Drug monitoring

Question 1

What investigation needs to be done in all patients BEFORE starting antipsychotics

Answer 1

BM (antipsychotics particularly olanzapine can cause hyperglycaemia)

Baseline ECG if patient with cardiovascular disease/ associated risk factors

Question 2

Most important MONITORING test for digoxin

Answer 2

Digoxin = Serum creatinine (need to monitor renal dysfunction)

Note: plasma digoxin concentration is not measured unless toxicity or inadequate effect suspected

Question 3

Most important MONITORING test for valproate

-When is this done?

Answer 3

Valproate = LFTs

Before starting and during first 6 months

Question 4

What MONITORING investigations needs to be done in all patients on antipsychotics

Answer 4

1. Serum prolactin (at start, 6months, then annually)
2. Fasting BM
3. ECG, BP, CVS risk assessment
4. FBC, UnEs, LFTs
5. Weight

Question 5

Who needs to register with a clozapine monitoring service

Answer 5

All patients on clozapine

Question 6

What drug is used to reverse heparin

Answer 6

Protamine

Question 7

What MONITORING investigation is most appropriate for checking the benefits of heart failure drugs

Answer 7

Heart failure = Exercise tolerance

BNP is too expensive to be done as serial monitoring tests

Question 8

What MONITORING investigation is most appropriate for ruling out adverse effects of ciclosporin

Answer 8

Ciclosporin = Serum creatinine

Most serious adverse effect is nephrotoxicity

Question 9

What MONITORING investigation is required for lithium

Answer 9

TFTs
UnEs
(And lithium levels weekly until stabilised)

Question 10

MONITORING investigation to assess therapeutic effect of aminophylline

Answer 10

Aminophylline = O2 sats