High risk drugs Flashcards
what are the monitoring requirements for vancomycin?
FBC Serum potassium Auditory function Renal function Urinalysis
What is the Target serum concentration for vancomycin?
10 - 15 mg/L for normal infection
15-20 mg/L for more serious infections
What are the warning sings of vancomycin?
Ototoxicity Nephrotoxicity Hypokalaemia Thrombophlebitis Red man syndrome Blood disorders such as thrombocytopenia or neutropenia
What are common interactions of vancomycin?
Increased risk of nephrotoxicity and ototoxicity if given with gentamicin, loop diuretics or ciclosporins
What bacteria is vancomycin commonly used against?
Gram positive aerobic and anaerobic bacteria including MRSA
What bacteria is gentamicin commonly used against?
Pseudomonas aeruginosa
What are the serum gentamicin concentration targets for single dose and multiple dose treatments?
Single dose:
- Peak is 5 -10mg/L
- Trough is <2mg/L
Multiple dose:
- Peak is 3-5mg/L
- Trough is <1mg/L
What are the common warning signs of gentamicin?
Nephrotoxicity Ototoxicity Thrombophlebitis Nausea and Vomiting C. Diff Blood disorders Seizures Peripheral neuropathy
What are the common interactions of gentamicin?
Increased risk of ototoxicity with loops and vancomycin
Increased risk of nephrotoxicity with ciclosporin, platinum chemotherapy, cephalosporins or vancomycin
In which patients should amiodarone be avoided?
Heart block
Hypotension
Active thyroid disease
What are the monitoring requirements of amiodarone?
LFT before starting treatment and every six month
Thyroid levels before starting treatment and every six month
Renal function
Chest X-ray
Serum K/Mg levels- can result in hyper
Eye test once a year
What are the warning signs of amiodarone?
Hypo/Hyper thyrodism Skin toxicity i.e. burns or grey skin discolouration Phototoxicity SOB Liver disease Neuropathy Bradycardia Taste disturbances N/V Sleep disorders
What are the usual therapeutic doses of digoxin?
AF= 125-250mcg OD HF= 62.5-125mcg OD
What are the target serum concentration of digoxin?
1 to 2 mcg
Dose measured after 6hrs of administration
What are the monitoring requirements of digoxin?
Electrolytes (hypo Mg/K/Ca can increase the risk of digoxin toxicity) Liver function Kidney function Heart rate (can't fall below 60 Bpm)
What are the warning sings of digoxin?
GI disturbances i.e. NV Visual disturbances i.e. yellow vision Bradycardia Rash Dizziness
What conditions are CI with digoxin?
Second-degree Heart block
Intermittent complete heart block
Ventricular arrhythmias
What drugs interact with digoxin can result in increased risk of hypokalaemia ?
Loops and thiazide diuretics
What drugs interact with digoxin can result in increased digoxin toxicity?
Amiodarone
CCB
Spironolactone
Quinine
What is phenytoin serum concentration target?
10-20mg/L
What are the monitoring requirements of phenytoin?
Liver function because phenytoin is highly protein bound
Vitamin D- phenytoin increases metabolism of vitamin D
FBC
Serum concentration
Phenytoin is an antifolate so folate concetration
What are the toxicity signs of phenytoin?
CV collapse Respiratory depression Suicidal thoughts Skin disorders Blood disorders Nystagmus Ataxia Low vitamin D- can result in osteomalacia "softening of the bones" Slurred speech Diplopia Slurred speech
What is carbamazepine serum concentration target?
4-12mg/L measured before administration of next dose
What are the warning sings of carbamazepine toxicity?
IHANDBAG Incoordination hyponatraemia Ataxia Nystagmus Drowsiness Blurred vision Arrhythmia GI disturbances
+ Oedema
What are the serum lithium concentration targets?
- 4 to 1 mg/l
- 4mg/l for elderly
- 5+ is toxic
What are the warning sings of lithium toxicity?
Apathy Restlessness Vomiting Diarrhoea Ataxia Hypernatremia Visual disturbances Cardiac arrhythmia Seizures
What are the monitoring requirements for lithium?
FBC Cardiac Renal Thyroid BMI Serum electrolyte i.e. sodium
What is the warfarin target for new onset VTE, AF, post MI?
2.5
What is the warfarin target for recurrent VTE or mechanical prosthetic heart valves?
3.5
What are the colours of the warfarin tablets?
0.5mg = white 1mg= brown 3mg= blue 5mg= pink
How long is the duration of treatment with warfarin for isolated calf DVT?
6 weeks
How long is the duration of treatment with warfarin for provoked DVT?
3 months
How long is the duration of treatment with warfarin for unprovoked DVT?
3months +
What are the warning signs of warfarin?
Signs of excessive bleeding Purple toes Rash/ Skin necrosis Diarrhoea/Vomiting Headaches/ Confusion Signs of thrombosis
What are the monitoring requirements of warfarin?
Clotting screen Liver function Renal function FBC BP Thyroid function
What is the plasma theophylline concentration target?
10-20mgL
Measured after starting or dose adjustment
What causes an increase in plasma theophylline concentration?
Heart failure
Hepatic impairment
Viral infections
What causes a decrease in plasma theophylline concentration?
Smoking
Alcohol
What are the warning signs of theophylline toxicity?
Hypokalaemia Hyperglycaemia Convulsion Hematemesis - throwing up blood Cardiac arrythmias Dilated pupils Restlessness Agitation Vomiting
What are the monitoring requirements of ciclosporins?
FBC Liver function Serum electrolytes Blood lipids Renal function Dermatological/ Physical examination
What are the warning signs of ciclosporins?
Liver toxicity Nephrotoxicity Neurotoxicity blood disorders hypertension Headache Gingival hyperplasia - overgrowth of gum Hyperkalaemia
What are the monitoring requirements for tacrolimus?
Blood glucose levels Liver function Kidney function Eyes Blood pressure ECG
What are the warning signs for tacrolimus toxicity?
Hyperglycaemia Hyperkalaemia Hyponatraemia Photophobia Liver toxicity Blood disorders CV disorders
