Russ Baldani
Defective Drug Recalls Lawyer
Russ Baldani, the senior partner in Baldani Law Group has dedicated over thirty years as a practicing attorney to representing people accused of crimes in the state and federal courts of Kentucky. After graduating from the University of Kentucky Law School in 1984 personal injury law,
Russ Baldani, the senior partner in Baldani Law Group has dedicated over thirty years as a practicing attorney to representing people accused of crimes in the state and federal courts of Kentucky. After graduating from the University of Kentucky Law School in 1984, Russ took a job as a full-time public defender at Fayette County Legal Aid. In his first year as a public defender, Russ exclusively represented young people in juvenile court in Lexington. For the next three years, Russ represented citizens accused of felonies in Fayette Circuit Court.
Commonwealth v. LaFonda Fay Foster
As a felony court public defender, Russ gained extensive trial experience that paved the way for his private practice. He tried dozens of cases, the most noteworthy of which was Commonwealth v. LaFonda Fay Foster. Along with a co-defendant, Fay was charged with shooting, stabbing and running over five people in 1986. It was the biggest murder case in Fayette County history, and the Commonwealth sought the death penalty. Russ assembled a team that included three lawyers, an investigator, a psychologist, a licensed clinical social worker, a forensic toxicologist and a jury selection expert.
Austin Mehr
Defective Drug Recalls Lawyer
Austin Mehr wrote a book about insurance bad faith in the early 90’s before other lawyers were aware that such cases existed. He has been asked to lecture to other lawyers about insurance dozens of times. He has tried more insurance bad faith cases to judgment than any other attorney in Kentucky.
Austin is a volunteer board member of the Fayette County Bar Association Foundation, a nonprofit that manages and donates money to various community legal nonprofit organizations to help people in the central Kentucky community. He is on the Board of the Carnegie Learning Center, a Lexington based non-profit that helps people, primarily children, to read and write. He volunteers his legal expertise to help people with limited resources on pro bono cases. Austin also devotes time to volunteer at the Fayette County Legal Help Center.
Jeanine Truman
Defective Drug Recalls Lawyer
A native of Taylorsville, Kentucky, Jeanine Truman graduated from Spencer County High School and helps the Karl Truman Law Office connect with clients in need as the firm’s Director of Client Communications. Jeanine’s diverse experience includes roles as a legal assistant for the Hatmaker Law Office, an image consultant for BeautiControl Cosmetics and a real estate agent for Re/Max.
R. Nicole Iuliano
Defective Drug Recalls Lawyer
Born and raised in Lexington, Kentucky, Nicole has a passion for serving local residents. Nicole serves as an advocate for the Court Appointed Special Advocates (“CASA”), volunteering her time to assess the needs of neglected and abused children who have been placed in the local court system. Nicole also volunteers her time to Legal Aid of the Bluegrass, providing pro bono representation to individuals lacking the financial resources to pay for legal services.
Nicole’s commitment to the community was recognized in 2014 when she was named Pro Bono Attorney of the Year. Nicole Iuliano is committed to client satisfaction, which is supported by her Avvo five (5) star client rating. Nicole Iuliano’s legal practice is heavily concentrated in the area of family law and child custody. She also provides legal services in a broad array of other practice areas, including: animal law, contracts negotiation, criminal defense, DUI defense, medical malpractice, personal injury, wills and probate. Prior to attending law school, Nicole Iuliano served as a legal assistant and legal office administrator to the late Henry E.
Ashley Abaray
Defective Drug Recalls Lawyer
Ashley Ervin Abaray is originally from Iowa and graduated from the University of Iowa in 2012. She then moved to Louisville and graduated from the Brandeis School of Law at the University of Louisville in 2015.
Ashley began working for a local personal injury firm in 2013 during her first summer in law school and continued her practice there after she graduated. Thus, from the very beginning of her legal career, she always represented people, never corporations. She joined Thomas Law Offices in May of 2024. Her practice focuses on helping those who have been injured in work accidents, car wrecks, slip and falls, and civil rights violations, including jail misconduct and police brutality. She has tried several cases to jury verdict and has settled hundreds of cases for injured Kentuckians.
Scott Justice
Defective Drug Recalls Lawyer
He has dedicated his career to fighting for the injured and their families, pursuing justice for injury victims across the Commonwealth. In recognition of his skills, professional ethics, and client commitment, he was awarded membership to the 2019 Super Lawyers® Rising Stars list — a title so prestigious, no more than 2.5% of practicing attorneys in any state can earn it each year.
Scott was born and raised in the state of Kentucky. A proud native of the state, he is proud to base his practice here, serving members of the Louisville community who have been injured.
Scott received his undergraduate education at the University of South Carolina, then made the decision to attend law school and become an attorney. He received his law degree from the University of Louisville Brandeis School of Law.
Joe Suhre
Defective Drug Recalls Lawyer
Joe Suhre is the owner and principal of Suhre & Associates DUI and Criminal Defense Lawyers. Joe has dedicated his practice to the defense of OVI cases and other criminal offenses. Joe has over 20 years of criminal defense experience and an additional 5 years of experience as a police officer. He has handled hundreds of DUI cases before dozens of judges in numerous counties.
Joe began his legal career on the “other side of the fence” as a police officer. His 5 years of experience as a police officer help him understand the flaws and common mistakes of the criminal justice system, which he uses to his advantage when defending clients. When presented with a DUI charge, the first thing Joe looks at is the actions of the police officer. He uses his knowledge of police practices and training standards to uncover missteps made by the arresting officer.
