Drug Monitoring

Question 1

Statins

Answer 1

LFTS
- baseline
- 3 months
- 12 months

Question 2

ACEi

Answer 2

U&E
- prior to treatment
- after increasing dose
- annually

Question 3

Amiodarone

Answer 3

TFTs and LFTs
- every 6 months

• TFT, LFT, U&E, CXR prior to treatment

Question 4

Methotrexate

Answer 4

FBC, U&E, LFTs
- baseline
- weekly until therapy stabilised
- thereafter every 2-3 months’

Question 5

Azathioprine

Answer 5

FBC, LFT
- before treatment
- FBC weekly for the first 4 weeks
- both every 3 months

Question 6

Lithium

Answer 6

TFT, U&E
- prior to treatment
- every 6 months

LITHIUM level
- weekly until stabilised
- then every 3 months

Question 7

Sodium valproate

Answer 7

LFT, FBC
- before treatment
- LFT ‘periodically’ during first 6 months

Question 8

Glitazones

Answer 8

LFT
- before treatment
- ‘regularly’ during treatment

Question 9

When should a lithium level be taken? And what is normal range?

Answer 9

Lithium range = 0.4 - 1.0 mmol/l

Take 12 hrs post-dose

Question 10

When should a ciclosporin level be taken?

Answer 10

Trough levels immediately before dose

Question 11

When should you take a digoxin level?

Answer 11

at least 6 hrs post-dose

Question 12

When should phenytoin trough levels be measured?

Answer 12

• adjustment of dose
• suspected toxicity
• detection of non-compliance

Question 13

When should a gentamicin level be checked?

Answer 13

6-14 hours following the first dose

Question 14

When should a vancomycin level be checked?

Answer 14

Trough immediately before a dose
check within 48 hours of starting medication
DO NOT withhold next dose whilst waiting for trough to come back

Question 15

When should a tacrolimus level be checked?

Answer 15

Pre-dose trough