The structure of this book is uniform for each chapter and is derived from my lectures in clinical pharmacokinetics. The introduction, which consists of a brief discussion of the clinical pharmacology and mechanism of action for the drug, is followed by sections that describe the therapeutic concentration range and anticipated adverse effects for the drug as well as a general monitoring scheme for the agent. Clinical monitoring parameters for therapeutic response and toxicity and basic clinical pharmacokinetic parameters for the compound are discussed next. The next sections describe the effects of disease states and conditions on the pharmacokinetics and dosing of the drug, and drug interactions that may occur with concurrent use of other agents. Each chapter concludes with a comprehensive presentation (with examples) of various methods to compute initial drug doses and to modify drug therapy regimens using serum concentrations to adjust doses. All dosing methods used in this text are ones that are published in peer-reviewed literature. Additionally, they are techniques that I have personal clinical experience with and have produced acceptable results in my practice and clinical clerkships. Finally, problems (with solutions) are included for each chapter so that the various dosing methods can be practiced. The problems are made up of brief clinical vignettes which, given a brief background, request that initial doses be computed or that dosage regimens be modified using drug concentrations.
This text is meant to teach clinical pharmacokinetic and therapeutic drug monitoring techniques to all clinical practitioners regardless of professional background. Pharmacists, physicians, nurse practitioners, and physician assistants are among the individuals who could benefit from the text. With the advent of the almost-universal Doctor of Pharmacy degree in colleges of pharmacy, this book could be used in a pharmaceutics, pharmacokinetics, therapeutics, or clinical pharmacy course sequence. It is also possible to use this textbook in a self-directed manner to teach oneself or review important concepts and techniques. Every effort was made to make the chapters "student-friendly." Abbreviations are held to an absolute minimum. When abbreviations are used, they are defined near the place where they are used. Rather than using appendices, important information is repeated in each drug section so that readers do not need to jump from section to section for critical data. Multiple dosage computation and adjustment techniques for each drug, ranging from the simplest to the sophisticated, are presented. The easiest pharmacokinetic equations that produce accurate results are used in each instance.
It is my strong belief that clinical pharmacokinetics cannot be practiced in a vacuum. Individuals interested in using these dosing techniques for their patients must also be excellent clinical practitioners. Although it is true that "kinetics = dose," clinicians must be able to select the best drug therapy among many choices and appropriately monitor patients for therapeutic response, adverse drug effects, potential drug interactions, disease states and conditions that alter drug dosage, and so on. Thus, it is not acceptable to simply suggest a dose and walk away from the patient, satisfied that the job has been done. It is my sincere hope that this book will help clinicians increase their knowledge in the area of therapeutic drug monitoring and improve care to their patients.
Larry A. Bauer, PharmD
May 17, 2014