TDM for Cardiac Medications

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The page below is a sample from the LabCE course Pharmacology in the Clinical Lab: Therapeutic Drug Monitoring and Pharmacogenomics. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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TDM for Cardiac Medications

Inotropics (drugs used to increase the pumping ability of the heart) and antiarrhythmics may need TDM. The cardiac glycoside inotropics digoxin and digitoxin have narrow therapeutic windows. Overdose can cause vomiting, diarrhea, confusion, visual disturbances, and cardiac arryhthmias. A difficulty with these medications is that overdose produces the same symptoms that the drug is used to treat. For example, procainamide is used for arrythmyia, but an overdose of procainamide can produce an arrythmia. Thus, without TDM the physician will not know whether to give more drug or less, since both states can lead to the same presentation.
Examples of cardiac medications that are monitored by TDM include:
  • Digoxin
  • Digitoxin
  • Procainamide
  • N-acetylprocainamide (NAPA) -the metabolite of procainamide
  • Quinidine