WELCOME TO

Course Title: Clinical Pharmacy-III

Topic:TDM

Ms. Anum Hanif

Lecturer
Faculty of Pharmacy
Hajvery University (HU)
 Learning Outcomes
• TDM
• Importance of therapeutic drug monitoring
• Steps In Therapeutic Drug Monitoring
• Conditions For Applying TDM
 TDM
• TDM, also known as therapeutic drug monitoring
refers to the individualization of dosage by
monitoring plasma or blood drug concentrations with
in a target range.

• therapeutic drug monitoring is a tool that can guide

the clinical to prove effective and safe drug therapy in
the individual patient. monitoring can be used to
confirm a plasma drug concentration which is above
or below
• the therapeutic range, thus minimizing the time which
elapse before corrective measures can be
implemented in the patient.

Importance of therapeutic drug monitoring:

• To decrease chances of toxicity:
To prevent or confirm toxicity where there is little
difference in the dose required for a therapeutic end
dose which will produce toxicity.
• To assess poor patient response:
To investigate an adequate therapeutic response specially in
ICU patients who are at higher risk.
• To identify non compliance:
It helps to identify the patient’s non-compliance.
• Monitoring therapy in special conditions:
For example:
pregnancy, stress, surgery, HIV, CNS disease, liver disease,
thyroid disease, kidney disease.
• Dose tailoring:
It helps to tailor dosage and fit the current needs of specific
patient
 Steps In Therapeutic Drug Monitoring

Step-1: Selection of Drug

drug is selected on basis of pharmacokinetics,
pharmacodynamics and cost.
Step-2: Dosage Regimen Design
dosage regimen is designed by keeping in view
the optimal pharmacokinetic and individualized
pharmacokinetic.
Step-3: Pharmacokinetics of Drugs
• parameters like absorption, distribution, protein
binding etc are checked
• therapeutic window is checked.
Step-4: Dosage Form Determination:
route and desired outcome determine the dosage form
Step-5: Patient Compliance
factor affecting the patient compliance are assessed
Step-6: Drug Administration
drug is administered to patient.
Step-7: Dose Adjustmet
Dose is adjusted on the basis of pharmacokinetics data.
Step-8: Measurement of serum concentration
It is necessary for continous monitoring for ensuring
proper drug therapy.
Step-9: Assay of Drug
Assay of drug is performed; 2 important features:
• specificity
• sensitivity
Step-10: Pharmacikinetic evaluation
• Check reasons for altered response
• Evaluate if sub-therapeutic concertion
 Conditions For Appying TDM

a) unpredictable dose response relationship e.g.

anticonvulsant
b) concentration and toxicity correlation exists
c) lack of clinically observable end point e.g. in case of
transplant rejection
d) wide inter-patient variations in drug clearance
e) possibility of accurate serum conc. monitoring
 When TDM Is Not Useful
a) when the action is produce by the active metabolism
therefore in that case we are not allowed to moitor parent
drug, Example: primidone
b) Idiosyncratic effects are related to plasma concentration.
Example: aplastic anemia due to choramphenicol.
c) For drugs who show action when plasma conceration falls to
zero. Example: aspirin
d) Drugs with complex actions. Example ACE inhibitors where
action is not related tp plasma concentration
e) when the drug action is not related to the site of action.
Example: pencillin
Summary
The student have learnt about the:
• TDM
• Importance of therapeutic drug monitoring
• Steps In Therapeutic Drug Monitoring
• Conditions For Applying TDM
1. Students you can ask any
question regarding this
lecture.
2. Google Classroom discussion
board.