FARMAKOLOGI

KLINIK

Rahmatini
Bagian Farmakologi & Terapi
Fakultas Kedokteran Universitas
Andalas

WHO ( 1988)

Disiplin dalam bidang

kedokteran berdasarkan
prinsip ilmiah, menyatukan
keahlian farmakologi &
keahlian klinik dengan tujuan
meningkatkan manfaat &
keamanan obat

TUJUAN
FARMAKOLOGI KLINIK

Terapi Efektif, Aman , Rasional

RATIONAL DRUG USE

Ratio

Benefit Risk - Cost

F.Kinetika

F Dinamika

F Ekonomi

PHARMACOLOGICAL ASPECTS
IN CLINICAL PRACTICE
Pharmacokinetic

Pharmacodynamic

How drugs act

The dynamics of drug conc. in
the body

* Absorption / bioavailability
* Distribution
* Biotransformation
* Excretion

THERAPEUTIC DRUG
MONITORING (TDM)

Measuring the plasma drug conc.

Provide useful information about

the adequacy of the dosage
regimen or the likehood toxicity

Therapeutic Drug Monitoring (TDM)

Ph dynamic

Ph kinetic
Druginteraction
Measuring/
interpreting
plasma drug conc.

Therapeutic
response
Side effects
Toxic effects

Time-drug conc. relationship

Drug conc. (mg/l)

40

30

Drug toxicity

20

Therapeutic level
10

m.e.c

Low therapy
1

Time (hour)

Therapeutic Drug Monitoring (TDM)

1. Narrow margin of safety drugs

2. Drugs for prevention/ therapy of life threatening
diseases or life saving drugs
3. Difficulty in ditinguishing between the effects
of a disease and the toxic effects of a drug
4. Potent drugs drug amount is very small
5. Drugs that show variability of drug conc.
in plasma

Factors that modify drug plasma

concentration for a given dose

Drug formulation
Drug interaction
Environmental factors
Genetic variation
Renal and hepatic function

Reasons for monitoring

drug treatment

1. To see whether there is

therapeutic response
2. To assess drug toxicity
3. To assess compliance

DRUG

THERAPEUTIC
TOXIC

DIGOXIN
DIPHENYLHI
DANTOIN
LIDOCAIN
PHENOBARBITA
L
THEOPHYLINE

0,0010-0,0022
g/ml
10- 20
1,5-5
15-30
10-20

> 0,0025
> 25
>9
> 40
> 20

Examples of difficulty in ditinguishing between

the effects of a disease and
the toxic effects of a drug
1.

Digoxin toxicity

Congest.Heart Failure

Nausea / anorexia / arrythmias

2.

Gentamycin toxicity

Gram () septicaemia

Renal damage

Drugs- plasma conc.

Pharmacokinetic parameters
Cmax (peak)

Half life
AUC 24
Time

Cmin
(trough)

Visualisation of half-life
Drug conc. (mg/l)

First order elimination of a drug (t : 2 hours)

20

10

The plasma conc. falls by half each half-life

5
2.5
2

Hours

Clinical application of half life (t)

* Designing drug dosage regimen

* Determining time to reach steady state
drug level which show clinical effect
* Determining time to reach the drug level
which have no clinical effect anymore

CONSIDERATION

Phkinetic

Phdynamic

Pheconomic

RATIONAL & GOOD CLINICAL THERAPY

SESUNGGUHNYA BAGIMU,
ADA
MALAIKAT- MALAIKAT YANG
SELALU
MENGAWASI PEKERJAANMU
QS 82 :10