreted in feces
-Combo with cyclosporine and CS
Tacrolimus
-Excreted in feces
-Should NOT be used with cyclosporine
