Pharmacokinetics.
2. Therapeutic evaluation
Whether a drug is of value.
Pharmacoeconomics.
Clinical Pharmacology in Pediatrics
Clinical Pharmacology in Pregnancy
Clinical Pharmacology in Geriatric
etc
Teaching
Goverment
clinical care of patients can be improved
The RATIONAL USE of medicines individual
patients & patient populations
Clinical care of paediatric and geriatric patients needs
special attention
the critical evaluation of new and old therapies
pharmacoepidemiological
Drug and Therapeutics Committees where they help
the rational introduction and use of new and
expensive medicines into the delivery of health care.
Therapeutic drug monitoring
Ph kinetic Ph dynamic
Drug-
interaction
• Measuring/ • Therapeutic
interpreting response
plasma drug conc. • Side effects
• Toxic effects
Time-drug conc. relationship
40
30
Drug toxicity
20
Therapeutic level
10
m.e.c
Low therapy
1 2 3 4
Time (hour)
Therapeutic Drug Monitoring (TDM)
• Drug formulation
• Drug interaction
• Environmental factors
• Genetic variation
• Renal and hepatic function
Reasons for monitoring
drug treatment
3. To assess compliance
Examples of difficulty in ditinguishing between
the effects of a disease and
the toxic effects of a drug
Renal damage
Renal failure Stage of failure
◦ penyesuaian dosis pada gangguan fungsi ginjal tidak
diperlukan jika
(a) fraksi obat yang diekskresi utuh oleh ginjal (fR) < 0.33
dan metabolitnya tidak aktif, berapapun LFGnya, dan juga
(b) pada gangguan fungsi ginjal ringan atau LFG > 0.67
nilai normal, berapapun fRnya.
◦ penyesuaian dosis diperlukan pada semua derajat
gangguan fungsi ginjal
untuk obat dengan margin of safety yang sempit dan
eliminasi terutama melalui ginjal, misalnya
aminoglikosida, vankomisin, dan digoksin.
Hepar impairment
Rumus Cockcroft & Gault
Penyesuaian dosis pada gagal ginjal terutama
dilakukan untuk DM (dosis pemeliharaan)
dengan menggunakan persamaan Giusti-
Hayton sbb. :
ClCrU
G = 1 – fR 1 –
ClCrN
G = faktor koreksi Giusti-Hayton
ClR
fR = fraksi eliminasi obat oleh ginjal
ClT
ClCrU = klirens kreatinin pada uremia
ClCrN = klirens kreatinin normal
Penurunan DM dengan interval T yang tetap
DMU = DMN x G
◦ DMU = DM pada uremia
◦ DMN = DM yang normal
Cmax (peak)
Half life
AUC 24
Cmin
(trough)
Time
Visualisation of half-life
First order elimination of a drug (t ½ : 2 hours)
20 The plasma conc. falls by half each half-life
10
t½
5 t½
2.5 t½
2 4 6
Hours
Clinical application of half life (t½)