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Describe the general guidelines for TDM testing • Discuss the basic Drug Sample Prep IS Column Detection Run AMR MPA 1 PPT – 100ul S MPAC C18

[PDF] Therapeutic drug monitoring with drugs concentrations in an organism

Therapeutic Drug Monitoring – TDM ▫ action leading to achieve such a dosage of the drug in a patient that the obtained levels of concentration remain within 

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Therapeutic drug monitoring (TDM) is the use of drug concentration measurements in body fluids as an aid to the management of drug therapy for the cure, 

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Therapeutic Drug Monitoring aims to individualise drug therapy and avoid both sub- therapeutic and toxic plasma drug concentrations A number of factors 

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18 mar 2019 · Therapeutic drug monitoring (TDM) refers to the individualisation of dosage by maintaining plasma or blood drug concentrations within a target 

[PDF] SECTION 6 THERAPEUTIC DRUG MONITORING

adjust dosing of the following commonly prescribed drugs that require therapeutic drug monitoring (TDM): ▫ Phenytoin ▫ Carbamazepine ▫ Gentamicin

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Therapeutic drug monitoring

Department of Clinical Pharmacology,

Medical University

Therapeutic index

ƒconcentration range characterized by a

high efficacy of action and low risk of upper toxic symptoms

The essence of therapeutic drug

monitoring with drug concentration

ƒrelationship between the pharmacological

activity and drug concentration in blood or in other available biological material

Therapeutic Drug Monitoring TDM

"action leading to achieve such a dosage of the drug in a patient that the obtained levels of concentration remain within the therapeutic range

Factors conditioning the

efficacy of therapeutic drug monitoring

ƒthe use of pharmacokinetic rules

ƒcombined analysis of obtained results and

clinical status of the patient

ƒverification of pharmacological activity of

administered drugs by means of other methods

Criteria for the selection of drugs

for monitoring

ƒlow therapeutic index

ƒdangerous toxic effects of the drug and

unnoticeable clinical effect

ƒclose interrelationship between the drug

concentration and its activity

ƒadministration in a long-term therapy

Criteria for the selection of drugs

for monitoring continuation

ƒthe use in life-threatening diseases

ƒsignificant individual differences in the

range of pharmacokinetics

ƒnon linear pharmacokinetics

ƒhigh distribution coefficient

Basic clinical indications

for the use of therapeutic drug monitoring

ƒlack of the expected result of therapy or

occurrence of unexpected toxic symptoms in spite of the administered dosage scheme

Basic clinical indications for

the use of therapeutic drug monitoring - continuation

ƒlack of the possibility of adequate clinical

or laboratorial control of the efficacy and power of the pharmacological effect of a drug, especially in long lasting therapy and in the prophylactic use

Basic clinical indications for

the use of therapeutic drug monitoring continuation "pathological conditions in which symptoms associated with unsuccessfully treated disease are the same as toxic

Basic clinical indications for

the use of therapeutic drug monitoring continuation "individual pharmacokinetic differences depend on the age and genotype of the patient

Basic clinical indications

for the use of therapeutic drug monitoring continuation

ƒcoincidence of diseases in organs

responsible for the drugs in the organism (renal failure, severe liver diseases, gastrointestinal diseases, pathological states in hypo or dysproteinemia, disturbances in water and electrolyte balance and acid-base balance)

Basic clinical indications for

the use of therapeutic drug monitoring continuation

ƒconcomitant administration of other

drugs, especially if there is a possibility of interaction between them

Basic clinical indications for

the use of therapeutic drug monitoring continuation

ƒprotection against toxic effects of some

drugs especially administered at high doses to achieve better therapeutic action of drug (calcium folinate + methotrexate)

Basic clinical indications for the

use of therapeutic drug monitoring continuation "estimation of the therapeutic value of new drugs

Rules for rational

pharmacotherapy based on measurements of blood serum drug concentration "development of such a dosage scheme of the drug that in a study state its concentration remains between the minimal active and the minimal toxic concentrations

Factors changing drug kinetics

"concomitant diseases specially renal and liver diseases, alimentary tract disease, thyroid disease, disturbances in protein binding "concomitant administration of other drugs and interaction of drugs

Factors changing drug kinetics

- continuation

ƒgenetic genotype, sex and age determine

the individual variability

ƒimproper dosage administration

ƒpoor bioavailability of drugs

ƒenvironmental factors, especially tobacco

smoking

Factors changing drug kinetics

continuation "tbe use of drugs by patients incompatible "analytical disturbances, e.g.: the presence of

Digoxin Like Immunoreactive Substance

DLIS in serum

Genetically directed

therapeutic monitoring "concomitant use of pharmacogenetics and traditional therapeutic monitoring of drugs concentrations in the organism to increase the efficacy and safety of pharmacotherapy

Genetically directed therapeutic

monitoring - continuation before initiation of treatment allows a priori dose modification of such drugs as: mercaptopurine, tioguanine, fluorouracil, azathioprine, trastusumab, irinotecan, tricyclic antidepressants, antiarrhythmic

Timing of blood sampling for the

estimation of drug concentration "after achieving the steady state "before administration of another dose of the drug, especially in the morning (minimal drug concentration, Cmin through concentration)

Timing of blood sampling for the

estimation of drug concentration continuation "in rare cases during administration of toxic drugs, e.g. aminoglycoside antibiotics the estimation of maximal concentration (Cmax peak concentration) is recommended

Recommendations for the

estimation of free level of drug concentration "diseases of the liver and kidney with associated hypoalbuminemia "concomitant use of therapeutic substances with concurrent displacement of the other drugs from serum protein bindings

Recommendations for the

estimation of free level of drug concentration continuation "non linear serum protein binding (salicylates, prednisolon, phenylobutazone, theophylline, disopyrimide) "increase of acid Įquotesdbs_dbs17.pdfusesText_23