Clinical Pharmacology and Toxicology

Background:  Individuals respond differently to medicines for multiple reasons – age, sex, comorbidities, anthromorphic

• There is often a better correlation between patient responses to a drug and the measured drug plasma concentrations than there is to the administered drug dose.
• Many drugs have highly variable pharmacokinetics (plasma concentrations) and pharmacodynamics (patient response to drug).
• Optimising drug dosage according to pharmacokinetics and pharmacodynamics is the key to optimising drug effectiveness.

Methods:

• Clinical: Patient recruitment, blood collections.
• Laboratory: Chromatography (HPLC/LCMS), DNA extraction and genetic analysis (SNPs).
• Quantitative analysis:
  
  • Pharmacokinetics & Pharmacodynamics (computerised modelling)
  • Concentration-response relationships
  • Simulations and optimising dosing
  • Correlations with patients' responses
  • Review of medication charts
• Qualitative analysis:
  • Interviewing patients, prescribers, allied health.

Drugs studied:

• Allopurinol & Febuxostat (gout), Metformin, Empagliflozin (antidiabetic), Tacrolimus (immunosuppressant), Amikacin, Vancomycin (antibiotics), Voriconazole (antifungal), Antihypertensives.

Example projects:

• Understanding the drug exposure-response relationship between allopurinol and renal function in patients with chronic kidney disease. 
• Economic analysis of the cost-benefit of therapeutic drug monitoring.
• Social network analysis of therapeutic drug monitoring processes.
• Observational studies of pharmacist workflow – how are they talking?
• Telepharmacy – Service adaptations for the post-COVID era?
• Pharmacogenomics - impact on clinical decision-making.
• Impact of haemodialysis on pharmacokinetics.
• Impact of acute kidney injury on pharmacokinetics.
• Use of capillary blood samples to guide therapeutic drug monitoring in patients with complex conditions.
• Using national and state health, medication and administrative data bases to test hypotheses regarding medication usage and outcomes trends.
• Point of Care testing of analytes and medicines in order to make dosing decisions faster
• Evaluation of routine drug monitoring data to describe novel drug interactions
• Evaluation of prescribing trends of antineoplastic tyrosine kinase inhibitors to inform drug monitoring strategies
• Evaluating routine medication use data to identify priority areas for medication management in people from vulnerable populations

Background:

• Illicit drug use can be associated with significant toxicity. 
• Little is known about the extent and range of drug use at music festivals. 
• There is an escalating prevalence of people presenting with GHB overdose and dependence.
• There is limited understanding of the patterns of morbidity associated with opioid overdose
• There is an evolving understanding of the impact of illicit drug use on accelerated ageing

Available projects:

• Wastewater analysis for illicit drugs at night time music venues
• GHB overdose management and prevention
• Management of GHB dependence
• Understanding morbidity and outcomes from opioid overdose
• Frailty assessment in people who use alcohol or other drugs

Background: 

There is increasing interest in PP for a range of conditions, but little is known about the prevalence and patterns of use of psychedelics in the Australian community.

Available projects:

• Designing/ implementing survey of people who regularly use psychedelics.
• Systematic reviews of psychedelic psychotherapy topics
• Working on trials of psychedelic psychotherapy

Background:

• Gout is the most common form of inflammatory arthritis in men. It is characterised by extreme pain and swelling and caused by a build-up of uric acid in the bloodstream. 
• Gout is a chronic condition, which requires life-long medication and self-management. Long-term urate-lowering therapy (ULT), if taken daily at the correct dose, can lower urate in the blood (serum urate) to the target concentration or below. 
• Maintaining serum urate at the target concentration or below is essential to prevent gout flares from recurring, thus checking serum urate is an important aspect of “treat to target” in the management of gout.

Available projects:

• Using quantitative methods:
  
  • Association of serum urate concentrations with patient-reported outcomes, including gout attacks, tophi, health-related quality of life and work productivity and activity impairment. To examine the evidence on the benefits of lowering serum urate in people with gout using baseline data.  
  • Serum urate concentrations and renal function: To examine whether there is any difference in renal function at 6 months and at 12 months between participants at the target serum urate at baseline and those above the target.    
• Using qualitative methods (e.g., interviewing doctors and gout patients) to:
  
  • Examine the feasibility of pharmacist-led chronic care delivery in people with gout.
  • Develop educational materials for people with gout and better understand their perception of the disease.
• Use of electronic apps to promote improved self-management in people with gout