Home > Clinical Pharmacokinetics & Pharmacodynamics
Clinical Pharmacokinetics & Pharmacodynamics
Welcome to the pharmacokinetics and pharmacodynamics category for pharmacists. This clinical pharmacy category contains links to resources on drug dosing in renal and liver disease, pharmacokinetic calculations, TDM (therapeutic drug monitoring) and more.
electronic Medicines Compendium (eMC)
Summaries of Product Characteristics (SPCs)
The SPC is used by healthcare professionals, such as doctors, nurses and pharmacists, and explains how to use and prescribe a medicine.
 Source: medicines.org.uk |
| Clinical Resource: Summaries of Product Characteristics (SPCs) |
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The site has been designed to increase understanding of important and sometimes difficult concepts and principles in Clinical Pharmacology.
The site is for any student or practitioner requiring Clinical Pharmacology knowledge, e.g. undergraduate and post-graduate students in medicine, pharmacy and pharmacology. A basic understanding of physiology and pharmacology is assumed.
Tutorials
Drug Clearance
Drug Elimination
Volume of Distribution
The Half-Life
Dosing Variations
Oral Availability
Pharmacodynamics
Pharmacogenetics
Saturable Drug Metabolism
Protein Binding
PH and Pharmacokinetics
Dosing and Age
Drugs in Pregnancy
Drug Interactions
Drug Transport
Graph Plotter
| Source: icp.org.nz |
| Clinical Resource: CE / CPD / Learning |
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The Merck Manual for Health Care Professionals
Pharmacokinetics
Topics in Pharmacokinetics
- Overview of Pharmacokinetics
- Drug Absorption
- Drug Bioavailability
- Drug Distribution to Tissues
- Drug Metabolism
- Drug Excretion
| Source: merckmanuals.com |
| Clinical Resource: Manual |
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The University of Nottingham
Reusable Learning Objects (RLOs)
RLOs are small, 'bite-sized' chunks of e-learning focussing on a particular narrow topic, containing typically 15-30 minutes of learning material.
RLOs
Introduction to the concept of the bioavailability of drugs.
Examines some of the factors which affect total body clearance of a drug and how this, in turn, influences a drug's clinical impact.
To understand the half-life of drugs and its relationship with volume of distribution and clearance.
Provides a definition of clearance and a basic explanation of the processes
Examines how the absorbtion and distribution of aminoglycosides within the body affects the dosing regimens used.
Examing the role of plasma proteins in the blood in the distribution and elimination of drugs in the body.
The role of the kidneys in the excretion of drugs.
The role of the liver in the metabolism of drugs.
Description of first pass metabolism of orally-administered drugs in the liver and gastrointestinal tract
Explains the pharmacological concept of Volume of Distribution, and how it is calculated.
| Source: nottingham.ac.uk |
| Clinical Resource: CE / CPD / Learning |
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Pharmacokinetics and Pharmacodynamics - the basics
By the end of this session, you should be able to:
- Define pharmacodynamics and the four basic processes involved in pharmacokinetics
- Define parameters which can affect
- Drug absorption
- Drug distribution
- Drug metabolism
- Drug excretion
- Understand the concept of agonist and antagonist
- Define bioavailability, half life and therapeutic index and
describe the relevance of these to drug action
| Source: associationforprescribers.org.uk |
| Clinical Resource: Notes |
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In the first article in a series intended to remind pharmacists about the basic principles of pharmacokinetics, pharmacodynamics and therapeutic drug monitoring, Alison Thomson describes the principal pharmacokinetic parameters
In the second article in a series intended to remind pharmacists about the basic principles of pharmacokinetics, pharmacodynamics and therapeutic drug monitoring, Alison Thomson describes inter-individual variability issues that should be considered when recommending a dosage regimen
In this third article in our back to basics series on pharmacokinetics, Alison Thomson gives an overview of the factors that make therapeutic drug monitoring necessary and looks at some of the groups of drugs where monitoring is often needed
In this final article in our back to basics series on pharmacokinetics, Alison Thomson uses two case studies to describe approaches that can be taken to design drug dosage regimens to achieve target concentrations in individual patients
| Source: pharmaceutical-journal.com |
| Clinical Resource: Journal Articles |
| Register to Access Content: Yes - content available to members of the RPS and paid subscribers |
Table of Contents
Pharmacokinetic definitions and principles
Aminoglycoside overview
Extended-interval (Once daily) aminoglycoside dosing
Aminoglycoside pharmacokinetic calculations
Aminoglycoside dosing in patients with cystic fibrosis
Vancomycin overview and pharmacokinetic calculations
Clinical Pearls
Dialysis – Aminoglycosides and Vancomycin
TNMC Nephrology Protocol for Vancomycin Dosing
Clinical Pharmacokinetic Consult Service
| Source: nebraskamed.com |
| Clinical Resource: Training Packet |
| Register to Access Content: No |
Half Life
Calculate the half-life of a drug from two plasma levels separated by a time interval.
