CLINICAL- MONITORING Flashcards
What do we need to monitor before starting Carbimazole for treatment of hyperthyroidism?
FBC, white cell count (as it’s contraindicated in sever blood disorders)
LFTs: as must be used with caution in mild to moderate impairment and avoided in severe
Look for signs of sore throat, fever or bruising (says in BNF patient should tell doctor immediately)
What is it imperative to monitor with propyluracil (drug used as alternative to Carbimazole in hyperthyroidism)?
LFTs due to risks of hepatotoxicity!
Patient should be told how to spot signs of liver disorder
What should we monitor if a patient has an infection?
Temperature
Heart rate/ respiratory rate
CRP
White cell count
You should do this anyway, but if all else fails and we can’t think of any monitoring what should we monitor?
Monitor for side effects: look these up and see which we can look out for
In treating asthma, what can cause a drop in potassium levels?
Steroids
Aminophylline
Both used in asthma attacks IV, monitor potassium!
What do we monitor when treating hypothyroidism with Levothyroxine?
Monitor TSH levels
We want them to become euthyroid so for TSH to be in reference range (0.4-4 range)
We don’t want their TSH level to fall too low: osteoporosis and bone fracture risk
Note: changes in dose/ new treatment with levothyroxine may take a while to work: so only need to monitor TSH 6-12 weeks after the change has been made. Remember this!!
Once TSH is normal (euthyroid) monitor annually!
What can we monitor for all the NOACs, Heparins, warfarin etc?
Renal function
Monitor LFTs
Monitor bleeding and bruising
Don’t monitor efficacy (but do for warfarin and UFH)
How do we monitor UFH efficacy?
APTT monitoring
What electrolyte should we monitor with the heparins?
K+
Heparins can raise it
With LMWH, we monitor anti-Xa in certain conditions, what are these?
Preganancy
Renal impairment
Extremes of body weight
Paediatrics
How do we monitor for heparin induced thrombocytopenia ?
Monitor platelets
Watch out for low platelet count !!
If platelets are low don’t give LMWH or UFH!
What is the Glasgow coma scale used for?
To assess patients level of conciousness and cognition
Can be used to see if patient is confused etc
Could be used if patient is dehydrated: see if fluid therapy is working and their confusion is getting better
What 4 things need baseline monitoring with the NOACS?
Prothrombin time
Liver function
Renal function
Blood pressure
Also patients still need to monitor for signs of bleeding or aneamia!!
In the treatment of AF, amiodarone is often used (for rhythm control). But so is the anticoagulant warfarin. There is an interaction between these two medications. What should we do?
Amiodarone is beneficial with warfarin in AF.
Due to the interaction, we need to monitor the INR closely. Whilst loading amiodarone, we may see an unstable INR.
