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Extra info for Primer of Drug Action (12th Edition)

Sample text

Clinically, these factors guide drug therapy when blood levels of the drug are monitored and correlated with therapeutic results. Therapeutic Drug Monitoring Therapeutic drug monitoring (TDM) can aid a clinician in making critical decisions in therapeutic applications. In psychopharmacology, TDM can dramatically improve the prognosis of psychological disorders, making previously difficult-to-treat disorders much more treatable. The basic principle underlying TDM is that a threshold plasma concentration of a drug is needed at the receptor site to initiate and maintain a pharmacological response.

First, it is now becoming apparent that genetic variations may affect how different people respond to medications. Psychogenetic testing allows prescribers to consider genetic information from patients in selecting medications and doses for certain psychiatric disorders. , 2006; deLeon, 2009). , 2009). A simple example may be in order. Genetic DNA testing can now identify how a person may metabolize several drugs of different therapeutic classes, including antidepressants, analgesics, and antipsychotics.

The interdependent variables that determine the ultimate concentration (or steady-state blood level of drug) are the dose (which determines the blood level but not the time to steady state), the dose interval, the half-life of the drug, and other more complex factors that can affect drug elimination. In summary, steady, regular-interval dosing leads to a predictable accumulation, with a steady-state concentration reached after about six 31 32 CHAPTER 1 H O W D R U G S A R E H A N D L E D B Y T H E B O DY half-lives; the magnitude of the concentration is proportional to dose and dosage interval.

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