Week 3 - Therapeutic Drug Monitoring Flashcards

1
Q

Therapeutic Drug Monitoring is the clinical practice of measuring the ______ levels of specific drugs to ______ individual dosage regimens

A

plasma, optimize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The main goal of therapeutic drug monitoring is to ?

A

achieve the desired therapeutic effect while minimizing adverse effects in each individual patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Two main reasons to undertake TDM

A

• Avoid drug toxicity
• Improve therapeutic efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TDM will be useful if the following criteria are met:
• Drug has a________ ________ range
• ________ _______ can not be readily assessed by the clinical observation
• A direct relationship between the drug levels in _______ and the _____ effects
• Availability of _____-effective drug _______

A

narrow,therapeutic,Therapeutic,effect,plasma,toxic,cost,assay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Special Populations where TDM is useful

A

• Patients at the extremes of age
• Patients with dosing problems
• Patients taking multiple medications
• Patients who have unusual PK as a result of physiological, environmental, disease, or genetic factors

mdr1 defect; can not give drug that you normally use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Advantages of TDM

• Maximizing drug ______
• Avoiding ______
• Identifying Therapeutic ______
• ____ effective

A

efficacy, toxicity, Failure, Cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What information is required for TDM?

•_____ of drug administration
• Present and previous (if applicable) ______ drug concentrations
•______ status of the patient
•_______ of sampling
•______ data
•________ drug therapy

A

History,plasma,Clinical,Time,Physiological,Concurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Once you have acquired the necessary information for TDM, what can you do?

A

From such observations, the patient’s current pharmacokinetic parameters can be estimated, and a new dosage regimen can be designed to more closely achieve the target value(s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Three PK variables:

A

• Absorption, clearance, volume of distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Two PD variables:

______ ______ in the target tissue

________

A

Maximum efficacy, Potency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is TDM’s relationship with Absorption?

A

Compliance failure (over- or under-dosage): Can be detected by drug measurements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is TDM’s relationship with Clearance?

• _______ is the single most important factor determining drug fate
• Factors influencing clearance are:?

A

Clearance, Dose and intrinsic function of liver and kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe TDM’s relationship with Volume of Distribution

• Increase Vd, _____ binding
• Decrease Vd, _____ ______ binding
• Older patients: Decreased _____ ______ mass, ___ binding, a ____ Vd
• Accumulation of ___ (?) markedly ______ Vd of ____ drugs
(e.g., gentamicin) that normally have a small Vd.

A

tissue, plasma protein, skeletal muscle, less, lower, fluid, edema, ascites, increases, hydrophilic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is TDM’s relationship with Half life?
• Determines the ____ taken to reach a _____ _____ level
• Decreased Drug clearance causes _______ half-life
• TDM usually involves measurement of drug levels at _____ ____ (the rate of drug _______ is balanced by the drug of ______)

A

time, steady state, increased, steady state, administration, elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is TDM’s relationship with Efficacy?

• When drug concentrations are&raquo_space; EC50, all pharmacological responses are _____
• Avoid administration of further, _____ (and possibly ____) doses of drug

A

saturated, ineffective, toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is TDM’s relationship with Potency?

• Diminished potency/sensitivity
• Measuring drug in a patient who is not _____ but who is receiving _____ dosage

A

improving, normal

17
Q

Define the target concentration strategy
A multi-step process for _______ dosage in an individual on the basis of ___ and ___ and pharmacogenetics properties

A

optimizing, PK, PD

18
Q

What are the steps of the target concentration strategy
The steps are:
1. Chose _____ ________ (?)
2. Predict __ and __ from standard population values
3. Measure patient’s ______ and drug ________
4. Revise ___ and/or ___ based on measured drug concentration

A

target concentration, TC, Vd, CL, response, concentration, Vd, CL

19
Q

How do you measure the target concentration?

A
20
Q

If a patient has drug concentrations outside the therapeutic range, the dose should be ?

A

modified to change the drug concentrations into the therapeutic range by a proportional adjustment

21
Q

E.g. of dosage adjustment formula (dose)

A
22
Q

E.g. dosage adjustment formula (interval)

A
23
Q
A
24
Q
A
25
Q

What drugs would be good candidates for TDM?
• Drugs with ____ therapeutic index
• Drugs with _____ variability in their PK properties
• Drugs used in patients who are at ___ risk of toxicity

A

low, great, high