Pharmacokinetics addresses the absorption, distribution, metabolism and excretion of drugs in patients.
Pharmacokinetics and therapeutic drug level monitoring
Pharmacokinetics
addresses the absorption, distribution, metabolism and excretion of drugs in
patients. A sound knowledge of the pharmacokinetic profiles of different drugs
enables the pharmacist to assess the dosing requirements for certain drugs in
patients in extremes of age and in the presence of impairment of kidney and
liver function. Clinically important drug interactions and adverse reactions
can sometimes be predicted. Dosing calculations of aminoglycoside antibiotics
are usually made by employing pharmacokinetic principles.
A number of
medicines in common use have a narrow therapeutic index; that is, the
difference between the lowest effective dose and a potentially toxic dose can
be quite small. In many cases it is necessary or desirable to undertake
therapeutic drug level monitoring (TDM) to ensure that patients can be treated
safely. TDM services include the measurement of drug levels in the patient’s
blood and the application of clinical pharmacokinetics to optimise drug
therapy. There is a wide range of medicines that fall into this category, but
TDM services typically include aminoglycoside antibiotics, anticonvulsants, immune
suppressants, digoxin, lithium and theophylline. Monitoring drug levels in
patients can also provide an important indicator as to whether they are taking
their medicine. Clinical pharmacy input into TDM services can range from the
provision of simple advice to other clinicians on when to take samples and how
to interpret results, to fully fledged services that may include collection and
laboratory analysis of the blood sample.
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