TDM = Therapeutic Drug Monitoring.
To put it simply, TDM is the monitoring of drug levels in the bloodstream so that it is maintained at the effective concentration - neither subtherapeutic nor toxic. If you want to know more click here.
Pharmacokinetics knowledge is thus very, VERY important in TDM, which is the reason why I was so nervous when I first started TDM attachment at Hospital Seberang Jaya (HSJ). HBM does not have a TDM department, no surprise there, so I have to go all the way to HSJ from BM which takes around 30 minutes in the morning due to bad traffic. I'm really, really bad at pharmacokinetics back in university, so I was nervous of the 4 weeks attachment.
Surprise, surprise, it was not as difficult as I thought! The calculations are (ehem) pretty simple once you understand them. I guess I never really bothered to seriously study them before, which is why I was really "blur" with all those calculations. It was a miracle that I passed the degree exam, Alhamdulillah. The TDM boss in HSJ is nice. Thanks to her, I will consider to apply for TDM after completing my PRP year.
To fellow PRPs who have yet to attach for TDM, do study the calculations for aminoglycosides, vancomycin, digoxin, theophylline and phenytoin as these were among the most common drugs monitored. Note: renal adjustment, correction for hypoalbuminaemia...anddd who am I kidding? You guys are way better at pharmacokinetics than I am. Haha. TDM is not all about the levels and calculations though. It is better if you have had your clinical attachment beforehand since you will then be more familiar with patient's condition when monitoring. I had a difficult time when monitoring patients' conditions with the little clinical experience that I have. Note: indications and dosing regime for antibiotics, drug interactions which may affect the measured levels, signs and symptoms of toxicity...etc.
I will end this post with a quote from my TDM boss,
"Treat the patients, not the levels!" - Ms Ooi
Told you this is boring.
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