Therapeutic Drug Monitoring

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Course Objectives
- Describe the concept and significance of Therapeutic Drug Monitoring (TDM)
- Identify key concepts related to pharmacokinetics and pharmacodynamics
- Relay the drugs that require monitoring
- Discuss the role of TDM in preventing adverse drug reactions.
Course Content
Course Creator: Kirsten Hermens, NCMA-P
Total CE Hours: 1 Credit Hour 
Pace Course #: 586-2407-25

Key Terms: 
- Pharmacokinetics
- Pharmacodynamics
- Therapeutic Range
- Toxicity
- Adverse Drug Reaction (ADR)
 
Outline: 
  • Introduction
  • Key Terms
  • Introduction to Therapeutic Drug Monitoring
    • Brief History of Therapeutic Drug Monitoring
    •  Overview of Therapeutic Drug Monitoring (TDM)
    •  Definition of TDM
    •  Importance of TDM in Patient Care
      • Examples of successful TDM applications
    •  Therapeutic Drug Monitoring (TDM) is useful in cases of 
    • Key Concepts in TDM
      • Therapeutic Range
      •  Bioavailability
        • Examples
          • Oral Administration
          •  Intravenous Administration
      •  Volume of Distribution (Vd)
      •  Steady State
      •  Reaching Steady State 
        • Initial Doses 
        • Time to Steady State
      •  Half-life
      •  Trough
      •  Peak
  •  Pharmacological Foundations
    • Understanding Pharmacokinetics
      • ADME
        • Absorption 
        • Distribution 
        • Metabolism 
        • Excretion
  •  Key Reasons for Importance in TDM
    • Individualized Dosing
    • Understanding Drug Levels
    •  Adjustments for Narrow Therapeutic Window
    •  Monitoring Drug Interactions
  • Pharmacodynamics Essentials
    • Drug-Receptor Interactions
    • Dose-Response Relationship
    •  Therapeutic Index
    •  Index Classifications
      • Narrow Therapeutic Index (NTI)
      • Wide Therapeutic Index (WTI)
    • Factors Affecting Drug Levels
      • Drug Toxicity
        • Types of Toxicity
          • Acute Toxicity 
          • Chronic Toxicity
  • Drugs Commonly Monitored
    • Digoxin 
    • Lithium 
    • Carbamazepine 
    • Theophylline 
    • Phenytoin 
    • Vancomycin 
    • Warfarin 
    • Cyclosporine
  • The Role of Phlebotomy in TDM
    • Overview of Phlebotomy 
  • Purpose and Applications of Phlebotomy:
    • Diagnostic Purposes 
    • Medical Research 
    • Blood Donations 
    • Therapeutic Applications
  •  Phlebotomy Techniques
    • Venipuncture 
    • Capillary Puncture
  • Venipuncture: Impact on TDM accuracy
    • Consistency 
    • Lower Contamination Risk
  •  Capillary Puncture: Impact on TDM accuracy
    • Potential for Contamination 
    • Variability
  •  Therapeutic Drug Monitoring: 
    • Acceptable Specimens For TDM:
      • Whole Blood 
        • Usage 
        • Example
      • Serum 
        • Usage 
        • Example
      •  Plasma 
        • Usage 
        • Example
  • Blood Collection Protocols for TDM
    • Patient Identification 
    • Patient Information 
    • Consent and Comfort
  • TDM Timing of Collection
    • Trough
    •  Peak
  • Drug Half-Life Consideration
    • Reaching Steady State
    •  Trough Level Measurement
  •  Venipuncture Collection Procedure
    • Aseptic Technique
    •  Tube Filling
    •  Post-Collection Handling
  • Impact of Phlebotomy on TDM Accuracy
    • Timing of Blood Collection 
    • Sample Integrity
      • Hemolysis
      •  Contamination
      •  Best Practice
    •  The wrong tube used 
    • Proper Labeling and Documentation
    •  Scenario 
      • Scenario Conclusion
  • Clinical Application of TDM
    • Overview of Laboratory Processing Steps in TDM Specimens
      • Acquiring 
      • Centrifugation 
      • Aliquoting 
      • Storage 
      • Analysis Preparation
    • Interpreting TDM Results
      • Assessment of Results
        • Requires integration with patient-specific data 
        • Age 
        • Organ Function 
        • Sample Timing
      • Pattern Recognition 
        • Therapeutic Range 
        • Subtherapeutic Levels 
        • Toxic Levels 
        • Clinical Decision Support
      • Patient Care
        • Why is TDM Important in Patient Care?
          • Optimizes drug efficacy and safety:
            • Personalized Dosage Adjustment 
            • Monitoring and Response
            •  Managing Drug Interactions and Variability
            •  Improving Compliance and Outcomes
        • Monitoring to Avoid Adverse Reactions 
          • Individualized dosing 
          • Optimal therapeutic range 
          • Early detection of toxicity 
          • Identifying drug interactions 
          • Necessary Adjustments 
          • Education and Support
        • Importance of TDM in Special Patient Populations 
          • Elderly Patients 
          • Pediatric Patients 
          • Immunocompromised Patients 
          • Oncology Patients 
  • Future of Therapeutic Drug Monitoring
    • Emerging TDM technologies
      • Point-of-Care Testing (POCT)
        • Portable Devices 
        • Wearable Sensors 
        • Lab-on-a-Chip (LOC) 
        • Microfluidic Sensors 
      • Pharmacogenomics
        • Genetic Testing for Personalized Medicine
        •  Biomarker Discovery
      •  Artificial Intelligence (AI) and Machine Learning 
        • AI for Data Interpretation 
        • Decision Support Systems (DSS)
      •  Liquid Biopsy 
        • Non-invasive Drug Monitoring
        •  Monitoring Cancer Therapies
      •  Nanotechnology
        • Nanoparticles for Drug Delivery and Monitoring
        •  Nano-sensors
  •  TDM Case Study Scenarios  
    • Monitoring Anti-Seizure Medication in a Pediatric Patient Scenario
    • Monitoring Antibiotics in a Critically Ill Patient Scenario
  • Conclusion

 
References: 
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