Data interpretation- intro to drug monitoring Flashcards
What are the commonest drugs which require monitoring?(5)
Gentamicin, vancomycin Digoxin Theophylline Lithium Phenytoin
Toxicity symptoms:
confusion, nausea, visual haloes, arrythmia
digoxin
Toxicity symptoms:
tremor, seizures, coma, diabetes insipidus
lithium
Toxicity symptoms:
gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, teratogenicity
phenytoin
Toxicity symptoms:
ototoxicity, nephrotoxicity
gentamicin, vancomycin
What are the indications for divided daily dosing in gentamicin? (2)
Endocarditis, renal failure
When is a peak gent level taken?
1h post dose
When is a trough gent level taken?
just before next dose
What is the toxic metabolite of paracetamol?
NAPQI
What does treatment with N-acetylcysteine achieve in paracetamol overdose?
Replenishes stores of glutathione, which reduces the formation of NAPQI
How is the paracetamol nomogram interpreted?
4 hours after ingestion- if plasma paracetamol above the line, treat with NAC
Under what other circumstances is treatment with NAC indicated, regardless of the paracetamol level? (2)
Staggered overdose, uncertainty over time of ingestion
Management of over anticoagulation:
a) INR <6
b) INR 6-8
c) INR >8
d) major bleed
a) reduce dose
b) omit for 2 days, then reduce dose
c) omit warfarin, oral vitamin K
d) stop warfarin, IV Vitamin K, prothrombin complex
What is the trade name for the commonest prothrombin complex?
Beriplex
Neutropenic sepsis protocol?
IV Piperacillin + tazobactam (Tazocin) and IV Gentamicin
