3. Data Interpretation Flashcards
What do you do if:
Clinical response low + Serum levels low
Increase dose of drug
What do you do if:
Response adequate, serum levels low
Don’t change anything
What do you do if:
Response adequate, serum levels high
Reduce dose of drug
What do you do if serum levels of gentamycin are high
Reduce frequency of dosing
Features of Digoxin toxicity
- confusion
- nausea
- visual halos
- arrhythmias
Features of Lithium Toxicity (early, intermediate, late)
- Early: Tremor
- Intermediate: fatigue
- Late: arrhthmias, seizures, coma
- Late (cont): diabetes insipidus, renal failure
Features of Phenytoin Toxicity
- Gum hypertrophy
- Peripheral neuropathy
- Nystagmus + ataxia
- Teratogenicity
Features of Gentamycin/Vancomycin Toxicity
- Ototoxicity
- Nephrotoxicity
Treatment options for drug toxicity (3)
1 - Stop drug
2 - Supportive measures (e.g. fluids)
3 - Give antidote (if there is one)
Gentamycin Dosing
- Most people: once daily, 5-7mg/kg
- Renal impairment/IE: 12 hourly 1mg/kg
What are the features of a once-daily Gent nomogram
- Serum gent level against time
- 3 lines: 24-hour, 36-hour + 48-hour lines
How does the 6 hour measurement affect Gent prescription (using OD nomogram)
- Below 24-hour line: continue as normal
- Between 24-36 hour lines: change to 36 hourly
- Between 36-48 hour lines: change to 48 hourly
- Above 48-hour line: stop until level <1mg/L
How does 12-hourly Gent nomogram differ to OD
- Peaks and troughs instead of lines
How do measurements affect Gent prescriptions (using 12-hourly nomogram)
- Peak out of range: adjust dose
(high = reduce, low = increase) - Trough out of range: adjust frequency
(high = reduce, low = increase)
How does INR level affect management of warfarin toxicity
INR <6: Reduce dose
INR 6-8: Omit for 2 days then reduce
INR >8: Omit + give oral vitamin K
