Optimum Use of Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics in the NICU.
Therapeutic drug monitoring is increasingly giving way to dosing drugs based on population-based pharmacokinetic parameters, even when pharmacokinetic values vary quite a bit in individual patients. Further, drug concentrations are often considered appropriate if they are within a defined therapeutic range, even if the patient response is suboptimal. This lecture discusses the limitations of therapeutic ranges in neonates, and proposes greater emphasis on pharmacodynamic curves to individualize drug therapy. Examples are provided using methylxanthines, indomethacin, antiepileptic drugs and aminoglycosides. The potential to use pharmacokinetic findings to describe physiologic changes and occasionally assist with diagnosis is also discussed.
Graduate Pharmacy Education, Greensboro Area Health Education Center; UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina; Neonatal Pharmacotherapy Fellowship and Neonatal Pharmacology Research Laboratory, Women's Hospital, Moses Cone Health System, Greensboro, North Carolina.
Peter
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Gal