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Therapeutic drug monitoring (TDM) refers to the measurement of drug concentrations in biological fluids with the goal of optimising a patient’s drug therapy and clinical outcomes. Drugs where TDM is used include those with a narrow therapeutic index, concentration-dependent pharmacokinetics, or where the desired therapeutic effect is difficult to monitor or there are large pharmacokinetic variations between individuals.
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The latest RGH E-Bulletin focuses our attention on anticoagulation. With more and more of the population taking anticiagulants understanding the factors for patient variability becomes more important.
The single most major concern in connection to anticoagulant use is the risk of bleeding. Perhaps the biggest driver of this concern is increasing intensity of anticoagulation. Often there is unpredictable variability in patient response to anticoagulant therapy that may inadvertently lead to overanticoagulation and subsequent bleeding.
Most variability in response to warfarin is driven by two genetic elements – the vitamin K epoxidase system, which is the basis for the action of warfarin, and the cytochrome P450 2C9 liver enzymes responsible for warfarin metabolism. As a result, daily maintenance doses can range from 0.5 mg – 20 mg/day.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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Gout is a metabolic disease with symptoms arising from the deposition of monosodium urate crystals in joints and connective tissue tophi. Colchicine does not affect uric acid levels, but reduces the inflammatory reaction to urate crystals.
It may be used for pain relief in the acute treatment of gout and/or at lower doses for prophylaxis when urate-lowering treatment is initiated. Allopurinol is a xanthine oxidase inhibitor used to prevent gout attacks, acting by reducing urate levels through inhibition of the metabolism of xanthine to uric acid.
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Drug-induced myopathies may present in varying degrees of severity from mild muscle weakness to rhabdomyolysis with acute renal failure. Drugs may cause myopathic symptoms by directly affecting a muscle organelle, inducing immunological or inflammatory myopathy, altering systemic functions leading to electrolyte disturbances or via nutritional deprivation, and this in turn affects muscle function. Many toxic myopathies are reversible, thus prompt detection of the offending agent is essential. These are some common drugs implicated in this condition
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