Kontakt 2005, 7(3-4):211-218 | DOI: 10.32725/kont.2005.043

Clinical significance of therapeutic drug monitoring in pharmacotherapy rationalization and individualizationNursing

Jozef Novotný

Jihočeská univerzita v Českých Budějovicích, Zdravotně sociální fakulta, katedra ošetřovatelství

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 concentration 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.

Keywords: 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

Published: November 22, 2005  Show citation