Title 7. THERAPEUTIC DRUG MONIROTING.pdf ✅

PHARMD GURU Page 3  Antibiotics (Gentamycin, amikacin, tobramycin)  Antineoplastics (Methotrexate)  Antimanics (Lithium)  Bronchodilators (Theophylline)  Immunosuppressives (Cyclosporine) INDICATIONS FOR TDM: While there may be specific individual circumstances for TDM, most indications can be summarized as follows:  Low therapeutic index.  Poorly defined clinical end point.  Non compliance.  Therapeutic failure.  Drugs with saturable metabolism.  Wide variation in the metabolism of drugs.  For diagnosis of suspected toxicity & determining drug abuse.  Drugs with steep dose response curve (small increase in dose can result in a marked increase in desired/undesired response e.g. theophylline)  When another drug alters the relationship between dose & plasma concentration e.g. plasma concentration of lithium is increased by thiazide.  Renal disease (alters the relationship between dose & the plasma concentration. Important in case of digoxin, lithium & aminoglycoside antibiotics.) TDM IS UNNECESSARY WHEN: 1) Clinical outcome is unrelated either to dose or to plasma concentration. 2) Dosage need not be individualized. 3) The pharmacological effects can be clinically. Quantified (BP, HR, Blood sugar, urine volume etc.) 4) When concentration effect relationship remains unestablished. 5) Drugs with wide therapeutic range such as beta blockers and calcium channel blockers. 6) Hit and run drugs e.g. Omeprazole.