Drug monitoring Flashcards
What is the focus of the Drug Monitoring section of the PSA?
✅ Checking baseline tests before starting certain medications
✅ Regular monitoring of drug levels and side effects
✅ Identifying abnormal results and adjusting doses accordingly
✅ Managing toxicity and side effects of monitored drugs
Focuses on ensuring safe and effective medication management.
What is Therapeutic Drug Monitoring (TDM)?
Monitoring serum levels of drugs with a Narrow Therapeutic Index (NTI) to ensure effectiveness and avoid toxicity.
What is the target range for Lithium monitoring?
0.4–1.0 mmol/L (Check 5–7 days after dose change, then every 3 months)
What is the indication for monitoring Digoxin?
Heart failure, AF
What is the target range for Phenytoin monitoring?
10–20 mg/L (Check levels if toxicity suspected)
Fill in the blank: The target range for Carbamazepine monitoring is _______.
4–12 mg/L (Check after 1 week, then regularly)
What is the monitoring guidance for Theophylline?
10–20 mg/L (Monitor regularly, especially in smokers)
What are the trough and peak levels for Gentamicin?
Trough: <1 mg/L, Peak: 5–10 mg/L (Check before next dose)
What is the trough level for Vancomycin monitoring?
10–15 mg/L (Check before next dose)
What are the baseline tests required before starting ACE inhibitors?
U&Es (Check K+ and creatinine)
What is the baseline test required before starting Amiodarone?
TFTs, LFTs, CXR
What baseline tests are required for Methotrexate?
FBC, U&Es, LFTs
Fill in the blank: Statins require baseline tests for _______.
LFTs (Check ALT/AST)
What ongoing monitoring is required for Warfarin?
INR (Target 2–3, check weekly initially, then monthly)
What is the ongoing monitoring requirement for Heparin (LMWH)?
Anti-Xa levels in renal impairment/pregnancy
What monitoring is required for Diuretics like furosemide?
U&Es (Check Na+ and K+)
What renal function monitoring is required for Metformin?
Avoid if eGFR <30 mL/min
What is the ongoing monitoring requirement for Amiodarone?
TFTs, LFTs every 6 months
What is the action required if Lithium level is >1.5 mmol/L?
Withhold lithium, rehydrate, check renal function
What should be done if the INR is >5 on warfarin?
Omit warfarin, give vitamin K if bleeding risk
What action should be taken if there is a creatinine rise >30% on ACE inhibitors?
Stop ACEi if worsening renal function
What is the action if neutropenia occurs on methotrexate (WBC <3.5 x10⁹/L)?
Stop methotrexate, urgent FBC repeat
What is a key PSA tip for drug monitoring questions?
Know which drugs require monitoring and how often
True or False: DOACs require INR monitoring.
False
What should be done if there is hyponatraemia on SSRIs (Na+ <130 mmol/L)?
Stop SSRI, monitor sodium, consider switching medication
