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therapeutic drug monitoring
Therapeutic drug monitoring (TDM) is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication concentrations in blood. Its main focus is on drugs with a narrow therapeutic range, i.e. drugs that can easily be under- or overdosed.〔Marshall WJ, Bangert SK. Clinical Chemistry, 6th Edition. Edinburgh, London: Mosby Elsevier. 2008. ISBN 978-0-7234-3455-9〕 TDM aims at improving patient care by individually adjusting the dose of drugs for which clinical experience or clinical trials have shown it improved outcome in the general or special populations. It can be based on ''a priori'' pharmacogenetic, demographic and clinical information, and/or on the ''a posteriori'' measurement of blood concentrations of drugs (pharmacokinetic monitoring) or biological surrogate or end-point markers of effect (pharmacodynamic monitoring).〔IATDMCT Executive Committee. ("Definition of TDM" ), 2004, accessed July 18, 2011.〕
There are numerous variables that influence the interpretation of drug concentration data: time, route and dose of drug given, time of blood sampling, handling and storage conditions, precision and accuracy of the analytical method, validity of pharmacokinetic models and assumptions, co-medications and, last but not least, clinical status of the patient (i.e. disease, renal/hepatic status, biologic tolerance to drug therapy, etc.).〔Burton ME, Shaw LM, Schentag JJ, Evans, WE. Applied Pharmacokinetics & Pharmacodynamics, 4th Edition. Baltimore, Philadelphia: Lippincott Williams & Wilkins. 2006. ISBN 978-0-7817-4431-7〕
Many different professionals (physicians, clinical pharmacologists, clinical pharmacists, nurses, medical laboratory scientists, etc.) are involved with the various elements of drug concentration monitoring, which is a truly multidisciplinary process. Because failure to properly carry out any one of the components can severely affect the usefulness of using drug concentrations to optimize therapy, an organized approach to the overall process is critical.〔Burton ME, Shaw LM, Schentag JJ, Evans, WE. Applied Pharmacokinetics & Pharmacodynamics, 4th Edition. Baltimore, Philadelphia: Lippincott Williams & Wilkins. 2006. ISBN 978-0-7817-4431-7〕
== ''A priori'' therapeutic drug monitoring ==
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