Chapter 8 - Drug Monitoring Flashcards
Tests to monitor vancomycin + gentamicin?
Serum creatinine needed for baseline
But any tests to do with renal and hearing function as vancomycin and gentamicin are nephro/ototoxic
Tests to monitor statins?
Baseline - LFTs (mainly transaminases)
Check LFTs again at 3 and 12 months
CK only needs checked if there are risk factors in patient’s history or they have myopathy/myalgia
Lithium monitoring?
Sample 12 hours post-dose
Check FBC before initiating treatment
Check weekly on initiation, and 3 monthly once stable
Ensure adequate and consistent salt intake (low salt = increased risk of toxicity)
Methotrexate monitoring?
Baseline LFTs needed
Check FBC regularly and once stable 2-3 monthly
Stop immediately in infection
Renal failure increases risk of toxicity (mainly renal excreted)
If pulmonary toxicity (fibrosis) suspected then CXR
Baseline tests required for antipsychotics?
Fasting blood glucose - most important
ECG if CVD or significant RFs
Monitoring required in COCP?
Blood pressure - increased risk of arterial disease
Baseline tests + monitoring tests for amiodarone?
Baseline - TFTs + LFTs - monitor these regularly, baseline CXR too (pulmonary toxicity risk)
U&Es - do not start if hypokalaemia present (risk of arrhythmias)
Most important side effect of carbimazole?
Agranulocytosis - check urgent FBC in infection
Gentamicin multiple daily dose monitoring? (endocarditis)
Check serum concentration both pre- and post-dose
- pre-dose (trough level) = <1mg/L
- 1 hr post-dose (peak level) = 3-5mg/L
Baseline test for digoxin?
Renal function - renal excreted so need to check function first. This can be U&E’s or serum creatinine.
Baseline test for sodium valproate?
LFTs - hepatotoxic so check at baseline and at regular intervals throughout therapy
Clozapine monitoring?
Routine FBC monitoring - exact intervals should be indicated by the product license, but any answer with regular intervals on initiation is acceptable (e.g. FBC checked weekly for first 18 weeks)