| Source: weill.cornell.edu |
| Clinical Resource: Calculator |
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Table of Contents
List of Monitorable Drugs and Therapeutic Ranges
Basic Pharmacokinetic Concepts
Guidelines for Pharmacokinetic Monitoring
General Equations for BSA, IBW, and Clcr
Monitorable Drugs
| Source: hosp.uky.edu/pharmacy |
| Clinical Resource: Manual |
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TDM kinetics
Carbamazepine
Digoxin
Ethosuximide
Phenobarbital
Primidone
Phenytoin
Theophylline
Valproic acid
| Source: pathology.leedsth.nhs.uk |
| Clinical Resource: Table |
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Pharmacokinetics and Metabolic Drug Interactions
Pharmacokinetics and drug metabolism play an important role as determinants of in vivo drug action. The CYP450 enzyme family plays a determinant role in the biotransformation of a vast number of structurally diverse drugs. Many drug interactions are a result of the inhibition or induction of CYP enzymes. The non-compartmental pharmacokinetic analysis is the most used method for analyzing data from a drug interaction study. Compartmental analysis can be also useful and sometimes more informative than non-compartmental analysis. Many efforts to reduce polypharmacy are important, and pharmacokinetic tools used to study the mechanism of drug-drug interactions may help
in a better management of pharmacotherapy including the avoidance of clinically relevant drug interactions.
| Source: benthamscience.com |
| Clinical Resource: Journal Article |
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Welcome to the official database of the IUPHAR Committee on Receptor Nomenclature and Drug Classification.
Detailed, peer-reviewed pharmacological, functional and pathophysiological information on human, mouse and rat G Protein-Coupled Receptors, Voltage- and Ligand-Gated Ion Channels, Nuclear Hormone Receptors and selected Enzymes, including all Protein Kinases.
| Source: iuphar-db.org |
| Clinical Resource: Database |
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This is part 1 of a two-article series that is aimed to address how pharmacotherapy is affected by bariatric surgery. The current article is aimed to provide a detailed review of process and factors that affect drug absorption from the gastrointestinal tract. The discussion may help clinicians better predict how bariatric procedures may affect oral drug absorption and pharmacotherapy.
Drug Therapy-Related Issues in Patients Who Received Bariatric Surgery (Part II)
This is part 2 of a two-article series that is aimed to address how pharmacotherapy is
affected by bariatric surgery. The focus of this article is to review how each of the established bariatric procedures can affect pharmacokinetics based on information available
in the literature. Other pertinent pharmacotherapy-related issues in patients with bariatric surgery, such as the risk of pill esophagitis, hormonal contraception, anticoagulant therapy, will be also addressed.
| Source: virginia.edu |
| Clinical Resource: Journal Articles |
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LIVERTOX is a freely available website that provides up-to-date, comprehensive and unbiased information about drug induced liver injury caused by prescription and nonprescription drugs, herbals and dietary supplements.
LiverTox is a joint effort of the Liver Disease Research Branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Division of Specialized Information Services of the National Library of Medicine (NLM), National Institutes of Health.
| Source: nih.gov |
| Clinical Resource: Database |
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Frequently Asked Questions About GFR Estimates
Provides concise and direct answers to 23 frequently asked patient questions chosen by physicians about the use of glomerular filtration rate (GFR) in the evaluation of kidney function. Includes several related tables and graphs.
| Source: kidney.org |
| Clinical Resource: Frequently Asked Questions |
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Drug Dosage Adjustments in Chronic Kidney Disease: The Pharmacist’s Role
An important issue in drug therapy is dosage adjustment in chronic kidney disease (CKD). Many drugs need to be adjusted depending on a person’s kidney function; it is the pharmacist’s duty to ensure a patient is taking the optimal dose.
| Source: usask.ca |
| Clinical Resource: Drug Information Service Newsletter |
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Dosing recommendations are based on creatinine clearance calculated using the Cockcroft-Gault equation.
Click on the antibiotic for details of each dose adjustment
| Source: gloshospitals.nhs.uk |
| Clinical Resource: Database |
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Adult Anti-Infective Dosing Guidelines 2011-2012
NewYork-Presbyterian Hospital
Recommendations for Vancomycin and Aminoglycoside Dosing
Recommendations for Dose Adjustment in Patients With Renal Dysfunction
| Source: cumc.columbia.edu |
| Clinical Resource: Guideline |
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The ‘Pharmacokinetics’ course describes the basic ways in which drugs work as a foundation to studying applied pharmacology in pain.
