Drug Monitoring Flashcards
what are the monitoring requirements for lithium
lithium level every 3 months
thyroid and u and e every 6 months
what is the therapeutic range of lithium
0.4-1mmol/l
when do you take a lithium level
12 hours post dose
how do you monitor cyclosporin
take dose level immediately before dose (trough levek)
when do you take a digoxin level
6 hours post dose at least
how do you monitor phenytoin
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
how do you monitor effectiveness of digoxin
ventricular rate at rest
take a level at least 6 hours post dose but this can be done immediately before next dose
what do you need to monitor with statins
LFTs at baseline, 3 months and 12 months
what do you need to monitor with ACEI
U&E prior to treatment
U&E after increasing dose
U&E at least annually
what do you need to monitor with amiodarone
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
how do you monitor methotrexate
‘FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months’
how do you monitor azathioprine
FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months
how do you monitor lithium
TFT, U&E prior to treatment
Lithium levels weekly until stabilised then every 3 months
TFT, U&E every 6 months
how do you monitor sodium valproate
LFT, FBC before treatment
LFT ‘periodically’ during first 6 months
how do you monitor glitazones
LFT before treatment
LFT ‘regularly’ during treatment
What monitoring tests are required for antipsychotics at the start of therapy
FBC uAnd E lft lipids weight fasting blood glucose prolactin BP ECG
How often should patients on antipsychotics be given a cardiovascular risk assessment
Annually
How often should BP be checked when on antipsychotics
Frequently during dose titration
How often should a fasting blood glucose be taken when on an antipsychotic
At 6 mths then annually
How often should a patient get their lipids and weight checked when on an antipsychotic
Start
At 3 mths
Then annually
How often do patients on antipsychotics require monitoring of FBC U+E and LFT
At start and then annually
What is the main thing requiring monitoring for clozapine
FBC frequently monitored (initially weekly)
How often should BP be checked on the pill
Annually
What are the contraindications to the pill which generally the disadvantages outweighs the advantages
>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
What are absolute contraindications to the pill
> 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
What chronic health condition when diagnosed >20 years ago poses a potential absolute contraindications to the COCP
Diabetes mellitus
Which drugs should be avoided during breast feeding
Ciprofloxacin tetracycline chloramphenicol sulphonamide Lithium benzos clozapine Aspirin Carbimazole Methotrexate Sulphonylureas Cytotoxic drugs Amiodarone
Can warfarin be given while breast feeding
Yea
Can antiepilepfics and antipsychotics be used while breast feeding
Yeah apart from clozapine
Can ibuprofen be given to breast feeding women
Yes used in mastitis
Can you gove aspirin while breast feeding
No due to risk of Reye’s syndrome
When can you give activated charcoal in paracetamol overdose
If they present within the first hour
When should acetylcysteine be given regardless of the dose
If there is a staggered dose
Doubt over the ingestion time
How long is acetylcystein infused over
1 hour
When is an overdose considered staggered
If all tablets were not taken within one hour
