Drug monitoring

Question 1

when do you measure the levels of ciclosporin

Answer 1

trough levels immediately before dose

Question 2

what and when is needed for monitoring of statins

Answer 2

LFTs at baseline, 3 months and 12 months

Question 3

what is the range for lithium

Answer 3

0.4-1

Question 4

when to measure lithium levels

Answer 4

12 hours post dose

Question 5

when to measure levels digoxin

Answer 5

at least 6 hours post dose

Question 6

when to measure phenytoin levels

Answer 6

trough levels, if adjusting dose or suspected toxicity

Question 7

monitoring ACEi

Answer 7

U&E prior to treatment, after adjusting dose, at least annually

Question 8

monitoring amiodarone

Answer 8

TFT, LFT, U&E, CXR prior to treatment. TFT and LFT every 6 months

Question 9

monitoring methotrexate

Answer 9

FBC, U&E, LFT before treatment and repeated weekly until therapy stabilised, then every 2-3 months

Question 10

monitoring azathioprine

Answer 10

FBC, LFT before treatment, FBC weekly for first month, FBC LFT every 3 months

Question 11

monitoring lithium

Answer 11

TFT, U&E before treatment, lithium levels weekly until stabilised then every 3 months

Question 12

monitoring sodium valproate

Answer 12

LFT, FBC every 6 months. LFT periodically for 6 months

Question 13

monitoring glitazones

Answer 13

LFT before treatment and during treatment

Question 14

what should be measured in patient taking vancomycin

Answer 14

creatinine to check for renal dysfunction

Question 15

when are statins contraindicated

Answer 15

if AST/ALT over 3x normal range

Question 16

how is methotrexate excreted

Answer 16

mainly renally so toxicity more likely in renal dysfunction

Question 17

monitoring with olanzapine

Answer 17

fasting blood sugars measured at baseline and regular intervals due to risk of hyperglycaemia and diabetes. FBC every year

Question 18

monitoring clozapine

Answer 18

FBC checked weekly for first 18 weeks. registration with clozapine monitoring service for all patients

Question 19

what needs to be monitored when starting phenytoin infusion

Answer 19

cardiac monitoring due to its pro arrthymogenic effects

Question 20

when should you check theophylline levels

Answer 20

18hours after starting Rx or of concerns of toxicity

Question 21

when does the dose/ dose interval need to be changed when the patient is on gentamicin

Answer 21

if the peak is too high- reduce dose. if the trough is too high- lengthen dose interval

Question 22

what should be monitored when starting an aminosalicylate eg mesalazine

Answer 22

U&Es before starting, 3months and every year