High Risk Drugs Flashcards
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
