data intepretation questions

Question 1

when you’re shown a drug dose / level and the question is asking whether you should change it or not there are a few key things to consider.

Answer 1

1. Are you at the maximum dose already? because if you are, even if the level is subtherapeutic- you cannot increase it.
2. Is it really out of range, i.e., warfarin target may be 3.5 but if they’re 3 you dont actually need to change it. BNF says this under target INR: “An INR which is within 0.5 units of the target value is generally satisfactory”
3. Are they showing signs of toxicity? some drugs can be toxic even if theyre within the theurapeutic range i.e., digoxin, lithium, phenytoin, ciclosporin, tacrolimus, carbamezapine.
4. Liver function
5. Renal function
6. drug interactions- have they just started an enzyme inducer/inhibitor.