Drug monitoring Flashcards
RF for statin associated myopathy
PMHx or FHx of muscle disorders previous muscular toxicity high alcohol intake renal impairment hypothyroidism elderly
if high risk for statin associated myopathy what should be done to monitor pt?
baseline CK required prior to starting
what test should be done prior to starting vancomycin? and why?
creatinine
drug renally cleared - dosing altered if poor renal function prior to initiation
what should be checked prior to starting statins
LFTs
if AST or ALT 3x normal then statins are contraindicated
how are statins monitored?
3 and 12 months after starting do LFTS
monitor lipids for change
what is the normal range for lithium?
0.4-0.8 mmol/L
what level of lithium would you expect toxicity signs?
1.5 mmol/L
when should lithium levels be tested?
12 hours after last dose
how often should lithium levels be checked?
weekly after titration until stable, then 3 monthly
when should FBC be done during methotrexate treatment?
risk of blood dyscrasias
1-2 weekly until stable treatment
then 2-3 months
why do LFTs prior to methotrexate treatment?
deranged is a contraindicated
methotrexate hepatically metabolised
what should be monitored on olanzapine?
fasting blood glucose prior to starting
monitor blood glucose during treatment
what monitoring do women on combined OCP required?
annual review
in particular BP check as HTN increases risk of arterial disease associated with OCP use
what should be done prior to starting amiodarone treatment?
arrange for a baseline CXR
what is the peak serum concentration range for a multiple dose regimen of gentamicin?
3-5 mg/L
what is the trough serum concentration range for a multiple dose regiment of gentamicin?
< 1 mg/L
what needs to be checked prior to starting digoxin treatment and then throughout?
renal function (serum creatinine)
renally excreted, poor renal function is RF for toxicity
what should be monitored when on sodium valproate therapy?
LFT as hepatotoxic
what monitoring is required for clozapine?
FBC weekly for at least first 18 weeks
monitoring for statins
LFT
baseline, 3 months and 12 monthly
monitoring for ACEi
U&Es
prior to treatment
after increasing dose
at least annually if on stable dose
monitoring for amiodarone
TFT, LFT
TFT, LFT, U&E + CXR prior to starting
TFT, LFT every 6/12
methotrexate monitoring
CXR before starting
FBC, LFT, U&E - prior to starting then weekly till stabilised then every 2-3/12
monitoring for azathioprine
FBC, LFT before
FBC weekly for the first 4 weeks
FBC, LFT every 3 months
