THERAPEUTIC DRUG MONITORING

SALAZAR, KARL ANGELO

 Pharmacokinetics
 That’s what people will do
OUTLI
NE  Pharmacodynamics
I. THERAPEUTIC DRUG MONITORING
II. BASIC CONCEPTS  Mechanism of action of drug.
III. NATURE OF DRUGS
IV. PRINCIPLES OF PHARMACOKINETICS
V. A-D-M-E
VI. METHODS
VIII. INDIVIDUAL DRUGS

THERAPEUTIC DRUG MONITORING

 Related toxicology
 Also known as THERAPEUTIC MANAGEMENT -
DRUG SIZE
a multi-disciplined clinical activity initiated by
the physician ordering laboratory  Usually 100-1000 in molecular weight
quantification of drug concentration in a  MW 7 to MW 50,000
biological fluid.  MW 7 - is Lithium
These values are used to :  Thrombolytic
 Assess therapeutic compliance  Dissolve blood clots
 Assess efficacy or,  Coronary artery disease
 Elucidate the cause of drug induced toxicity.
PERMEATION
THERAPEUTIC MANAGEMENT
 Drug Vehicles
THERAPEUTIC MANAGEMENT is a proper specimen  AQUEOUS DIFFUSION
Example:  LIPID DIFFUSION
 Blood  Body compartment which has lipid membrane.
 Urine  Diffusion happens into biological environment
 differentiation fluid which has WATER.
 acetic fluid  SPECIAL CARRIER TRANSPORT
 etc.  Drugs that can’t transport through the
 Collection of specimen must be timely. lipid.
 ENDOCYTOSIS
BASIC CONCEPTS
 Movement of cell
 Drugs  PINOCYTOSIS
CLINICAL  Movement of bulp
CHEMISTRY 2
LAB
WANDAGAN DYNER
  EXOCYTOSIS
IONIZATION OF WEAK ACIDS AND WEAK
 unprotonated (A-) form is more water-
soluble and undergoes better clearance
 protonated (HA) form is more lipid-
soluble and more likely to cross biological
membranes
 Excretion of a weak acid may be
accelerated by alkalinizing the urine with
bicarbonate
 Excretion of a weak base may be
accelerated by acidifying the urine with
ammonium chloride
PRINCIPLES OF PHARMACOKINETICS
 EFFECTIVE DRUG CONCENTRATION
 APPARENT VOLUME OF DISTRIBUTION
 CLEARANCE
 Rate of the elimination of drugs
 BIOAVAILABILITY
 Fraction of “liver” - not all drugs bio
availability
 STEADY STATE
 HALF-LIFE
 Type of drugs where reduce will be into
every 2 hours 50%/ 25% until eliminate of
the body.
 DOSAGE REGIMEN
 Plan for the damage administration on a
period of time
 MAINTENANCE DOSE
 That is needed to be administered initial
dose in order to maintain aesthetic.
 LOADING DOSE
WANDAGAN DYNER
 Plasma level to the target concentration
 THERAPEUTIC WINDOW
 Stay / minimum therapeutic
concentration/ minimum toxic
 RENAL IMPAIREMENT
 ADJUSTMENT
 Most of the excretion of drugs
DISTRIBUTION
SIZE OF THE ORGAN
 Determines concentration gradient between
blood and the organ.
 larger organ = less distribution.
BLOOD FLOW
 Important determinant of the rate of drug
uptake.
 Concentration of drugs with rapid elimination
will not significantly rise in poorly perfused
tissues.
 Blood flow affects the rate of uptake of drugs
but not the amount of drug in tissue
equilibrium.
BLOOD FLOW
 Influences the concentration of the drug in the
extra cellular fluid surrounding blood
 Binding to macro molecules in the blood or
tissue will tend to increase the drug’s
concentration in that compartment
METABOLISM
FATES OF A DRUG
 Termination of drug action
 Drug activation  Arrhythmogenes is increased by
 Elimination without hypokalemia, hypomagnesemia, and
hypercalcemia.
 Phase 1
 Oxidation
 Reduction
 Hydrolysis
 Phase 2 (MGAS)
 Methylation
 Glucuronidation
 Acetylation
 Sulfation

INDIVIDUAL DRUGS

DIGOXIN
 SIMD
 Digitoxin
 CLASS
 Cardiac Glycoside
 MOA
 Inhibits Na/K ATPase, Increases
intracellular Ca, increasing cardiac
contractility
 USES
 Heart failure, Nodal arrhythmias
 SE
 Narrow therapeutic index, arrythmias,
vomiting, Diarrhea, VISUAL CHANGES
 NOTES
 Reduced clearance with quinidine,
amiodarone, cyclosporine, diltiazem, and
verapamil.

WANDAGAN DYNER