Paul J. Dickman
Defective Drug Recalls Lawyer
Paul J. Dickman is a native of Northern Kentucky. Born in Covington in 1961, he was raised in Edgewood and Ft. Mitchell, along with his two brothers and four sisters. Paul attended St. Pius Grade School in Erlanger and went to High School at Covington Latin School, in Covington, Kentucky.
Since he started practicing law in 1993 Paul has practiced before state and federal courts throughout Northern Kentucky and Greater Cincinnati. He has tried cases to judges and juries throughout the area and has gained an appreciation for the intricacies of the legal system that allows him to help his clients in dealing with their legal problems. He has successfully resolved complicated and overwhelming legal problems for hundreds of clients over the years.
which type of drugs need therapeutic drug monitoring?
Therapeutic drug monitoring (TDM) is a clinical tool used to measure the concentration of specific medications in a patient’s blood to ensure that the drug is both safe and effective. Not every medication requires this level of monitoring. TDM is reserved for drugs where maintaining the correct blood concentration is critical due to the risk of toxicity, therapeutic failure, or significant variability in how individuals process the drug.
Why Is TDM Needed?
Some drugs must be kept within a narrow therapeutic range—the difference between an effective dose and a toxic dose is small. Factors such as age, organ function, co-existing illnesses, drug interactions, and genetic differences can all impact how a drug is absorbed, distributed, metabolized, and eliminated from the body. For these medications, standard dosing may not be appropriate for everyone, and TDM helps clinicians tailor therapy to the individual’s needs. TDM is also useful to check if patients are taking their medication as prescribed or to adjust doses when clinical response is difficult to measure directly.
Key Characteristics of Drugs That Require TDM
Drugs considered for TDM typically share the following features:
Narrow therapeutic index (small margin between therapeutic and toxic levels)
Marked pharmacokinetic variability (differences in drug handling between individuals)
Concentration-dependent efficacy and toxicity
Serious consequences of under- or over-dosing (e.g., seizures, organ rejection)
Difficulty monitoring clinical effects directly
Availability of reliable laboratory assays for measurement.
Drug Classes and Examples Commonly Monitored
Below are the main categories of drugs that often require TDM, along with representative examples and the reasons for monitoring:
| Drug Class | Examples | Reason for TDM |
|---|---|---|
| Antibiotics | Aminoglycosides (gentamicin, amikacin, tobramycin), vancomycin | Prevent toxicity (kidney, ear) and ensure efficacy |
| Cardiac Drugs | Digoxin, amiodarone, lidocaine, procainamide, quinidine | Narrow therapeutic range, risk of arrhythmia or toxicity |
| Antiepileptics | Phenytoin, carbamazepine, valproic acid, phenobarbital | Narrow margin, variable metabolism, seizure control |
| Immunosuppressants | Cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil | Prevent organ rejection, avoid toxicity |
| Psychiatric Drugs | Lithium, valproic acid, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline) | Narrow range, toxicity risk |
| Bronchodilators | Theophylline, caffeine | Narrow range, variable metabolism, toxicity risk |
| Antifungals | Itraconazole, voriconazole, posaconazole | Variable absorption, toxicity risk |
| Anticancer Drugs | Methotrexate, some cytotoxic agents | Toxicity risk, variable clearance |
Most Commonly Monitored Drugs
Aminoglycoside antibiotics: Gentamicin, amikacin, tobramycin
Vancomycin
Antiepileptics: Phenytoin, carbamazepine, valproic acid, phenobarbital
Cardiac drugs: Digoxin, amiodarone, lidocaine, procainamide
Immunosuppressants: Cyclosporine, tacrolimus, sirolimus
Psychiatric drugs: Lithium
Antifungals: Itraconazole, voriconazole, posaconazole
Anticancer drugs: Methotrexate.
When Is TDM Especially Important?
TDM is particularly useful in the following situations:
After starting or changing the dose of a monitored drug
When treatment is not working as expected or toxicity is suspected
When starting or stopping other drugs that may interact
In patients with changing physiology (e.g., kidney or liver disease, pregnancy, aging)
To assess compliance or guide withdrawal of therapy.
Drugs That Do Not Require TDM
Most medications do not require TDM. Drugs with a wide therapeutic index, predictable pharmacokinetics, or easily observable clinical effects (such as most blood pressure or diabetes medications) are typically managed by adjusting the dose based on clinical response rather than blood levels.
Levels of Priority for TDM (According to WHO)
The World Health Organization (WHO) has prioritized certain drugs for TDM:
High priority: Amikacin, gentamicin, lithium, phenytoin
Moderate priority: Cyclosporine, methotrexate, vancomycin
Low priority: Carbamazepine, digoxin, phenobarbital, sodium valproate (clinical assessment is often sufficient for these, but TDM may be useful in special cases).
Conclusion
Therapeutic drug monitoring is a critical tool for ensuring the safety and effectiveness of drugs with narrow therapeutic margins, significant variability in handling, or serious consequences of incorrect dosing. The most commonly monitored drugs include certain antibiotics, antiepileptics, cardiac drugs, immunosuppressants, psychiatric medications, antifungals, and anticancer agents. TDM allows for individualized dosing, minimizes toxicity, and optimizes therapeutic outcomes, especially in complex or high-risk patients. Not all drugs require TDM—most are managed safely and effectively through standard dosing and clinical observation.