Therapeutic Drug Monitoring Flashcards
Therapeutic Drug Monitoring is
clinical lab measurments
Drug dosage individualized by PK and PD
Goal of optimal therapeutic effects:
target concentration range and context important (treat the pt not the number)
Why TDM?
Max efficacy
Minimize toxicity
PK changes
Monitor adherence
Max efficacy involves
Can tell if there if a lack of response or change in clinical status
TDM Summary
Individualized (uses Pk/PD)
Maximize response
Minimize AE
Context (treat the pt not the number)
AGs
Amikacin
Gentamicin
Tobramycin
Anti-epileptic
Carbamazepine
Phenytoin
Valproic acid
Anti-coagulants
Warfarin/Heparins
Anti-arrhythmics
Digoxin Procainamide
Immunosuppressants
Cyclosporine
Methylxanthines
Theophylline
Caffeine
PD includes
Therapeutic effects
AEs
PK =
Body effect on the drug
PD =
Drug effect on body
Dose –>
PK –> PD –> clinical effect or AE
Steps in TDM Process
Diagnosis –> Drugs –> Dose –> Drug administered –> pt assessment/drug concentration –> PK/clinical judgement –> dose adjust
Communication involves
MD or PharmD order
RN administration
Lab collection/phlebotomy
Interpretation
Pharmacists can have input
Solicited/unsolicited
Chart notes/unofficial notes/verbal discussion
Orders
Solicited Communication
Know limits
May involve writing orders
Chart documentation
Per MD consult
Unsolicited Communication
Know audience Let them lead Recommend Consider May involve writing orders
Both solicited and unsolicited involved?
RELATIONSHIPS
Components of communication
courteous professional factual key elements included concise clean and neat legible
