What is therapeutic drug level monitoring?
Therapeutic drug monitoring (TDM) refers to the clinical practice of measuring drugs and/or metabolites in blood or serum/plasma at a specific time point to determine if a patient’s drug concentrations are within the therapeutic range and confirm concentrations are neither subtherapeutic nor potentially toxic.
Which drug is suitable for TDM?
Which drugs?
| Table 1 | |
|---|---|
| Drugs suitable for therapeutic drug monitoring | |
| carbamazepine | 5-12 mg/L |
| flecainide | 0.2-0.9 mg/L |
| lamotrigine | 1.5-3 mg/L |
What type of drugs require TDM?
Examples of drugs widely analysed for therapeutic drug monitoring:
- Aminoglycoside antibiotics (gentamicin)
- Antiepileptics (such as carbamazepine, phenytoin and valproic acid)
- Mood stabilisers, especially lithium citrate.
- Antipsychotics (such as pimozide and clozapine)
- Digoxin.
What are the indications of TDM?
The indications for TDM are suspected dose-related toxicity, suspected noncompliance, acute overdose, chronic abuse, reduced kidney or liver function, potential interaction with other drugs, evaluation of absorption, and optimalization of treatment.
Why is TDM needed?
Therapeutic drug monitoring (TDM) is testing that measures the amount of certain medicines in your blood. It is done to make sure the amount of medicine you are taking is both safe and effective. Most medicines can be dosed correctly without special testing.
What is the therapeutic range for digoxin?
Therapeutic levels of digoxin are 0.8-2.0 ng/mL. The toxic level is >2.4 ng/mL.
What color tube is used for digoxin level?
| DIGOXIN LEVEL | |
|---|---|
| ORDERING INFORMATION: | Geisinger Epic Procedure Code: LAB2183 Geisinger Epic ID: 6345 |
| Preferred collection container: | Stat/Line draws: 3 mL green/yellow-top (plasma separator) tube Routine requests/off-site specimens: 3.5 mL gold-top (serum separator) tube |
| Specimen required: | 2 mL serum or plasma; minimum 0.2 mL. |
What heart rate do you hold digoxin?
Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant.
Which tube is used for digoxin sampling?
Conclusion: Blood samples drawn in plastic serum tubes and plastic plasma tubes can be interchangeably used for determination of digoxin concentration.
When do you draw digoxin trough?
– When monitoring digoxin therapy, drug levels should be drawn when the patient is at steady-state (ie: 4-5 half lives have passed since the last dose change or since drug initiation). – When monitoring digoxin, blood levels should be drawn no sooner than 6 hours after the most recent dose.
What pulse do you check before giving digoxin?
A nurse should assess the apical pulse for a full minute before administering digoxin due to its positive inotropic action (it increases contractility, stroke volume, and, thus, cardiac output), negative chronotropic action (it decreases heart rate), and negative dromotropic action (it decreases electrical conduction …
What should you check before giving digoxin?
Check your pulse before you take your digoxin. If your pulse is under 60 beats per minute, wait 5 minutes. Then check your pulse again.