Therapeutic Drug Monitoring
Definition, indications, sampling strategy, interpretation, dose-regimen math and drug-specific applications — RGUHS-mapped LAQ for MD Pharmacology
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Introduction & PK-PD basis
- Definition — Therapeutic drug monitoring (TDM) = use of validated assay procedures to measure plasma/serum drug concentrations and apply the result to individualise dosing so that exposure stays within a population-derived therapeutic range linked to efficacy and acceptable toxicity.
- Distinct from — Pharmacokinetics (time course of ADME) and pharmacodynamics (concentration → effect at the receptor); TDM is the bedside application that links the two.
- Kinetic homogeneity — Predictable equilibrium between plasma concentration and concentration at the inaccessible receptor site — the foundational assumption that lets a venous blood sample stand in for the receptor pool.
- Therapeutic range — Probabilistic band bounded below by the minimum effective concentration (MEC) and above by the minimum toxic concentration (MTC); a grey overlap zone exists for every drug — ranges are population averages, never absolute boundaries.
- Therapeutic index (TI) — MTC / MEC ratio; TDM is most useful when TI is narrow (synonyms in current literature: narrow-therapeutic-index [NTI] drug, critical-dose drug).
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Therapeutic Drug Monitoring
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