Jack Edwards
Defective Drug Recalls Lawyer
Jack D. Edwards is a passionate advocate for the injured men and women of Wyoming. He works tirelessly to protect the rights of his clients and to deliver the legal results they need. Jack is compassionately committed to helping his clients through the legal process personal injury law.
Jack is a graduate of the Trial Lawyer’s College. The Trial Lawyer’s College is dedicated to training and educating lawyers and judges who are committed to the American jury system and to representing and obtaining justice for every client—the poor, the injured, the forgotten, the voiceless, the defenseless, and the damned. The Trial Lawyer’s College is committed to protecting the rights of injured and mistreated people from corporate and government oppression. Jack shares that commitment and supports that mission in every aspect of his law practice.
JEREMY HUGUS
Defective Drug Recalls Lawyer
Jeremy is a Wyoming native. He became a lawyer to make life better for real people. You deserve a criminal defense lawyer who believes you’re more than a serious charge. That’s what you get with Jeremy. He’s focused, dedicated, and passionate about his clients and the law.
Jeremy works pro bono with Equal Justice Wyoming and dedicates some of his free time to a few different Wyoming non-profits.
Jeremy has received numerous awards and recognitions, including a 10.0 rating from AVVO, Top 10, and Top 40 criminal attorney ratings.
Above all else, Jeremy wants to deliver peace of mind. He’s not afraid to take your fight to court, and he has a track record of success.
Jason E. Ochs
Defective Drug Recalls Lawyer
Jason Edward Ochs is the general and managing partner of the Ochs Law Firm and is licensed in California, Colorado, Idaho, Kansas and Wyoming.
Jason started his career in 2004 with a nationwide plaintiff litigation firm where he practiced complex product liability, catastrophic injuries and medical malpractice.
In 2006, he joined the Orange County District Attorney’s office to refine his trial skills, trying multiple high-profile cases to verdict.
From 2008 through 2011, Jason was a member of the expert committee and deposition teams in the federal In Re Gadolinium MDL venued in Cleveland, Ohio against GE Healthcare, Bayer Pharmaceuticals and Mallinckrodt. Jason took more than 50 depositions in the pharmaceutical litigation in 2010 alone all over the country, including deposing GE Healthcare’s Global Pharmacovigilance department head in Oslo, Norway.
In 2009, Jason was selected by his peers to chair the expert committee in the coordinated California-state gadolinium cases venued in San Francisco.
ETHAN MORRIS
Defective Drug Recalls Lawyer
Ethan hails from Carrollton, Georgia and has lived in Jackson, Wyoming since October 2019. After graduating from Central High School, he traveled south to attend Georgia Southern University in Statesboro, Georgia, where he graduated with a Bachelor of Arts in Political Science, a Bachelor of Science in Biology, and a Minor in Chemistry.
After leaving Statesboro, Ethan spent the next fifteen months working in Cooper Landing, Alaska, Washington, D.C., and Atlanta, Georgia before enrolling in the University of Georgia School of Law. While in law school, Ethan served on the editorial board of the Georgia Journal of International & Comparative Law and externed with the DeKalb County Public Defender’s Office and the House Judiciary Committee of the Georgia General Assembly.
Ryan Wright
Defective Drug Recalls Lawyer
Ryan grew up in Sheridan, Wyoming where he enjoyed hiking, camping, fishing and hunting in the Bighorn Mountains. He attended public school until the 7th grade, then was home schooled and enrolled in Sheridan College at 14, later becoming the youngest graduate at 17 and with honors. After college, he worked as an insurance agent in his family’s business.
He pursued his passion for creating change in society through the study of law, enrolling at Georgetown University Law Center in 2005. During law school, Ryan worked on the U.S. Senate Health, Education, Labor & Pension Committee under then Chairman Senator Michael Enzi. After graduating law school, Ryan moved to New York City and joined a boutique New York City law firm where he practiced commercial and corporate law. In private practice, Ryan worked in numerous areas, including criminal law, contracts, construction, employment discrimination, insurance coverage, insurance defense, international law, negotiations, and mediation.
John Shimer
Defective Drug Recalls Lawyer
Attorney John Shimer, managing partner at the Law Offices of Shimer Zach, LLC, brings over 16 years of dedicated legal experience to his practice. A proud Henderson, Nevada native, Mr. Shimer earned his Bachelor of Arts in Criminal Justice with a minor in Business Law from the University of Nevada, Las Vegas.
He continued his legal education at the Thomas M. Cooley Law School in Michigan before returning home to serve his community.
Throughout his career, Mr. Shimer has specialized in criminal defense and personal injury law. Before founding the Law Offices of Shimer Zach, LLC, he sharpened his litigation skills at a prominent Las Vegas law firm. Today, he is committed to advising and representing clients in all areas of personal injury and criminal law, ensuring their legal rights are protected and vigorously pursued.
Laura Jackson
Defective Drug Recalls Lawyer
Prior to opening Jackson & Ojeda, LLC, Ms. Jackson practiced at Long Reimer Winegar Beppler LLP and clerked for the First Judicial District Court Judges in Cheyenne, Wyoming including the Honorable James E. Burke, the Honorable Nicholas G. Kalokathis, and the Honorable Edward L. Grant.
