Abstract

Urine drug testing is one of the objective tools available to assess adherence. To monitor adherence, quantitative urinary results can assist in differentiating “new” drug use from “previous” (historical) drug use. “Spikes” in urinary concentration can assist in identifying patterns of drug use. Coupled chromatographic-mass spectrometric methods are capable of identifying very small amounts of analyte and can make clinical interpretation rather challenging, specifically for drugs that have a longer half-life. Polypharmacy is common in treatment and rehabilitation programs because of co-morbidities. Medications prescribed for comorbidities can cause drug-drug interaction and phenoconversion of genotypic extensive metabolizers into phenotypic poor metabolizers of the treatment drug. This can have significant impact on both pharmacokinetic (PK) and pharmacodynamic properties of the treatment drug. Therapeutic drug monitoring (TDM) coupled with PKs can assist in interpreting the effects of phenoconversion. TDM-PKs reflects the cumulative effects of pathophysiological changes in the patient as well as drug-drug interactions and should be considered for treatment medications/drugs used to manage pain and treat substance abuse. Since only a few enzyme immunoassays for TDM are available, this is a unique opportunity for clinical laboratory scientists to develop TDM-PK protocols that can have a significant impact on patient care and personalized medicine. Interpretation of drug screening results should be done with caution while considering pharmacological properties and the presence or absence of the parent drug and its metabolites. The objective of this manuscript is to review and address the variables that influence interpretation of different drugs analyzed from a rehabilitation and treatment programs perspective.

摘要

尿液药物检测是可用于评估依从性的客观工具之一。为了监测依从性，定量尿液结果可以帮助区分“新”药物使用与“先前”（历史）药物使用。尿液浓度的“峰值”可以帮助确定药物使用方式。色谱-质谱联用的方法能够识别非常少量的分析物，并且可能给临床解释带来挑战，特别是对于半衰期较长的药物。由于合并症，在治疗和康复计划中多药店很常见。规定用于合并症的药物可能引起药物相互作用，并使基因型广泛代谢物转化为治疗药物的表型弱代谢物。这可能对治疗药物的药代动力学（PK）和药代动力学特性产生重大影响。结合PK的治疗药物监测（TDM）可以帮助解释表型转化的作用。TDM-PKs反映了患者病理生理变化以及药物-药物相互作用的累积影响，因此应考虑将其用于治疗疼痛和滥用药物的治疗药物/药物。由于仅有几种针对TDM的酶免疫测定方法，对于临床实验室科学家而言，这是开发TDM-PK方案的独特机会，该方案可能会对患者护理和个性化药物产生重大影响。在考虑药理特性以及母体药物及其代谢物的存在与否时，应谨慎解释药物筛选结果。本手稿的目的是从康复和治疗计划的角度审查并解决影响不同药物解释的变量。