High Risk Drugs Flashcards
(14 cards)
When should lithium levels be taken? How frequently should they be monitored?
12 hours post dose
Weekly on initiation and after dose changes until stable, then 3-monthly for 1 year, then 6-monthly thereafter
What is the target lithium concentration?
0.4-1mmol/L (lower end in elderly)
What should be assessed and measured before initiating lithium?
Assess: Renal, cardiac and thyroid function
Measure: Body weight or BMI, serum electrolytes, and FBC
How should you manage acute severe hyperkalaemia?
Calcium chloride 10% or calcium gluconate 10% to temporarily protect against myocardial excitability
IV soluble insulin (5-10units) with 50ml glucose 50%
Salbutamol nebuliser or slow IV injection
What k+ level indicates severe hyperkalaemia?
6.5mmol/L
What are the severe side effects of methotrexate?
Bone marrow suppression
Gastrointestinal toxicity (withdraw if stomatitis or diarrhoea develops)
Liver toxicity
Pulmonary toxicity
Can methotrexate be used in pregnancy?
No - teratogenic
What pre-treatment screening should take place beee initiating methotrexate?
FBC, renal and liver function
What monitoring is required for methotrexate?
FBC, renal and liver function every 1-2 weeks until stablised then every 2-3 months
Report symptoms of infection - especially sore throat
What OTC medications should be avoided if taking methotrexate?
Aspirin and NSAIDs
When should digoxin levels be taken?
6 hours post-dose
What should be monitored when taking digoxin?
Electrolytes and renal function
What is the MHRA warning for sodium valproate?
Risk of suicidal thoughts
Teratogenic - PPP programme required for women and girls of child-baring age
What are the severe side effects of valproate?
Liver toxicity
Pancreatitis