Learning Materials
How Drugs Work
Pharmacokinetics: Absorption and Distribution
Pharmacokinetics: Metabolism and Excretion
| Source: paincommunitycentre.org |
| Clinical Resource: CPD / CE / CME / Learning |
| Register to Access Content: Yes - registration is FREE to healthcare professionals |
Therapeutic drug monitoring
Therapeutic drug monitoring refers to the individualisation of dosage by maintaining plasma or blood drug concentrations within a target range (therapeutic range, therapeutic window). There are two major sources of variability between individual patients in drug response.
| Source: nps.org.au |
| Clinical Resource: Journal Article |
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ABC of Monitoring Drug Therapy
In this article we apply to digoxin the criteria which must be fulfilled in part or in full before the measurement of its plasma concentration can be considered worth while.
In this article we apply to phenytoin the criteria that must be fulfilled in part or in full before the measurement of its plasma concentration can be considered worth while.
In this article we apply to lithium the criteria which must be fulfilled in part or in full before measurement of its plasma concentration can be considered worth while.
In this article we apply to theophylline the criteria that must be fulfilled in part or in full before the measurement of its plasma concentration can be considered worth while.
In this article we apply to aminoglycosides the criteria which must be fulfilled in part or in full before the measurement of their plasma concentrations can be considered worth while.
Monitoring whole blood concentrations of cyclosporin is an important part of treatment since its toxic:therapeutic ratio is very low. Also, the variable pharmacokinetics of cyclosporin among patients make accurate prediction of the initial dosage difficult. This variability results from differences in the drug's absorption, distribution, and clearance.
When the criteria are not rigorously met the regular use of plasma drug concentration measurements is hard to justify. None the less, measurements are sometimes made for other drugs, including anticonvulsants such as carbamazepine and ethosuximide; antiarrhythmic drugs; tricyclic antidepressants; and methotrexate.
| Source: europepmc.org |
| Clinical Resource: Journal Articles |
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Therapeutic drug monitoring | Epilepsy Society
Monitoring drug concentrations
When should drug concentrations be monitored?
Sample type
In most clinical settings the measurement of total serum concentrations will suffice and indeed most routine methods for measuring AEDs in sera do not discriminate between the component of drug that is free (unbound) and that that is bound to serum proteins.
| Source: epilepsysociety.org.uk |
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Digoxin - Loading Dose Guide (Adults)
The intravenous route should be reserved for use in patients requiring urgent digitalisation for supraventricular arrhythmias
| Source: icid.salisbury.nhs.uk |
| Clinical Resource: Guidance |
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How is an intravenous aminophylline dose converted to an oral aminophylline or theophylline dose?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
When changing a patient’s therapy from IV aminophylline to oral therapy with either theophylline or aminophylline, the bioavailability and the salt equivalence should be considered.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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Welcome to WarfarinDosing.org, a free Web site to help doctors and other clinicians begin warfarin therapy by estimating the therapeutic dose in patients new to warfarin. This site is supported by the Barnes-Jewish Hospital at Washington University Medical Center, the NIH, and donations. Estimates are based on clinical factors and (when available) genotypes of two genes: cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1).
Recommendations on this Web site are based on data from over 1000 patients.Once information is entered onto the next page, the initial estimate of therapeutic dose explains 53% of the variability in a warfarin dose. If you return to the Web site and enter an INR value after 3 and/or 4 warfarin doses, the dose refinement is even more accurate.
| Source: warfarindosing.org |
| Clinical Resource: Calculator |
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Antimicrobial Therapeutic Level Monitoring & Dosing Guidelines
East Kent Hospitals University NHS Foundation Trust
Aminoglycosides:
- Gentamicin
- Amikacin
- Tobramycin
Glycopeptides:
Antifungals:
- Flucytosine
- Itraconazole
- Voriconazole
- Posaconazole
| Source: ekhuft.nhs.uk |
| Clinical Resource: Guidelines |
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Aminoglycoside antibiotics have limited tissue distribution, are dependent on renal elimination, and have a narrow therapeutic index. Thus, careful selection of empiric dosing regimens and serum level monitoring are needed to ensure safety and efficacy of these drugs.
There are several approaches to dosing aminoglycosides:
High-Dose, Extended-Interval Dosing (“Once Daily”)
Multiple-Daily Dosing (“Traditional”)
Gram-Postive Combination Dosing (“Synergy”)
| Source: idmp.ucsf.edu |
| Clinical Resource: Recommendations |
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