Drug monitoring

Question 1

CVS Drug Monitoring

• Statins
• ACEi
• Amiodarone

Answer 1

CVS Drug Monitoring

• Statins
  1. LFTs
• Baseline, 3 mo, 12 mo
• ACEi
  1. U&E prior
  2. U&E annual
  3. U&E after increase
• Amiodarone
  1. Prior TFT, LFT, U&E, CXR
  2. 6 monthly TFT, LFT

Question 2

Rheumatology drug monitoring

• Methotrexate
• Azathioprine

Answer 2

Rheumatology drug monitoring

• Methotrexate FBC, LFT, U&E
  1. Prior
  2. Weekly until stabilised
  3. 2-3 Monthly
• Azathioprine
  1. Prior FBC, LFT
  2. 4 weeks FBC
  3. 3 monthly FBC, LFT

Question 3

Psych drug monitoring

• Lithium
• Valproate

Answer 3

Psych drug monitoring

• Lithium
  1. Prior TFT, U&E
  2. Weekly levels until stable
  3. 6 monthly TFT, U&E
• Valproate
  1. Prior LFT, FBC
  2. Periodic LFT for 6 months

Question 4

Warfarin
- INR Responses

1. Major bleeding
2. INR 8
   - Minor bleed
   - No bleed
3. INR 5
   - Minor bleed
   - No bleed

Answer 4

Warfarin
- INR Responses

1. Major bleeding
   - Slow IV Vit K (Phytomenadione)
   - Prothrombin complex
2. INR 8
   a. Minor bleed
   - Slow IV Vit K

b. No bleed
- Oral vit K

3. INR 5
   a. Minor bleed
   - SLow IV Vit K

b. No bleed
- Withhold 1-2 doses