UNIVERSITY OF SANTO TOMAS

FACULTY OF PHARMACY | DEPARTMENT OF MEDICAL TECHNOLOGY

THERAPEUTIC DRUG MONITORING

PHARMACOLOGY PRINCIPLES

 PHARMACODYNAMICS
 processes of interaction of pharmacologically active substances with target sites, and the biochemical
and physiologic consequences leading to therapeutic or adverse effects.
 Drug Receptors
 determine the quantitative relations between dose or concentration of drug and pharmacologic
effects. The affinity determines concentration of drug required to form significant drug-
receptor complexex
 limit the maxiimal effect a drug may produce
 responsible for selectivity of action
 mediate actions of pharmacologic agonists and antagonists
 Dose-Response
 response is concentration dependent until a maximal effect is reached which then marks the
plateau where there is saturation at the receptor or overload of a transport process
 PHARMACOKINETICS
 Processes of uptake of drugs by the body, distribution into the tissue, biotransformations/metabolisms
they undergo, and elimination of the drug and its metabolites from the body
 Absorption
 Depends on drug’s dissociating from its dosing form, dissolving in gastrintestinal fluids, then
diffusing across the biological membrane barriers into the bloodstream.
 Bioavailability – fraction of the drug absorbed in the systemic circulation
- Bioavailability > 70% is most desirable for drugs to be orally useful
 Distribution
 Metabolism
 Biontransformation
 Occurs at the liver
 Phase I
 Phase II
 Clearance

THEREPAUETIC-DRUG MONITORING

 PEAK
 TROUGH

ANTI-EPILEPTIC DRUGS

 PHENYTOIN | DILANTIN
o Diphenylhydantoin
o Primary or secondary generalized tonic-clonic seizures, partial or complex-partial seizures, and status
epilepticus
o Principal Metabolite : 5-(p-hydroxyphenyl)-5-phenyldantoin
o Therapeutic Range : 10 – 20 ug/mL (40-79 umol/L)
o Side Effect independent of plasma concentration: Gingival Hyperplasia
o Toxic Effect Manifestations
 > 20 ug/mL : Seizure Control not enhanced; Nystagmus and Ataxia
 > 35 ug/mL : precipitate seizure activity
o Specimen Collection
 Peak : if px displays signs of intoxication; 4-5 hrs after the dose (up to 8 hrs)
 Trough :monitor adequacy of therapy
 Carbamazepine | Tegretol
o Same use with phenytoin with the addition of treating pain associated with trigeminal neuralgia and as
a mood-stabilizing drug in bipolar disorder
o

Endocrinology/wynlor| 1