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Year 4 Prescribing > Drug Monitoring > Flashcards

Drug Monitoring Flashcards

1
Q

what are the monitoring requirements for lithium

A

lithium level every 3 months

thyroid and u and e every 6 months

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2
Q

what is the therapeutic range of lithium

A

0.4-1mmol/l

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3
Q

when do you take a lithium level

A

12 hours post dose

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4
Q

how do you monitor cyclosporin

A

take dose level immediately before dose (trough levek)

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5
Q

when do you take a digoxin level

A

6 hours post dose at least

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6
Q

how do you monitor phenytoin

A

you dont need to regularly monitor but check a level immediately before a dose (trough level) if

  • adjustment of phenytoin dose
  • suspected toxicity
  • detection of non-adherence to the prescribed medication
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7
Q

how do you monitor effectiveness of digoxin

A

ventricular rate at rest

take a level at least 6 hours post dose but this can be done immediately before next dose

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8
Q

what do you need to monitor with statins

A

LFTs at baseline, 3 months and 12 months

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9
Q

what do you need to monitor with ACEI

A

U&E prior to treatment
U&E after increasing dose
U&E at least annually

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10
Q

what do you need to monitor with amiodarone

A

TFT, LFT, U&E, CXR prior to treatment

TFT, LFT every 6 months

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11
Q

how do you monitor methotrexate

A

‘FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months’

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12
Q

how do you monitor azathioprine

A

FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months

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13
Q

how do you monitor lithium

A

TFT, U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT, U&E every 6 months

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14
Q

how do you monitor sodium valproate

A

LFT, FBC before treatment

LFT ‘periodically’ during first 6 months

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15
Q

how do you monitor glitazones

A

LFT before treatment

LFT ‘regularly’ during treatment

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16
Q

What monitoring tests are required for antipsychotics at the start of therapy

A

FBC uAnd E lft lipids weight fasting blood glucose prolactin BP ECG

17
Q

How often should patients on antipsychotics be given a cardiovascular risk assessment

A

Annually

18
Q

How often should BP be checked when on antipsychotics

A

Frequently during dose titration

19
Q

How often should a fasting blood glucose be taken when on an antipsychotic

A

At 6 mths then annually

20
Q

How often should a patient get their lipids and weight checked when on an antipsychotic

A

Start
At 3 mths
Then annually

21
Q

How often do patients on antipsychotics require monitoring of FBC U+E and LFT

A

At start and then annually

22
Q

What is the main thing requiring monitoring for clozapine

A

FBC frequently monitored (initially weekly)

23
Q

How often should BP be checked on the pill

A

Annually

24
Q

What are the contraindications to the pill which generally the disadvantages outweighs the advantages

A 
>35yo and smoking <15/day 
BMI>35 
Fx thromboembolic disease in first degree relative <45yo 
Controlled hypertension 
Immobility ie wheelchair use 
Brca gene mutations 
Current gallbladder disease
25
Q

What are absolute contraindications to the pill

A

> 35 and smoking >15/day
Migraine with aura
History of thromboembolic disease or thrombogenic mutation
History of stroke or ischaemic heart disease
Breast feeding and <6 weeks post partum
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation

26
Q

What chronic health condition when diagnosed >20 years ago poses a potential absolute contraindications to the COCP

A

Diabetes mellitus

27
Q

Which drugs should be avoided during breast feeding

A 
Ciprofloxacin tetracycline chloramphenicol sulphonamide 
Lithium benzos clozapine 
Aspirin 
Carbimazole
Methotrexate 
Sulphonylureas 
Cytotoxic drugs 
Amiodarone
28
Q

Can warfarin be given while breast feeding

A

Yea

29
Q

Can antiepilepfics and antipsychotics be used while breast feeding

A

Yeah apart from clozapine

30
Q

Can ibuprofen be given to breast feeding women

A

Yes used in mastitis

31
Q

Can you gove aspirin while breast feeding

A

No due to risk of Reye’s syndrome

32
Q

When can you give activated charcoal in paracetamol overdose

A

If they present within the first hour

33
Q

When should acetylcysteine be given regardless of the dose

A

If there is a staggered dose

Doubt over the ingestion time

34
Q

How long is acetylcystein infused over

A

1 hour

35
Q

When is an overdose considered staggered

A

If all tablets were not taken within one hour

Year 4 Prescribing (28 decks)

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