Drug monitoring Flashcards
what are risk factors for myopathy in those on statin therapy
RFs: personal/FHx, muscular disorders, hx of muscular toxicity, high alcohol, renal impairment, hypothyroidism, elderly
what to measure for statin myopathy in those with risk factors
CK
what to measure for statin myopathy in those with NO risk factors
ALT
statin monitoring
Check LFTs at 3 and 12m
When to stop taking a statin
stop if taking a macrolide
+ caution in CYP inducers (ZAG DEVICES)
when is a statin CI
Active liver disease, ALT/AST <3x normal
does phenytoin need monitoring
NO (only check if adjusting dose, suspected toxicity, suspected non-adherence)
ciclosporin monitoring
trough levels immediately before dose
lithium monitoring
sample 12h after last dose
- monitor weekly after 1st dose/change until stable
- and every 3m
lithium therapeutic range + toxic effects
therapeutic range 0.4-0.8
toxic effects >1.5
low Na+ –> higher lithium toxicity risk
what to use as anti-hypertensive with lithium
CCBs (amlodipine)
NOT ACEi, thiazides, loops
NO NSAIDs
methotrexate monitoring
FBC, U+E, LFTs every 2-2wks until stable
then FBC, U+E, LFTs every 2-3 months
usu taken ONCE A WEEK
when should a statin be taken
ONCE AT NIGHT
methotrexate important to tell pts
REPORT SORE THROATS/INFECTIONS
methotrexate imp CI
abnormal LFTs
how often should methotrexate be taken
Once a week
Antipsychotics Monitoring at 0m (5 things)
- ECG (if RF for CVD)
- Prolactin
- Lipids
- Weight
- BMs
Antipsychotics Monitoring at 1m
- Weight
5. BMs
Antipsychotics Monitoring at 3m
- Lipids
4. Weight
Antipsychotics Monitoring at 6m
- Prolactin
- Lipids
- Weight
- BMs
Antipsychotics Monitoring Yearly
- Prolactin
- Lipids
- Weight
- BMs
OCP monitoring
BP montioring (na+ retention) BMI monitoring
what is the risk with OCP + HTN
increased arterial disease risk
Amiodarone what 4 things to monitor at baseline
- CXR
- TFTs (TSH, T3,T4)
- LFTs
- K+ (commence with caution if LOW due to incr risk of arrhythmias)
Amiodarone and renal ftn link
does NOT affect renal ftn
but should be adjusted to renal ftn
SO no need to check renal ftn before starting
Carbimazole monitoring
FBC (neutrophils) –> agranulocytosis due to BM supression
Gentamicin/Vancomycin IV monitor whwat 3 things
U&E
Auditory monitoring
Vestibular monitoring
Gentamicin/Vancomycin IV SEs
renal toxicity
ototoxicity
Gentamicin IV what is the 1 hour peak + pre-dose trough you want for most ppl
1 hour peak 5-10mg/L
Pre-dose trough <2mg/L
Gentamicin IV what is the 1 hour peak + pre-dose trough you want for ENDOCARDITIS pts
1 hour peak 3-5mg/L
Pre-dose trough <1mg/L
Gentamicin IV what to do IF high 1 hour PEAK
reduce dose
Gentamicin IV what to do if HIGH TROUGH
INCR interval bet doses ie stop
ACEi monitoring
U&Es (creatinine, K+)
-monitor at baseline and after dose changes
SE of ACEi
high K+ low Na+ AKI - it is CI in RAS BUT it is GOOD IN CKD cough angioedema (months later)
CI of ACEi (x1)
AORTIC STENOSIS
Digoxin Monitoring x2 things
U&Es (creatinine, K+)
Levels at least 6 hours post dose (IV)
Digoxin excreted from where
KIDNEYS
so you need to check for renal dysftn
what electrolyte abnormality leads to digoxin toxicity
LOW K+
Sodium valproate monitoring + WHEN
LFTs (ALT, before + during first 6m)
associated with hepatotoxicity so LFTs monitoring at baseline + regular intervals
SV SEs
Pancreatitis
Clozapine what to monitor and who to register with
FBC risk of agranulocytosis (BM supression)
+ register with clozapine monitoring clinic
Clozapine when to monitor FBC
First 18 weeks –> every 1 week
18 weeks - 1 YR –> every 2 weeks
>1YR –> every month
when to stop clozapine
leucocytes <3000 cells/mm3
neutrophils <1500 cells/mm3
what can thiazides cause
DYSLIPIDAEMIA , not in eGFR <30
what happens if you use furosemide + lithium together
INCR lithium concentration (as less renal excretion of lithium)
