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13 views

TDM Presentation

Uploaded by

vlea.oates
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Emerging TDM

Technologies

Lea Oates
What exactly is TDM?
• TDM or therapeutic drug monitoring combines the elements of clinical chemistry and
pharmacology, focusing on the concentration of the drug in the blood. This allows us to assess if
a person is receiving too little or too much of a medication, particularly with drugs having a
narrow therapeutic range.

• What drugs have a narrow therapeutic range?


• Anticoagulants like vitamin K agonists and heparin
• Antiepileptic drugs like valproic acid, phenobarbital, phenytoin, carbamazepine
• Aminoglycosides like streptomycin, kanamycin, netilmicin, tobramycin and neomycin
• Immunosuppressants like cyclosporine, sirolimus, mycophenolic acid
• Glycosides like digoxin and digitoxin
• Mood stabilizing agents like lithium carbonate
• Central analgesics like opioids
What is the problem with NTI’s?
• In the previous slide it was mentioned • Dosage can also vary on an individual’s
that these drugs can easily be an genetic makeup, for example someone
overdose or underdose situation that needs opioids after surgery but their body
can affect the patient drastically. processes opioids slowly, they shouldn’t

• These medicines are picked based on take an opioid every 6 hours because it

their ability to provide the greatest could lead them to an overdose.

benefit with the least amount of risk


What are the goals to
monitoring?
• The goals we reach for with these drugs through monitoring are

1. Minimizing side effects

2. Enhancing treatment response

3. Adapting to patient needs over time

4. Navigating regulatory requirements


Emerging TDM Technologies
• A key innovation in recent technology are biosensors and wearables which convert
certain measurements from individuals into measurable drug concentration related
signals using optical and electrochemical techniques.

• Liquid Chromatography with mass spectrometry more recently ultraperformance liquid


chromatography (plasma and breast milk are samples).

• Immunoassays.
Biosensors
• Biosensors are one of the most promising choices among recent technological
advancements.
• Continuous TDM is a big reason why biosensors are so promising, it provides a more
complete concept of a drug’s concentration over time.
• This helps optimize dosing, improve decision making in the clinical lab and monitor toxicity levels in
real time.
• Biosensors, with emphasis on the ones using the electrochemical techniques, play a big role in this.

• They can also be used for drug administration in the in vivo category, as they are suitable for
feedback controlled closed loop systems.
• They have high sensitivity, reliability and multiplexing capabilities.
Biosensor Methods
• Optical methods use photodetectors this is mainly used for antibiotics, anticancer drugs,
antifungals, antiepileptic drugs, therapeutic drug antibodies and more

• Electrochemical methods generates an electrical signal that is equivalent to the drug


concentration, this is used with antibiotics, antiepileptics, anti-cancer and antifungals
Disadvantages of Biosensors
• They are very susceptible to background noise and environmental interferences

• Signal loss depending on matrix used

• Fragility of the instrument

• Cost

• Invasiveness for sample collection


Results
• The algorithms used in TDMs help identify patterns in pharmacokinetic (PK) variability by
analyzing data from large studies.
• Factors that can influence the variability include:
• Body size
• Genetic traits
• Medical history
• Diet
• Potential interactions between drugs (including herbal and nutritional supplements)
The Future
• These advancements enhance the effectiveness of TDM by ensuring accurate
measurements and creating a sensitive personalized model or algorithm for each patient.

• They can trach changes in the body caused by drug-drug interactions, and it helps
deepen our understanding of human biology.

• The main challenges remain the lack of standardized practices and the need to validate
these technologies.
Sources:

Ates, H Ceren, et al. “On-Site Therapeutic Drug Monitoring: Trends in Biotechnology.” Trends in
Biotechnology, Nov. 2020, www.cell.com/trends/biotechnology/fulltext/S0167-7799(20)30061-
5.
Gozzo, Lucia, et al. “Bioequivalence, Drugs with Narrow Therapeutic Index and the Phenomenon of
Biocreep: A Critical Analysis of the System for Generic Substitution.” Healthcare (Basel,
Switzerland), U.S. National Library of Medicine, July 2022,
pubmed.ncbi.nlm.nih.gov/35893214/.
Liang, Winnie S., et al. “Emerging Therapeutic Drug Monitoring Technologies: Considerations and
Opportunities in Precision Medicine.” Frontiers, Frontiers, 27 Feb. 2024,
www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1348112/full.
Routis, Elizabeth. “Pharmacological Considerations with Targeted Medicines.” PharmaLex,
PharmaLex, 27 Aug. 2024, www.pharmalex.com/thought-leadership/blogs/targeted-
medicines-enhancing-efficacy-safety-and-regulatory-success/.

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