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Reference:
Bishop, M. L., Duben-Engelkirk, J. L., & Fody, E. P. (1996). Clinical chemistry: Principles,
procedures, correlations. Philadelphia: Lippincott.

Report Content:
Therapeutic
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A.THERAPEUTIC DRUG & MONITORING

3BSMT1

CONTENTS: 04. DRUG DISTRIBUTION 08. PHARMACOGENOMICS

01. ROUTES AND ADMINISTRATION 05. DRUG ELIMINATION 09. CARDIOACTIVE DRUGS 12. PSYCHOACTIVE DRUGS
02. ABSORTION 06. PHARMACOKINETICS 10. ANTIBIOTICS 13. IMMUNOSUPPRESSIVE DRUGS
03. FREE VERSUS BOUND DRUGS 07. SAMPLE 11. ANTIEPILECTIC DRUGS 14. ANTINEOPLASTICS
COLLECTION
➢

OVERVIEW
Therapeutic Drug Monitoring (TDM)
Involves the analysis, assessment, and
evaluation of circulating concentrations of drugs
in serum, plasma, or whole blood.
• The purpose of these actions is to ensure that
a given drug dosage produces maximal
therapeutic benefit and minimal toxic adverse
effects.
• With certain drugs, however, the correlation
between dosage and therapeutic effects or
toxic outcomes is weak, and it is difficult to
predict what dose should be used. In this
situations, trial, and error, in conjunction with
direct observation, may work.
• The standard dosage is statistically derived
from observations in a healthy population.
• Disease states may produce altered
physiologic conditions in which the standard
dose does not produce the predicted
concentration in circulation. In these cases,
individualizing a dosage regimen is
warranted.
Common indications for TDM:
✓ The consequences of overdosing and
underdosing are serious.
✓ There is a small difference between a
therapeutic and a toxic dose.
✓ There is a poor relationship between the
dose of drug and circulating
concentrations but a good correlation
between circulating concentrations and
therapeutic or toxic effects.
✓ There is a change in the patient’s
physiologic state that may unpredictably
affect circulating drug concentrations.
✓ A drug interaction is or may be occurring.
✓ TDM helps in monitoring patient
compliance.
01. ROUTES AND ADMINITRATION
A drug must be at the proper concentration at its
site of action to provide therapeutic benefit. It
would be excellent to measure drug concentration
at the site of action.
● Bioavailability is defined as the unaltered
percentage of the injected dose as it
enters systemic circulation.
● The goal of most therapeutic regimens is
to acquire (blood, plasma, or serum)
concentration
Drugs can be administered by several routes:
a. Intravenous (IV) - Directly into the
circulation
b. Intramuscular (IM) - Into the muscles
c. Subcutaneous (SC) - Under the skin
d. Transcutaneous - Inhalation or absorbed
through the skin
e. Suppository - Rectal delivery
02. ABSORPTION
Factors affecting the efficiency of absorption for
orally administered drugs:
1. Dissociation from administered form
2. Solubility in gastrointestinal fluids
3. Diffusion across gastrointestinal
membranes
Two types of drug absorption
● Passive
● Active