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Therapeutic Drug Management, To monitor / To confirm overdose
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- To monitor / To confirm overdose
- identify drug overdose & track the progress of treatment
- to counteract the overdose
- Eg. overdose of Acetaminophen - liver toxicity
- It metabolize into two forms: reactive & non-reactive forms
- When the non-reactive metabolite become saturated, increase production of reactive metabolites causes toxicity.
- To determine the dosage of a medication
- Most medications exhibit either the firs-order/linear kinetics or saturation/non-linear/Michealis-Menten kinetics
- Some medications exhibit both
- Eg. Phenytoin (anticonvulsant)
- First-order kinetic at ""low"" conc.; Saturated the metabolic pathway at higher doses
- To evaluate the impact of the patient's social habit's and disease states
- Eg. Smokers require higher dosage of Theophylline (bronchodilator)
- Smokers eliminate Theophylline faster, have lower serum levels
- To minimize toxicity
- To minimize dosage
- give patient the exact dose for the right treatment
- to maximize clinical outcome
- avoid toxicity
- Eg. Aminoglycoside antibiotics
- Get concentrated in urine, Increase concentration in urine (24-75x greater) than peak plasma conc.
- Administer lower doses for UTI compare to pulmonary or blood infections - reduce risk of SE
- To save money
- Optimum therapy will shorten the duration of therapy/hospitalized - reduce cost
- To monitor for active metabolites
- To access the metabolites/byproduct which may hv the same therapeutic effect as the drug
- Increase accumulation of active metabolites may cause toxicity
Eg. Procainamide
- To explain how a medication failed
- Tracking compliance of a therapy
- Eg. Phenytoin for seizure treatment
- TDM helps to rule out non-compliance of seizures continue
- To find out that patient hv seizure may due to not following the treatment plan
- Preventing from unnecessary increase dosage or adding-up second line drug
- To monitor interactions between drugs
- Eg. Phenobarbital - decrease serum level of Phenytoin & Theophylline
- To monitor drug interactions with food
- To identify the absorption of drug - reduction in absorption due to food
- which can be compensated by increasing the dosage
Eg. Theophylline - Foods reduce bioavailability by 50%
Diagnostic is made
:arrow_right: Drug is selected
:arrow_right: Dosage schedule is designed to reach target plasma conc.
:arrow_right: Drug is administered
:arrow_right: Patient assessment are performed & Drug conc. is determined
:arrow_right: Pharmacokinetics model is applied & clinical judgement is used
:arrow_right: If dosage adjustment is necessary
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