Clinical significance of therapeutic drug monitoring in pharmacotherapy rationalization and individualization
Klinický význam terapeutického monitorovania liekových hladín pri racionalizácii a individualizácii farmakoterapie
Jozef Novotný
2005
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The monitoring of drug levels has not only academic significance, but it also enables pharmacotherapy rationalization and protects the patient in case of high dose therapy often in the field of toxic doses that damage vital organs (kidney, heart, hematoporesis, mucous membranes etc.). Therapeutic Drug Monitoring (TDM) is one of the means to increase safety and efficiency of pharmacotherapy, enabling dose adaptation to the individual patient. It is based on the possibility of fixing the drug
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... entration in biological liquids, most often in plasma or in urine, but also in saliva etc. TDM is a part of monitoring of treatment of chronically and critically ill patients. It is substantiated in patients with different pharmakinetics of drugs -older patients, newborns, children etc. The monitoring of drug levels during therapy, or therapeutic drug monitoring, is complex analytic activity that, unlike simple drug analytics in biologic material (intoxication etc.), studies also other factors that are important with regard to dynamics of organism during illness and therapy. The aim of monitoring of drug levels during pharmacotherapy is: analysis of drugs with narrow therapeutic range; application at drugs with well defined relation between drug concentration and effect (either therapeutic or toxic); analysis of drugs with great interindividual or intraindividual differences in pharmaceutical distribution or its clearance; to define the right regime and program of medication dosage for individual patients, i.e. individualization of pharmacotherapy; to reach optimally efficient drug concentration for therapy result; to forestall origin of toxic manifestations, e.g. gentamycine, digoxine, cyclosporine etc.; to follow continuously the changes during certain pharmacotherapy and to adapt it to current patient's condition and needs; to follow patient's compliance during the introduced therapy. Key words: therapeutic drug monitoring -rational pharmacotherapy -pharmacotherapy individualization -complex analytic activity -therapeutic range of medication -compliance -polytherapy -drug interaction -patient's age -interpretation of drug levels Súhrn Monitorovanie liekových hladín má význam nielen akademický, ale umožňuje aj racionalizáciu farmakoterapie a chráni pacienta pri vysokodávkovanej terapii často v oblasti toxických dávok, ktoré poškodzujú vitálne dôležité orgány (obličky, srdce, hematopoézu, sliznice a ďalšie). Terapeutické monitorovanie hladín liekov (TDM, Therapeutic Drug Monitoring) je jedným z prostriedkov na zvýšenie bezpečnosti a efektívnosti farmakoterapie a umožňuje prispôsobenie dávok individuálnemu pacientovi. Je založené na možnosti stanovenia koncentrácie liečiva v biologických tekutinách, najčastejšie v plazme alebo v moči, ale i v slinách a pod. TDM je súčasťou monitorovania liečby chronicky a kriticky chorých pacientov. Je zdôvodnené u pacientov s odlišnou farmakinetikou liečiv -starších pacientov, novorodencov, detí a i. Sledovanie liekových hladín v priebehu terapie, alebo terapeutické monitorovanie liekov, je komplexná analytická činnosť, ktorá na rozdiel od jednoduchej liekovej analytiky v biologickom materiáli
doi:10.32725/kont.2005.043
fatcat:3oc3j35e3zdcxkud77m4fkq4ci