Therapeutic drug monitoring and toxicology

Details

Title

Therapeutic drug monitoring and toxicology

Type

Stage Two

Module code

HLS141

Requirement

Compulsory

Module objective

By the end of the training period trainees will, in respect of competencies in the clinical biochemistry of therapeutic drug monitoring and toxicology, be able to:

• analyse, synthesise, evaluate and apply knowledge
• perform a range of technical and clinical skills and procedures
• demonstrate the attitudes and behaviours necessary for professional practice as a consultant clinical scientist dealing with the complexities, uncertainties and tensions of professional practice at this level.

Knowledge and understanding

By the end of the training period the trainee will be able to demonstrate the ability to analyse, evaluate and synthesise relevant knowledge and its application to their professional practice in relation to:

• the basic principles of pharmacokinetics including absorption, distribution, metabolism and excretion. Explain in the context of TDM the impact that diseases of the GI tract, liver and kidneys may have on drug metabolism
• the toxic effects of drugs and how they arise, including drugs commonly used for control of blood pressure, such as diuretics, ACE inhibitors and angiotensin receptor blockers
• the general principles of pharmacogenomics in the context of TDM and toxicology and how the clinical biochemistry laboratory can support more effective treatment.
• the clinical benefits of therapeutically monitored drugs, their potential side effects and the rationale for concentration monitoring of commonly requested drugs and their metabolites including digoxin, lithium, anti-epileptics, theophylline, caffeine, methotrexate, immunosuppressives and antibiotics
• the metabolic effects of ethanol
• the laboratory investigation of a patient who has taken an overdose and in particular the laboratory analysis of salicylate, paracetamol, and other drugs
• the support that clinical biochemistry may offer to drug addiction services including compliance testing for methadone treatment and the testing of commonly abused drugs such as opiates, amphetamine, methylenedioxy-methamphetamine (MDMA), benzodiazepines, cocaine
• the principles of laboratory testing related to the poisoned patient such as assessment of carbon monoxide exposure and analysis of paraquat, iron, ethylene glycol, methanol, organophosphate compounds, lead, mercury, aluminium
• the laboratory investigation of the unconscious patient
• the principles of analytical techniques used for TDM and toxicology, including spectrophotometry, immunoassay, GC, HPLC and mass spectrometry
• the advantages and disadvantages of different analytical techniques for the analysis of both therapeutic and abused drugs
• the legal framework for screening for drugs, including pre-employment screening, industrial health screening and drugs of abuse screening
• the principles and legal implications of specimen collection, chain of custody, release of results and employer responsibilities related to drugs of abuse screening and forensic science
• the requirements associated with storage and security of drugs
• the requirements to confirm drug screening results with techniques with superior methods that are based on different analytical principles
• the relative benefits of different sample materials including blood, urine, saliva and hair in toxicological investigationsthe principles and legal implications of specimen collection, chain of custody, release of results and employer responsibilities related to drugs of abuse screening and forensic science
• how to investigate post-mortem toxicology cases.

Technical and clinical skills

By the end of the training period the trainee will be able to demonstrate a critical understanding of current relevant research, theory and knowledge and its application to the performance of the following technical procedures and laboratory skills:

• the sample types and sampling requirements for TDM including factors that may lead to variation in circulating concentrations relative to half-life, dosage, the effect of changing dose, and the use of peak/trough levels
• the biochemical assessment of a patient who has taken an overdose or who has been exposed to a poison
• factors that affect drug action or metabolism
• appropriate investigations to ascertain the cause of death in post-mortem analysis
• interactions with the police and the coroner with respect to due process in the investigation of death

By the end of the training period trainees will, in respect of the competencies in the clinical biochemistry of therapeutic drug monitoring and toxicology, be able to perform the clinical skills necessary to manage under supervision:

• liaison with clinical teams on strategies for therapeutic drug monitoring
• liaison with clinical teams on the laboratory support and advice offered to support the management of the patients who may have overdosed or who may be unconscious due to an unknown cause.
• liaison with drug rehabilitation teams, the forensic service and the police in the context of drug abuse to manage both the clinical and legal aspects
• to advise and support coroner work in the investigations of suspicious deaths.