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TDM

Therapeutic drug monitoring (TDM) involves measuring specific drug levels in a patient's bloodstream to maintain concentrations within a therapeutic range. This optimizes dosage regimens and avoids toxicity. TDM is useful for lithium and gentamicin. For lithium, used to treat bipolar disorder, the therapeutic range is 0.4-1.1 mmol/L and levels are checked every 4-7 days when starting or adjusting dosage. For gentamicin, used to treat various infections, peak levels should be 5-12 mg/L and trough levels below 2 mg/L to maximize efficacy while avoiding toxicity. Both drugs require monitoring and dosage adjustment based on renal function and other factors.

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0% found this document useful (0 votes)
161 views16 pages

TDM

Therapeutic drug monitoring (TDM) involves measuring specific drug levels in a patient's bloodstream to maintain concentrations within a therapeutic range. This optimizes dosage regimens and avoids toxicity. TDM is useful for lithium and gentamicin. For lithium, used to treat bipolar disorder, the therapeutic range is 0.4-1.1 mmol/L and levels are checked every 4-7 days when starting or adjusting dosage. For gentamicin, used to treat various infections, peak levels should be 5-12 mg/L and trough levels below 2 mg/L to maximize efficacy while avoiding toxicity. Both drugs require monitoring and dosage adjustment based on renal function and other factors.

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faria marium
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© © All Rights Reserved
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THERAPEUTIC

DRUG MONITORING TDM


Lithium & Gentamicin

GROUP # 02
Faria Maium Iqra
Hamna Tanveer Marium Akber
Mibsar Mushad Sadia Ijaz
What is TDM?
Therapeutic drug monitoring is the measure of the plasma
concentration level of the drug and the coordination of this serum
level with a serum therapeutic range.

OR
TDM is the clinical practice of
Drug in Drug in
measuring specific drugs at blood tissue
designated intervals
to maintain a constant
concentration the patient’s
bloodstream thereby optimizing Sample removed for drug
individual dosage regimen. Concentration
determination
CLINICAL SIGNIFICANCE
OF TDM:
•Maximizes efficacy
•Avoids Toxicity
•Identifies therapeutic failure
- Non compliance, sub therapeutic dose.
•Facilitates adjustment of dose
- New dose = Old dose x Desired Css/ Old Css
•Facilitates the therapeutic effect of drug by achieving target drug conc.
•Identify poisoning drug toxicity and drug abuse
PROCESS OF TDM
A DIAGNOSIS IS MADE

DRUG IS SELECTED

DOSAGE SCHEDULE IS DESIGNED TO REACH A TARGET PLASMA CONC.

DRUG IS ADMINISTERED

PT’s ASSESMENT IS DONE DRUG CONC. ARE DETERMINED

A PHARMACOKINETIC MODEL IS APPLIED AND CLINICAL JUDGEMENT IS USED

IF DOSAGE ADJUSTMENT IS NECESSARY


TDM OF LITHIUM
INDICATIONS:
It is a neuro protective agent
1st line therapy in acute mania and prophylaxis in bipolar
disorder
Augmentation for treatment resistant depression
Narrow therapeutic window drug that’s why TDM is
necessary.
TDM OF LITHIUM:
THERAPEUTICS
DOSAGE FORM: oral
LOADING DOSE: Not necessary
MAINTENANCE DOSE: 500 – 1200 mg/day
THERAPEUTIC RANGE: 0.4 – 0.1nmol/L
TIME TO STEADY STATE: 4-7 days
TOXIC EFFECT: vomiting, diarrhea, weight gain (within therapeutic range)
, hand tremor, irritability, stupor, seizure, nephrotoxicity and increased
reflexes

Don’t stop lithium abruptly or treat intermittently unless toxicity


present
TDM OF LITHIUM:
THERAPEUTICS
TDM OF LITHIUM:
PHARMACOKINETICS:
ABSORPTION:
Dosage form (Tmax)
Tab, cap: 0.5 -3
Bioavailability: 80-100%
Volume of distribution: 0.8L/kg
METABOLISM:
Not metabolized, renal clearance
ELIMINATION:
Elimination Half life: 18-36 hrs
Clearance : 10-40 mL/min
FACTORS EFFECTING PLASMA CONC.:
Increased: Renal impairment, by diuretics, ACE inhibitors,
Angiotensin II receptor antagonist, NSAID’S
Decreased: theophylline, acetazolamide, cisplatin
TDM OF LITHIUM:
SAMPLING:
VOLUME OF BLOOD: Fill to line
SAMPLING TIME: 12 hrs after previous dose. The time since the last dose
should be stated
RESAMPLING TIME: When commencing a therapy or after a dose
change, conc. should be checked after 4 to 5 days (never longer the
week) and thereafter every week until dosage has remained constant for
4 weeks and ever 3 months
TDM OF LITHIUM:
ADDITIONAL INFORMATION:
•Plasma conc. Should be checked if changing brand of lithium
preparation

•Many drug interactions, contact the pharmacy dept for the detailed
info

•Close monitoring of perioperative fluid balance is important in patients


taking lithium
TDM OF GENTAMICIN:
INDICATIONS:
Pneumonia
Gynecological infections
Intra abdominal infections
Osteomyelitis
Pyrexia of unknown origin
Septicimia
Soft tissue infections
Sub acute bacterial endocarditis
Urinary tract infection
TDM OF GENTAMICIN:
THERAPEUTICS:
Dosage forms: Slow intravenous bolus injection (over at least 3
minutes), intravenous infusion, intramuscular injection.
Loading dose: 3mg/kg IBW.
Maintenance dose: Contact the Pharmacy Department for
individualized estimates.
Time to steady state: 12 to 24 hours (depending on renal function).
Therapeutic range: Peak 5 to 12mg/L, trough
TDM OF GENTAMICIN:
PHARMACKINETIC:
Elimination half-life: 2.5 to 4 hours (normal renal function). Prolonged in
renal impairment.
Major route of elimination: Renal excretion.
Volume of distribution: 0.3L/kg.
Target for Gentamicin: peak 30-60 min post-dose = 5-10 mg/L
trough before next dose <2mg/L
Factors affecting plasma concentration:
Increased in renal impairment.
Decreased in ascites, cystic fibrosis and sepsis.
TDM OF GENTAMICIN:
ADDITIONA L INFORMATION:
1. Dosage is related to the severity of the infection, the age of the
patient and the patient’s renal function.

2. Lower peak concentrations (5mg/L) may be acceptable in patients


with urinary tract infections or endocarditis due to gram-positive
bacteria.
DO YOU HAVE ANY QUESTION?

THANK YOU FOR YOUR


ATTENTION!

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