Tuesday, November 13, 2012

PRP Week 4 - Therapeutic Drug Monitoring (TDM)

Assalamualaikum peeps! How are you today? Feeling good and healthy? Alhamdulillah.. Currently, there's a few of my friends getting sick lately so please take care of yourself okay.. Live healthy, stay healthy, eat healthily.. :)

So, my second station for my PRP training is therapeutic drug monitoring (TDM) or clinical pharmacokinetic as the logbook refers as. Under this rotation, I will be doing calculations, a lot of them. We have learned this calculations back in school, thus this is just kinda revision for me. However, I still need to refer to the notes as I might make mistakes if not doing so. In TDM, everything must be perfect, the calculations must be always right. Any small mistakes might lead the patients into harm. Serammmm..

However, there are not so many drugs that we need to calculate the TDM, only few of them such as aminoglycoside antibiotics (gentamicin & amikacin), vancomycin and some antiepileptics such as valproic acid, phenytoin and carbamazepine. Other than that are, digoxin tacrolimus and cyclosporin. Every day, in the morning I will clerk some TDM cases with Steven and also do some ward rounds. Then the TDM results will always come out at noon. The results came from the lab into our system. 

We will start calculating all those stuffs we learned previously like ke, t1/2 (half life), Vd, Cmax and Cmin. Calculations for different class of drugs are different. We also need to know about the therapeutic range and from these we can determine how safe the drug levels are. If the level is subtherapeutic, then we will probably increase the dose after discussing with the ward pharmacists. If the level is higher than the range, than we need to withhold the dose and restart back with a lower dose. Finally, we will write comments in the pharmacist clinical notes before informing the doctor/house officer/staff nurse about the change in the drug regime. 

Since the lab love to release the result in the evening (like after 4 pm) so mostly the TDM pharmacist will stay back and go back home late. If there are a lot of case, we normally go back at 8pm or so. Kesian sangat.. huhuhu.. Steven said that on the first day, he went back at 11 pm. Oh goshhhhh.. =.=

This week is my final week with Steven. The next following two weeks I will be alone in TDM department. Sedih.. Lol


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