CAP Pro Course - Chemistry - Therapeutic Drug Monitoring

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Author: Kevin F. Foley PhD, DABCC, MT, SC
Reviewers: DeRhonda Crawford, MT(ASCP); Laurie Bjerklie, MA, MLS(ASCP)CM

Continuing Education Credits

Objectives

  • Define therapeutic drug monitoring (TDM) and compare and contrast it with drugs of abuse testing.
  • Identify categories of therapeutic drugs that are frequently monitored in clinical settings.
  • Describe the different stages of drug disposition over time and list factors that can influence drug distribution.
  • Describe what is meant by a drug's half-life and how this relates to peak and trough concentrations in the serum.
  • Discuss criteria for reporting TDM results, including documentation of drug administration information, when appropriate, and critical result reporting.

Course Outline

  • Define therapeutic drug monitoring and compare and contrast it with drugs of abuse testing.
      • What is Therapeutic Drug Monitoring?
      • How is Therapeutic Drug Monitoring Used?
      • Which of the following is not correct concerning therapeutic drug monitoring (TDM) and urine drugs of abuse screening (DOA)?
      • A physician calls the laboratory and asks to run a digoxin level on a urine specimen. How should you proceed?
      • In which of the following scenarios is therapeutic drug monitoring (TDM) not useful?
      • Which one of the following is true of therapeutic drug monitoring (TDM)?
  • Identify categories of therapeutic drugs that are frequently monitored in clinical settings.
      • Types of Drugs That Are Monitored
      • Drugs Measured with Therapeutic Drug Monitoring (TDM)
      • Categories of Therapeutic Drugs Commonly Monitored by TDM
      • Some Common Therapeutic Drugs monitored by TDM
      • Miscellaneous Therapeutic Drugs
      • You are tasked with building a new clinical laboratory in a newly-constructed community hospital. Which of the following drugs is least likely to be n...
      • A laboratory receives an order for a serum caffeine level. Which of the following is likely?
      • A nurse calls the laboratory and asks to have a quantitative acetaminophen level measured. Which of the following is not an appropriate response?
      • Which of the following are classes of drugs not commonly measured with TDM?
  • Describe the different stages of drug disposition over time and list factors that can influence drug distribution.
      • Absorption, Distribution, Metabolism, and Excretion (ADME)
      • ADME continued
      • Routes of Administration
      • Establishing and Maintaining a Therapeutic Range
      • Other Factors That Affect Drug Disposition
      • A laboratorian is running samples for serum tobramycin levels just delivered by a nurse. The nurse states that both patients received the same injecte...
      • A tacrolimus level from a transplant patient is sent to your laboratory. The result obtained is below detectable limits. The surgeon calls the laborat...
      • Which of the following drugs would one expect to see on their laboratory's TDM testing menu and is also highly protein-bound?
      • Which of the following refers to ADME?
  • Describe what is meant by a drug's half-life and how this relates to peak and trough concentrations in the serum.
      • Acceptable Sample Types
      • Sample Collection Times
      • Laboratory Methods for Therapeutic Drug Monitoring (TDM)
      • Which of the following collection tubes is most common for TDM tests?
      • Which of the following is the correct explanation of when to collect a trough specimen for TDM?
      • A drug is administered using an already-placed IV line and a peak drug level is ordered. At which time should the laboratory draw the sample?
      • A phlebotomist mistakenly collects several TDM specimens using a serum-separator tube. Why is this a problem?
      • A medical laboratory scientist obtains a serum lithium result of 15.9 mmol/L (reference range: 0.4 - 0.8 mmol/L) from a normal-appearing psychiatric p...
      • Which of the following is not commonly used to measure therapeutic drug concentrations?
  • Discuss criteria for reporting TDM results, including documentation of drug administration information, when appropriate, and critical result reporting.
      • Clinical Interpretation of TDM Results
      • Critical Values
      • Will Pharmacogenomics Replace Therapeutic Drug Monitoring (TDM)?
      • A colleague explains that they no longer need INR testing to measure their coumadin response since they have recently received pharmacogenomic testing...
      • A laboratorian receives a call from a pharmacist who is concerned that a patient had a vancomycin level of 43 µg/mL and the pharmacy was not noti...
      • A laboratory performs a tacrolimus test and obtains a result of 34 ng/mL. The critical threshold defined for their laboratory is > 20.0 ng/mL. What...
      • A physician orders TDM for a patient starting phenytoin. The patient comes to the laboratory after having had their first oral dose 30 minutes ago. Th...
      • A specimen has been ordered for 'serum peak gentamicin.' The specimen is being collected by the laboratory. Which of the following is true?
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: This program is designed as an educational and training tool for MLS, MT, and MLT personnel, medical laboratory science students and interns, pathology residents, and practicing pathologists.
Author: Kevin F. Foley, PhD, DABCC, MT, SC is the director of clinical pathology for the Kaiser Permanente Northwest region. He also teaches clinical chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at East Carolina School of Medicine in North Carolina. He recieved a PhD in clinical pharmacology and toxicology from Brody School of Medicine, Greenville, NC. He has been working in laboratory medicine for over 15 years, starting his career as a medical technologist.
Reviewer Information: DeRhonda Crawford, MT(ASCP) is the chemistry supervisor at Gwinnett Medical Center in Lawrenceville, Georgia and the technical supervisor for the Gwinnett Medical Center in Duluth, Georgia. She holds a BS in Medical Technology from the Medical College of Georgia.
Reviewer Information: Laurie Bjerklie, M.A., MLS(ASCP)CM is currently a Content Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 14 years of experience in higher education and has held faculty positions in both MLT and MLS programs. She most recently served as the Program Manager of Medical Laboratory Science at Saint Louis University.

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