Evidence-Based Medicine and Therapeutic Drug Monitoring

Flashcards covering key terminology, evidence levels, PICO structure, and principles of therapeutic drug monitoring from the FCM 435-2 lectures by Prof Idenfor.

Evidence-Based Medicine (EBM)

The integration of the best research evidence with clinical expertise and patient values.

Three Pillars of E.B.M

The foundational components of E.B.M, described as a three-legged stool: Best available evidence, Clinical expertise, and Patient values & preferences.

5 As of E-BM

The process for applying E-BM in practice: Assess (the patient), Ask (well-built clinical questions), Acquire (the evidence), Appraise (the evidence applicability), and Apply (the evidence to practice).

PICO Model

A framework used to construct a clinical question consisting of Patient ($P$), Intervention ($I$), Comparison ($C$), and Outcome ($O$).

Level 1 Evidence

The highest level of evidence, consisting of systematic reviews or literature meta-analysis.

Level 2 Evidence

Evidence obtained from cohort studies.

Level 3 Evidence

Evidence obtained from case control studies.

Level 4 Evidence

Evidence obtained from case series.

Level 5 Evidence

The lowest level of evidence, based on expert opinion.

Grade A Recommendation

A recommendation supported by good research-based evidence.

Grade B Recommendation

A recommendation supported by fair research-based evidence.

Grade C Recommendation

A recommendation based on expert opinion and panel consensus.

Grade X Recommendation

A recommendation grade indicating evidence of harm from intervention or infection.

Therapeutic Drug Monitoring (TDM)

The clinical practice of measuring drug concentration in biological fluids to optimize drug therapy and individualize dosing regimens.

Narrow Therapeutic Index (T-I)

A drug characteristic where small differences in concentration separate toxic from therapeutic effects, requiring therapeutic drug monitoring.

Loading Dose ($D_L$)

A calculated initial drug dose defined by the formula $D_L = \text{target conc.} \times V_d$.

Peak Concentration

The parameter representing the maximum concentration of a drug in the plasma.

Trough Concentration

The minimum drug concentration in plasma, measured from a blood sample drawn just before the next dose ($30\,\text{mins}$ before trough).

International Normalized Ratio (INR)

A laboratory measurement used to monitor Warfarin and other anticoagulants rather than direct drug plasma concentration monitoring.

Five Key Pharmacokinetic Parameters in TDM

The five primary parameters evaluated in TDM: Bioavailability, volume of distribution ($V_d$), clearance ($CL$), half-life ($t_{1/2}$), and protein binding of drugs.