What is the work here?
- Some drugs need their blood concentrations to be kept within very narrow limits. Too low a level and the drug will not function properly but at too high a level the patient can get side effects. In the Unit we give the patients education about the test. An appointment will be made and they will then come to the Unit where we will take all the necessary details. A blood specimen will be taken BEFORE the patient takes their medicine for that day. For some tests the blood must be taken many times in the day. This means that some patients need to spend many hours in the Unit.
- Sometimes it is not the drug concentration that needs to be measured but the activity of an enzyme (eg thiopurine methyl transferase) that is involved in how the body deals with the drug once the medicine is taken. If the enzyme activity is too low then the dose of the drug should be less or perhaps the patient cannot be prescribed the drug and an alternative drug should be given. If the enzyme activity is high then the patient may need to start at a higher dose.
- Testing for a disorder of metabolism is important as the food that we eat is basically made up of three groups: Carbohydrates, proteins and fats. In very few babies an enzyme (needed for breaking down of the food) is missing and this means that the body cannot deal with one of the main groups. If the test is not done soon after the baby is born and the enzyme problem is not detected, when the baby becomes sick, he/she may be left with severe damage of the nervous system causing physical, mental and learning disability. If the test is performed early in life, before the toxins have started to cause damage to the various systems, then there are things that can be done to help the baby grow and live a normal life or minimize the damage of the disease.
- Patients on antibiotics are followed up after measurement of drug concentrations and clinical support on decisions are given related to antibiotic dose adjustments especially in the critical care units in the hospital.
What areas do we focus on?
Therapeutic Drug Monitoring (TDM)
The Clinical Pharmacology Unit measures the concentration of drugs in the blood, this is called therapeutic drug monitoring or TDM. TDM is of vital importance in the case of drugs where there are no biomarkers to predict clinical outcome or side effects. This means that for some people a dose will produce such low concentrations as to have no benefit and for other patients the same dose or even a lower dose will be toxic to their bodies.
Monitoring for patient safety with visit to the wards and ICU’s, causality analysis and collating reports for analysis.
Medicine use audits
This is being done in collaboration with the Pharmacy services.
Audits are done within the hospital where prescriptions are audited for drug interactions.
Serious Adverse Events monitoring
All serious adverse events related to clinical trials (both, international Pharmaceutical trials and in house clinical trials) are send to the Unit where they are collated, trends are looked at and it is reported to the Ethics committee