Ms. Jackson is a member of the National Academy of Elder Law Attorneys (NAELA), Wyoming Bar Association, and Laramie County Bar Association.
Community Service. Ms. Jackson regularly acts as a community guest lecturer to educate the community regarding elder law issues. Additionally, Ms. Jackson provides legal services through Wyoming Legal Aid on a consistent basis to aid those who are underprivileged and to educate Legal Aid attorneys regarding estate planning and elder law matters.
Ian Sandefer
Defective Drug Recalls Lawyer
Ian received an Associates of Arts degree, cum laude, from Casper College in 1999. Ian was the recipient of the Wyoming President’s Honor Scholarship at the University of Wyoming, which he attended for one year, maintaining a 4.0 GPA and receiving the William Steckel Undergraduate Scholarship for “excellence in scholarship.” Ian went on to earn his Bachelor’s Degree in History in 2003 from the University of Massachusetts at Amherst, where he earned a number of distinctions, including the Harold W. Carey Prize (awarded to the graduating senior History major with the highest GPA in history courses) and the Simon & Satenig Ermonian Scholarship (awarded annually to “outstanding history majors” selected by the Undergraduate Studies Committee).
Which drugs need blood tests to monitor levels?
Therapeutic drug monitoring (TDM) is the practice of measuring specific drug concentrations in the blood to ensure they remain within a target therapeutic range. This is especially important for drugs with a narrow therapeutic window, where small changes in blood levels can mean the difference between effective treatment and toxicity.
Characteristics of Drugs That Require Monitoring
Drugs suitable for TDM generally have the following features:
Marked variability in how individuals absorb, metabolize, or eliminate the drug (pharmacokinetic variability)
A narrow therapeutic index (the safe and effective dose range is small)
Well-defined target concentration ranges
Concentration-related therapeutic and adverse effects
Difficulty in monitoring therapeutic effect by clinical signs alone
Serious consequences if therapy fails (e.g., seizure, transplant rejection)
Reliable laboratory assays available for measurement
Common Drug Classes Requiring Blood Level Monitoring
1. Antiepileptics (Anti-seizure medications)
Examples: Phenytoin, valproic acid, carbamazepine, phenobarbital
Reason: Narrow therapeutic range; risk of both underdosing (seizures) and overdosing (toxicity).
2. Cardiac Drugs
Examples: Digoxin, procainamide, lidocaine
Reason: High risk of toxicity, especially in the elderly or those with kidney dysfunction.
3. Mood Stabilizers
Example: Lithium
Reason: Small difference between effective and toxic doses; toxicity can be life-threatening.
4. Immunosuppressants
Examples: Cyclosporine, tacrolimus, sirolimus
Reason: Preventing organ rejection requires precise dosing; too little leads to rejection, too much to toxicity.
5. Antibiotics (Certain types)
Examples: Aminoglycosides (gentamicin, amikacin), vancomycin
Reason: Risk of kidney and ear toxicity; underdosing can lead to treatment failure.
6. Anticoagulants
Example: Warfarin (monitored via INR, not direct drug level)
Reason: Risk of bleeding or clotting if not properly dosed.
7. Chemotherapy Agents
Example: Methotrexate
Reason: High toxicity risk; requires precise dosing.
8. Tricyclic Antidepressants
Examples: Amitriptyline, imipramine
Reason: Risk of cardiac and neurological toxicity at high levels.
When Is Monitoring Needed?
Blood level monitoring is typically recommended:
After starting or changing a dose
If treatment appears ineffective or toxicity is suspected
When starting or stopping other medications that may interact
If there are changes in patient physiology (e.g., kidney or liver function, pregnancy)
To check for medication adherence
Why Aren’t All Drugs Monitored?
Most medications do not require routine blood level monitoring because:
They have a wide therapeutic index (safe range)
Their effects can be easily monitored by clinical signs or symptoms
Blood level does not reliably predict effect or toxicity
Summary Table: Drugs Commonly Monitored by Blood Tests
| Drug Class | Examples | Reason for Monitoring |
|---|---|---|
| Antiepileptics | Phenytoin, valproic acid, carbamazepine | Narrow therapeutic window, toxicity risk |
| Cardiac Drugs | Digoxin, procainamide, lidocaine | Toxicity, variable metabolism |
| Mood Stabilizers | Lithium | Narrow therapeutic index |
| Immunosuppressants | Cyclosporine, tacrolimus | Prevent rejection, avoid toxicity |
| Antibiotics (Aminoglycosides) | Gentamicin, amikacin, vancomycin | Kidney/ear toxicity, efficacy |
| Anticoagulants | Warfarin | Bleeding/clotting risk (via INR) |
| Chemotherapy Agents | Methotrexate | High toxicity |
| Tricyclic Antidepressants | Amitriptyline, imipramine | Cardiac/neurotoxicity |
Conclusion
Therapeutic drug monitoring is reserved for medications where dosing must be individualized to avoid serious adverse effects or treatment failure. The most commonly monitored drugs include certain antiepileptics, cardiac drugs, mood stabilizers, immunosuppressants, specific antibiotics, anticoagulants, and some chemotherapy agents. TDM helps clinicians tailor therapy for maximum benefit and minimum risk.