DRUG LEVELS, THERAPEUTIC AND TOXIC CONVENTIONAL

(US SYSTEM OF MEASUREMENTS)

DRUG

THERAPEUTIC LEVEL

TOXIC LEVEL

acetaminoph 1030 mcg/mL

en

>200 mcg/mL at 4 hr or 50 mcg/mL at

12 hr after ingestion

amikacin

peak: 2030 mcg/mL

peak: >40 mcg/mL

trough: <8 mcg/mL

trough: >10 mcg/mL

amiodarone

0.52.5 mg/L

>2.5 mg/L

amitriptyline

0.52.5 mcg/mL

>2.5 mcg/mL

amoxapine

120150 ng/mL

>500 ng/mL

carbamazepi 412 mcg/mL

ne

>15 mcg/mL

chlorampheni peak: 1025 mcg/mL

col

peak: >40 mcg/mL

trough: 515 mcg/mL

trough: >15 mcg/mL

0.13 mcg/mL

>25 mcg/mL

chlorpromazi 50300 ng/mL

ne

>750 ng/mL

clonazepam

2080 ng/mL

>80 ng/mL

cyclosporine

100400 ng/mL

>400 ng/mL

desipramine

50300 ng/mL

>300 ng/mL

diazepam

0.21.5 mcg/mL

>1.5 mcg/mL

digoxin

0.52 ng/mL

>2.5 ng/mL

chlordiazepo
xide

disopyramide 2.87.5 mcg/mL

>7.5 mcg/mL

doxepin

>500 ng/mL

110250 ng/mL

ethosuximide 40100 mcg/mL

>100 mcg/mL

flecainide

0.21 mcg/mL

>1 mcg/mL

gentamicin

peak: 610 mcg/mL

trough: >1 mcg/mL

trough: <1 mcg/mL

haloperidol

520 ng/mL

>42 ng/mL

imipramine

150250 ng/mL

>500 ng/mL

kanamycin

peak: 1530 mcg/mL

peak: >35 mcg/mL

trough: 510 mcg/mL

trough: >10 mcg/mL

lidocaine

1.55 mcg/mL

>6 mcg/mL

lithium

0.61.2 mEq/L

>1.5 mEq/L

meperidine

70500 ng/mL

>1000 ng/mL

mexiletine

0.52 mcg/mL

>2 mcg/mL

morphine

6580 ng/mL

>200 ng/mL

nortriptyline

50150 ng/mL

>500 ng/mL

phenobarbita 1540 mcg/mL

l

>40 mcg/mL

phenytoin

1020 mcg/mL

>30 mcg/mL

primidone

512 mcg/mL

>15 mcg/mL

procainamide procainamide: 410 mcg/mL

procainamide: >10 mcg/mL

N-acetylprocainamide (NAPA):
1525 mcg/mL
propranolol

50100 ng/mL

>150 ng/mL

quinidine

25 mcg/mL

>6 mcg/mL

salicylate

100400 mcg/mL

>400 mcg/mL

theophylline

1020 mcg/mL

>20 mcg/mL

tobramycin

peak: 610 mcg/mL

trough: >1 mcg/mL

trough: <1 mcg/mL

trazadone

0.52.5 mcg/mL

>2.5 mcg/mL

valproic acid

50125 mcg/mL

>125 mcg/mL

vancomycin

trough: 1020 mcg/mL

trough: >20 mcg/mL

MAGIC 2s IN DRUG MONITORING

DRUG

NORMAL RANGE

TOXICITY

INDICATION

CLASSIFICATION

LEVEL
Digoxin/ Lanoxin

.5 1.5 meq/L

CHF

Cardiac Glycoside

(Increase force of
cardiac output)
Lithium/ Lithane

.6 1.2 meq/L

Bipolar

Anti-Manic Agents

10 19 mg/100 ml

20

COPD

Bronchodilators

Dilantin/ Phenytoin

10 19 mg/100 ml

20

Seizures

Anti-Convulsant

Acetaminophen/Tylen
ol

10 30 mg/100 ml

200

Osteo

Non-narcotic
Analgesic

(Decrease level of
Ach/NE/Serotonin)
Aminophylline
(Dilates bronchial tree)

1. Digitalis Toxicity
Signs and Symptoms
nausea and vomiting
diarrhea
confusion
photophobia
changes in color perception (yellowish spots)
Antidote: Digibind
2. Lithium Toxicity
Signs and Symptoms
anorexia
nausea and vomiting
diarrhea
dehydration causing fine tremors
hypothyroidism

Arthritis

Nursing Management
force fluids
increase sodium intake to 4 10 g% daily
3. Aminophylline Toxicity
Signs and Symptoms
tachycardia
palpitations
CNS excitement (tremors, irritability, agitation and restlessness)
Nursing Management
only mixed with plain NSS or 0.9 NaCl to prevent development of crystals or precipitate.
administered sandwich method
avoid taking alcohol because it can lead to severe CNS depression
avoid caffeine
4. Dilantin Toxicity
Signs and Symptoms
gingival hyperplasia (swollen gums)
hairy tongue
ataxia
nystagmus
Nursing Management
provide oral care
massage gums
5. Acetaminophen Toxicity
Signs and Symptoms
hepatotoxicity (monitor for liver enzymes)
SGPT/ALT (Serum Glutamic Pyruvate Transaminace)

 SGOT/AST (Serum Glutamic Oxalo-Acetil Transaminace)

nephrotoxicity monitor BUN (10 20) and Creatinine (.8 1)
hypoglycemia
Tremors, tachycardia
Irritability
Restlessness
Extreme fatigue
Diaphoresis, depression
Antidote: Acetylcisteine (mucomyst) prepare suction apparatus as bedside.