THERAPEUTIC DRUG MONITORING 1

Therapeutic Drug Monitoring

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Therapeutic Drug Monitoring (TDM)

TDM refers to a medical practice to determine the amount of particular drugs in blood at

specified intervals. Some drugs pose difficulties to find out a particular dose that provides

appropriate treatment to patients without causing harmful side effects. Therefore, TDM forms a

frequent exercise in healthcare utilized by care practitioners to provide harmless and effective

drug dosage (Buclin et al., 2020). The assignment will critically discuss the given questions

related to therapeutic drug monitoring.

How Age Affect Drug Absorption, Metabolism and Excretion

At older age, the level of tissue and organ performances in the body gradually decrease.

Consequently, the rate of drug absorption, metabolization and removal from the body reduce and

become complicated than in young individuals. Most drug absorption occurs in the small

intestine due to increased surface area while others occurs in the stomach. As one ages, the

digestive system get affected, making intestinal cells to minimize the rate of drug entry into the

bloodstream. Metabolization entails the chemical changes that drugs encounter within the body

until their exit, mostly through urine or bile. Increase in age causes age-associated changes in the

liver, including reduction in liver mass and low hepatic blood flow. Drugs depending on hepatic

blood flow for their exit would pose an increased bioavailability. Therefore, lowered dosages

may be necessary in this condition (Cossart et al., 2021). For instance drugs like antidepressants

ad warfarin.

Excretion focuses on drug removal from the body, either through urine in kidneys or bile

in the liver. Therefore, any affected liver or kidney can surge the amount of drugs in the body.

Aging causes decrease in liver and kidney mass. Studies show that an age of forty to eighty years

causes about ten to twenty percent of kidney mass. Therefore, care providers should adjust doses
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for certain drugs excreted through kidneys, such as antibiotics and allopurinol (Cossart et al.,

2021).

What Drug Types can cause Hyperkalemia in aged adults when used in Conjunction with

Salt Substitutes?

There are certain types of drugs which when used with salt substitutes may increase

hyperkalemia risks in aged adults. One drug type include angiotensin-converting enzymes (ACE)

inhibitors. The ACE inhibitors blocks angiotensin II and prevents production of aldosterone

which helps t absorb sodium salts in kidney tubules. Consequently, excess potassium in the body

occurs increasing hyperkalemia risks in older adults. Another drug types to avoid using with salt

substitutes include potassium-sparing diuretics such as midamor and dyrenium. Other drug types

include angiotensin-receptor blockers (Oktaviono & Kusumawardhani, 2020). The drugs should

not be used together with salt substitutes due to high hyperkalemia risks in older adults.

How to Avert and Assess Risk Factors for Medication Nonadherence in Aged Adults

One way to avert medication nonadherence in aged adults include reducing the amount of

medication. Patient needs medications that they can manage. Therefore, care provider need to

evaluate their elderly patient drug regimes. Secondly, patients should be inspire to bring their

medications to appointments. Care providers should advise elderly patients to bring their

medications to appointments to enable the providers to discuss any question, make

recommendations and explain any strategy to increase medication compliance. Another way, cre

providers should encourage elder patients to use only one pharmacy to prevent the risk for

medicine duplication which may increase nonadherence to the prescribed drugs. Lastly, in

assessing the medication adherence by older adults, one should check for any warning signs. For
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example, cognitive impairment may result to patients stopping medication. Therefore,

development of a safe medication control plan may increase adherence (Oates et al., 2020).

In conclusion, TDM help to check the concentration of drugs in blood. As one ages, drug

absorption, mainly in the digestive tract, metabolism and excretion reduces because tissues and

organs decline in their functioning. Development of safe medication control plan may help

prevent medication nonadherence to aged adults.

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References

Buclin, T., Thoma, Y., Widmer, N., André, P., Guidi, M., Csajka, C., & Decosterd, L. A. (2020).

The steps to therapeutic drug monitoring: a structured approach illustrated with imatinib.

Frontiers in Pharmacology, 11. https://doi.org/10.3389/fphar.2020.00177

Cossart, A. R., Isbel, N. M., Scuderi, C., Campbell, S. B., & Staatz, C. E. (2021).

Pharmacokinetic and pharmacodynamic considerations in relation to calcineurin usage in

elderly kidney transplant recipients. Frontiers in Pharmacology, 12.

https://doi.org/10.3389/fphar.2021.635165

Oates, G. R., Juarez, L. D., Hansen, B., Kiefe, C. I., & Shikany, J. M. (2020). Social risk factors

for medication nonadherence: findings from the CARDIA study. American Journal of

Health Behavior, 44(2), 232–243. https://doi.org/10.5993/ajhb.44.2.10

Oktaviono, Y. H., & Kusumawardhani, N. (2020). Hyperkalemia associated with angiotensin

converting enzyme inhibitor or angiotensin receptor blockers in chronic kidney disease.

Acta Medica Indonesiana, 52(1), 74–79. https://pubmed.ncbi.nlm.nih.gov/32291375/