Drug monitoring

Question 1

what are risk factors for myopathy in those on statin therapy

Answer 1

RFs: personal/FHx, muscular disorders, hx of muscular toxicity, high alcohol, renal impairment, hypothyroidism, elderly

Question 2

what to measure for statin myopathy in those with risk factors

Answer 2

CK

Question 3

what to measure for statin myopathy in those with NO risk factors

Answer 3

ALT

Question 4

statin monitoring

Answer 4

Check LFTs at 3 and 12m

Question 5

When to stop taking a statin

Answer 5

stop if taking a macrolide

+ caution in CYP inducers (ZAG DEVICES)

Question 6

when is a statin CI

Answer 6

Active liver disease, ALT/AST <3x normal

Question 7

does phenytoin need monitoring

Answer 7

NO (only check if adjusting dose, suspected toxicity, suspected non-adherence)

Question 8

ciclosporin monitoring

Answer 8

trough levels immediately before dose

Question 9

lithium monitoring

Answer 9

sample 12h after last dose

• monitor weekly after 1st dose/change until stable
• and every 3m

Question 10

lithium therapeutic range + toxic effects

Answer 10

therapeutic range 0.4-0.8
toxic effects >1.5
low Na+ –> higher lithium toxicity risk

Question 11

what to use as anti-hypertensive with lithium

Answer 11

CCBs (amlodipine)
NOT ACEi, thiazides, loops
NO NSAIDs

Question 12

methotrexate monitoring

Answer 12

FBC, U+E, LFTs every 2-2wks until stable
then FBC, U+E, LFTs every 2-3 months
usu taken ONCE A WEEK

Question 13

when should a statin be taken

Answer 13

ONCE AT NIGHT

Question 14

methotrexate important to tell pts

Answer 14

REPORT SORE THROATS/INFECTIONS

Question 15

methotrexate imp CI

Answer 15

abnormal LFTs

Question 16

how often should methotrexate be taken

Answer 16

Once a week

Question 17

Antipsychotics Monitoring at 0m (5 things)

Answer 17

1. ECG (if RF for CVD)
2. Prolactin
3. Lipids
4. Weight
5. BMs

Question 18

Antipsychotics Monitoring at 1m

Answer 18

4. Weight

5. BMs

Question 19

Antipsychotics Monitoring at 3m

Answer 19

3. Lipids

4. Weight

Question 20

Antipsychotics Monitoring at 6m

Answer 20

2. Prolactin
3. Lipids
4. Weight
5. BMs

Question 21

Antipsychotics Monitoring Yearly

Answer 21

2. Prolactin
3. Lipids
4. Weight
5. BMs

Question 22

OCP monitoring

Answer 22

BP montioring (na+ retention) 
BMI monitoring

Question 23

what is the risk with OCP + HTN

Answer 23

increased arterial disease risk

Question 24

Amiodarone what 4 things to monitor at baseline

Answer 24

1. CXR
2. TFTs (TSH, T3,T4)
3. LFTs
4. K+ (commence with caution if LOW due to incr risk of arrhythmias)

Question 25

Amiodarone and renal ftn link

Answer 25

does NOT affect renal ftn but should be adjusted to renal ftn SO no need to check renal ftn before starting

Question 26

Carbimazole monitoring

Answer 26

FBC (neutrophils) --> agranulocytosis due to BM supression

Question 27

Gentamicin/Vancomycin IV monitor whwat 3 things

Answer 27

U&E Auditory monitoring Vestibular monitoring

Question 28

Gentamicin/Vancomycin IV SEs

Answer 28

renal toxicity | ototoxicity

Question 29

Gentamicin IV what is the 1 hour peak + pre-dose trough you want for most ppl

Answer 29

1 hour peak 5-10mg/L | Pre-dose trough <2mg/L

Question 30

Gentamicin IV what is the 1 hour peak + pre-dose trough you want for ENDOCARDITIS pts

Answer 30

1 hour peak 3-5mg/L | Pre-dose trough <1mg/L

Question 31

Gentamicin IV what to do IF high 1 hour PEAK

Answer 31

reduce dose

Question 32

Gentamicin IV what to do if HIGH TROUGH

Answer 32

INCR interval bet doses ie stop

Question 33

ACEi monitoring

Answer 33

U&Es (creatinine, K+) | -monitor at baseline and after dose changes

Question 34

SE of ACEi

Answer 34

``` high K+ low Na+ AKI - it is CI in RAS BUT it is GOOD IN CKD cough angioedema (months later) ```

Question 35

CI of ACEi (x1)

Answer 35

AORTIC STENOSIS

Question 36

Digoxin Monitoring x2 things

Answer 36

U&Es (creatinine, K+) | Levels at least 6 hours post dose (IV)

Question 37

Digoxin excreted from where

Answer 37

KIDNEYS | so you need to check for renal dysftn

Question 38

what electrolyte abnormality leads to digoxin toxicity

Answer 38

LOW K+

Question 39

Sodium valproate monitoring + WHEN

Answer 39

LFTs (ALT, before + during first 6m) | associated with hepatotoxicity so LFTs monitoring at baseline + regular intervals

Question 40

SV SEs

Answer 40

Pancreatitis

Question 41

Clozapine what to monitor and who to register with

Answer 41

FBC risk of agranulocytosis (BM supression) | + register with clozapine monitoring clinic

Question 42

Clozapine when to monitor FBC

Answer 42

First 18 weeks --> every 1 week 18 weeks - 1 YR --> every 2 weeks >1YR --> every month

Question 43

when to stop clozapine

Answer 43

leucocytes <3000 cells/mm3 | neutrophils <1500 cells/mm3

Question 44

what can thiazides cause

Answer 44

DYSLIPIDAEMIA , not in eGFR <30

Question 45

what happens if you use furosemide + lithium together

Answer 45

INCR lithium concentration (as less renal excretion of lithium)