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17. Therapeutic Drug Monitoring


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What is pharmacology?
The science of drugs - their origin, kinetics, influence, and therapeutic processes.
What is pharmacokinetics?
Study of the bodily absorption, distribution, metabolism, and excretion of drugs.
What is pharmacodynamics?
branch of pharmacology dealing with reactions betwn drugs and living systems
What is toxicology?
The study of poisons and their effect and the problems involved.
List the 4 pharmacokinetic process related to change in [drug] with time.
What 2 factors affect drug absorption?
-Perfusion of the drug at its absorption site
-Polarity of the drug
What 3 things related to drug polarity affect drug distrbn?
-Additional compartments that the drug has to get to (CNS)
-How fat the patient is
Drug distribution is dependent on what 2 things?
-Protein binding
What is the Vd?
Volume of distribution; the vol required to contain a distributed dose
What are 4 factors that can alter the Vd?
What are the routes of drug elimination?
-Liver - removes drug from circulation by chemical metabolism
-Renal - in urine
What is a "Narrow Therapeutic Index"?
Refers to when therapy drug levels are very close to toxic levels
What is an example of a drug with a very low TI?
What is the "first pass effect"?
Refers to when a drug is significantly metabolized by the liver on its FIRST pass through it; means more has to be given to reach therapeutic levels.
What could reduce first pass effect?
Reduced hepatic blood flow in congestive heart failure - means that more drug will be given than thought.
What is an example of a drug whose CLEARANCE is dose-dependent?
What is the Half-life of a drug?
-Affected by Vd and Clearance;
-Time it takes for a drug to reach steady state level.
How does protein binding affect drug levels?
-Pharmacologic effect of drug is intended for FREE drug.
-Measurement is of TOTAL drug
-Increased/Decreased Protein levels will alter the amt measured AND distributed.
Give an example of drug interference:
Quinidine reduces Digoxin clearance
how many doses does it take to reach steady state drug concentration?
What is therapeutic range based on?
Graphing Drug concentration vs. Toxicity
What is digibind?
Anti-digoxin antibody
What are the aminoglycosides?
Amikacin, gentamicin, kanamycin, etc.
What are the aminoglycosides prescribed for?
gram negative aerobes
How are aminoglycosides toxic?
Nephrotoxic and ototoxic - they concentrate at the kidneys during clearance.
What are the Anti-arrythmics?
What is another name for Phenytoin?
What are the anti-convulsants?
1. Phenytoin
2. Valproic acid
3. Phenobarbital
4. Primidone
5. Carbamezapine
What's another name for Carbamezapine?
What is methotrexate?
An anti-cancer drug
What are the anti-depressants?
-Tricyclic antidepressants
What is Digoxin?
A Cardiac glycoside used to increase cardiac output
What is another name for digoxin?
Digitoxin, Lanoxin
What is Theophylline?
What is it prescribed for?
-An Anti-asthmatic
-Prescribed for Bronchospasms and neonatal apnea

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