Drug monitoring

Question 1

Baseline test before commencing vancomycin?

Answer 1

Creatinine

Question 2

Baseline test before commencing simvastatin?

Answer 2

Serum ALT- hepatic impairment increases the chance of statins causing myopathy.

Question 3

How is phenytoin therapy monitored?

Answer 3

Pre-dose trough phenytoin levels

Question 4

Recommended sampling time for lithium monitoring?

Answer 4

12 hours post dose

Question 5

Toxic effects of lithium are likely to manifest at what serum concentration?

Answer 5

Above 1.5mmol/L

Question 6

How often is routine Li level monitoring carried out?

Answer 6

Weekly after initiation and each dose change until concentrations are stable, then 3-monthly afterwards

Question 7

What dietary change increases the risk of lithium toxicity?

Answer 7

Sodium depletion

Question 8

How is methotrexate excreted?

Answer 8

Renally

Question 9

Baseline test for olanzapine? (3)

Answer 9

Fasting blood glucose, lipids, prolactin

Question 10

Amiodarone monitoring requirements? (2)

Answer 10

Baseline and 6-monthly thyroid function tests

Baseline chest X ray

Question 11

For multiple daily dosing regimen in gentamicin, what should the 1hr peak serum concentration be?

Answer 11

3-5 mg/L

Question 12

Monitoring for ACE inhibitors?

Answer 12

Serum urea and electrolytes- due to risk of hyperkalaemia, hyponatraemia, AKI

Question 13

Digoxin monitoring?

Answer 13

Serum creatinine, U&Es. Digoxin is renally excreted and renal impairment increases risk of toxicity

Question 14

Valproate monitoring?

Answer 14

Liver function tests, valproate associated with hepatotoxicity

Question 15

Clozapine monitoring?

Answer 15

All patients required to be registered with clozapine monitoring service- weekly FBC for first 18 weeks