Therapeutic Drug Monitoring (TDM) is an indispensable tool in therapeutic handling and medication safety. A definition of TDM is: "Therapeutic drug monitoring is a system of quality assurance of a drug management system , aiming that the right drug is given to the right patient in the right dose in order to obtain the right effect." TDM is especially applied for drugs with a narrow therapeutic window, or when no direct pharmacodynamic parameter can be found to titrate the dose to the desired level. Sometimes even a dose advice is required before blood levels are drawn. TDM is supported very often by computer modeling and computer calculation. A few programs are available to do these dose calculations but TDM is more than calculus. Besides a vision on the application of TDM a pharmacist should also possess the skills to make a well founded dose advice. This workshop will provide the knowledge about the principles of TDM, give information about the mathematical background of the calculations, like MAP Bayesian adaptive control. The participants will learn to use a user-friendly program, MW/PHARM, that is being used in many hospital pharmacies all over Europe. This workshop will focus on renal impairment. Drugs eliminated by the renal pathway are very sensitive for a changing creatinine clearance. The MW/PHARM program can be used in case of decreased renal function and different ways of dialysis. Continuous Venous Venous Haemodialysis can be simulated and calculations for reduced doses can be made using the program. TDM of immunesuppressive drugs, administered after transplantation can be done and calculations using the

AUC (ciclosporin) will be performed by the participants.

Teaching goals:

• to know how to perform Therapeutic Drug Monitoring
• to learn the theory behind TDM
• to have an overview of the program MW/PHARM and get knowledge how to use this program in daily practice
• to learn how to dose drugs in case of renal impairment and dialysis
• to know to do TDM of immunosuppressive drugs

Learning Objectives:

After the workshop the participant should:

• have a theoretical background how to do TDM
• be able to use a simple TDM computer program
• be able to do dose calculations for drug in renal impairment and dialysis
• know how to dose immunosuppressive drugs using PK-parameters like AUC