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PSA > Communicating Info and Drug Monitoring > Flashcards

Communicating Info and Drug Monitoring Flashcards

1
Q

Which drugs usually require monitoring?

A

Drugs with a narrow therapeutic index.

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2
Q

What does “narrow therapeutic index” mean?

A

Small difference in blood concentration between therapeutic and toxic effects.

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3
Q

Name five drugs that have a narrow therapeutic index.

A 
Digoxin
Theophylline
Lithium
Phenytoin
Aminoglycosides
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4
Q

Peripheral neuropathy, gum hypertrophy, ataxia, and nystagmus, are features of toxicity of which drug?

A

Phenytoin

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5
Q

Visual halos, arrhythmias, nausea, and confusion, are features of toxicity of which drug?

A

Digoxin

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6
Q

What are some features of gentamycin monitoring?

A

Patients with severe renal failure or endocarditis may receive divided daily dosing 12-hourly

Gentamycin levels are measured at 6-14h after the last infusion

A normogram is used to determine whether the level is too high.

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7
Q

What is INR?

A

A ratio of a patient’s prothrombin time compared to the normal population

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8
Q

What is the target INR for patients on warfarin, and an exception?

A
  1. 5

3. 5 if recurrent VTE on warfarin or mechanical valve replacement

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9
Q

How is over anti-coagulation managed?

A

INR<6 reduce warfarin dose

INR 6-8 omit warfarin for 2 days, then reduce dose

INR>8 omit warfarin and give 1-5mg oral Vitamin K.

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10
Q

If a patient is bleeding, on warfarin, how is this managed?

A

Assuming INR>8
Stop warfarin
5-10mg IV vitamin K or prothrombin complex e.g. Beriplex

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11
Q

At what time of day should ACEIs be administered and why?

A

Evening due to postural hypotension

Exception - perindopril

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12
Q

What anti-hypertensive drug is used in pregnancy?

A

Labetalol

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13
Q

Following initiation of an ACEI, what should be monitored?

A

Renal function
Potassium
1-2 weeks after initiation

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14
Q

Name a drug which increases the risk of endometrial cancer.

A

Tamoxifen

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15
Q

What are two other adverse effects associated with tamoxifen?

A

VTE

Increased efficacy of warfarin

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16
Q

What is important information regarding initiation of sulphonylureas, to reduce the risk of hypoglycaemia?

A

Eat regularly and do not miss meals
Do not double the dose
Take in the morning with breakfast
Do not take at night - increased risk of nocturnal hypo

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17
Q

How often is methotrexate taken, and the route?

A

Once weekly

PO, or if not tolerated, SC

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18
Q

Name two other folate antagonists.

A

Trimethoprim

Co-trimoxazole

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19
Q

How often is FBC monitored in patients on methotrexate therapy?

A

1-2 weekly for first 18 weeks

Then every 2-3 months

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20
Q

Why is folic acid given with methotrexate, and when is it given?

A

Limits bone marrow toxicity

5mg once weekly 24h later

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21
Q

What advice regarding alcohol should be given to patients taking warfarin?

A

Ideally, not to drink

If drinking alcohol, it should be moderate and spread out over the week to least impact the INR

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22
Q

How often is INR monitored on warfarin therapy?

A

Initially weekly

Once stable, monthly

23
Q

What is a steroid sick day?

A

If ill, patients should increase the dose of steroid.

24
Q

What drug should be started with corticosteroids?

A

Bisphosphonate

25
Q

Why should patients not stop corticosteroids abruptly?

A

Risk of Addisonian crisis

26
Q

How should insulin doses be amended when patients are unwell?

A

Increased doses

27
Q

What should diabetic patients do to reduce the risk of lipohypertrophy?

A

Rotate injection sites

28
Q

How often is alendronic acid given?

A

Once weekly

29
Q

What should be avoided at the time a bisphosphonate is taken?

A

Calcium salts and food reduces absorption

30
Q

What are the instructions for taking a bisphosphonate?

A

Swallow tablet with a full glass of water and remain upright for 30 minutes afterwards

31
Q

Before starting a statin, what is important to check?

A

Transaminases, rather than albumin

32
Q

In what scenario, should creatine kinase be checked at baseline, in patients who are starting a statin?

A

Increased risk of myopathy

33
Q

How long after maintenance dosing of phenytoin, should the reported level be within the reference range?

A

14 days

34
Q

How long after the last dose of lithium, should the serum concentration be sampled?

A

12 hours

35
Q

What is the normal lithium reference range and at what level are toxic effects likely to manifest?

A

0.4-0.8mmol/L

>1.5mmol/L

36
Q

How often should serum lithium concentrations be monitored?

A

Weekly after initiation and after each dose change, until concentrations are stable, then every 3 months

37
Q

In what scenarios should you stop, or not start methotrexate?

A

Abnormal LFTs
Low white cells or platelets
Infection

38
Q

How is olanzapine monitored?

A

Fasting blood glucose at baseline and at regular intervals thereafter
Baseline ECG if RF

39
Q

What should be monitored in patients on the COCP?

A

Blood pressure

40
Q

For which drug is a baseline CXR, and thyroid function required?

A

Amiodarone

41
Q

Which drugs can cause agranulocytosis?

A

Clozapine

Carbimazole

42
Q

In monitoring of gentamycin, what action should be taken if the serum concentration is too high? It should be 5-10mg/litre

A

Reduce the dose, keep the frequency the same

43
Q

In monitoring of gentamycin, what action should be taken if the trough level is too high (>1mg/litre), but the serum concentration is adequate?

A

Dosing interval should be increased

Dose remains the same

44
Q

Which drugs significantly reduce lithium excretion?

A

ACEI
Diuretics
NSAIDs

45
Q

Which type of diuretic is safest for use in patients taking lithium?

A

Loop

46
Q

In up or down titration of a drug, what increment should be used?

A

The smallest possible - use BNF as a guide.

Unless toxicity is suspected.

47
Q

When aminophylline is prescribed in acute asthma attack, how is its effect monitored?

A

Improved oxygen saturations

48
Q

How is pneumonia treatment monitored?

A

Improvement in oxygen saturations, ABG, or RR.

Consolidation on a CXR may take up to 6 weeks

49
Q

How is DKA response to treatment monitored?

A

Serum ketones

50
Q

How is acute HF response to treatment with furosemide measured?

A

Weights

51
Q

Is a small rise in creatinine after initiation with ACEI normal?

A

Yes, repeat U&Es a week later

52
Q

In steroid induced hyperglycaemia, how Is insulin treatment changed?

A

Increase usual insulin dose by 10%

53
Q

What should INR be before surgery in patients on warfarin?

A

<1.5

If >1.5, give PO vitamin K

PSA (4 decks)

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