Therapeutic Drug Monitoring Flashcards
Trough and peak level collection times
Collect for trough level right before next dose
Collect for peak level 1 hour after oral or .5 hour after IV
Digoxin
Treat CHF, peaks 2-3 hrs after oral ingestion
Ref range = 0.8-2.0 ng/mL
Lidocaine
Treat arrhythmia and prevent ventricular fibrillation
Metabolized by liver into MEGX (contributes to toxicity not therapy), so need to measure both lidocaine and MEGX
Ref range = 1.5-4 ug/mL
> 4 ug/mL causes CNS depression, > 8 ug/mL seizures and hypotension
Quinidine
Anti-arrhythmia drug
Ref range = 2-5 ug/mL
Procainamide
Anti-arrhythmia drug
Metabolized to NAPA (similar effects so need to measure both)
Ref range = 4-8 ug/mL
Aminoglycosides
Antibiotic against gram neg bacteria
Associated with nephrotoxicity and ototoxicity
Vancomycin
Antibiotic against gram pos bacteria
Associated with nephrotoxicity, ototoxicity, and “red-man syndrome” (flushing of extremities)
Phenobarbital
Control seizures
Peak at 10 hours
Give primidone (inactive form) when you need fast absorption
Toxicity can cause drowsiness, depression, fatigue, altered mental ability
Ref range = 15-40 ug/mL
Phenytoin
Treat seizures
Peak 4-5 hours after dose
Total serum = 10-20 ug/mL
Free serum = 1-2 ug/mL
Valproic acid
Control seizures
Ref range = 50-100 ug/mL
Carbamazepine
Control seizures
Ref range = 4-12 ug/mL
Lithium
Treat manic depression
Peak 2-4 hours after
Ref range = 1.0-1.2 mmol/L
Tricyclic antidepressants
Treat depression, insomnia, apathy, loss of libido
Peak 2-12 hours after
Amitriptyline to nortritriptyline
Imipramine to desipramine
Theophylline
Treat asthma and COPD
Ref range = 10-20 ug/mL
Cyclosporine
Suppress transplant rejection/graft-versus-host disease
Peak 4-6 hours after
