Monitor that drug!

Question 1

Loop Diuretics

Answer 1

Electrolytes

Question 2

Digoxin

Answer 2

Plasma digoxin concentration if toxicity suspected
Serum Electrolytes
Renal Function (e.g. creatinine)

Question 3

ACEi

Answer 3

Renal function and electrolytes before and during tx

Question 4

ARBs

Answer 4

Plasma K+ Conc (esp in elderly and renal impairment)

Question 5

Thiazide Diuretics

Answer 5

Electrolytes during tx

Question 6

K+ Sparing Diuretics

Answer 6

Electrolytes during tx
In HF check K+ and Creatinine regularly

Question 7

Loop Diuretics

Answer 7

Electrolytes during tx

Question 8

Statins

Answer 8

Before: Full lipid profile, TSH, renal function, liver function (ALT & AST)
During: Liver function
Don’t start if v raised CK

Question 9

Warfarin

Answer 9

Base line PT before starting
INR

Question 10

Antipsychotics

Answer 10

Prolactin at 0, 6 and 12 months.

Question 11

Olanzapine

Answer 11

Blood lipids at baseline, 3m then yearly
Weigh regularly during first 3m then yearly
Fasting BM at 0, 1m, 6m, yearly

Question 12

Clozapine

Answer 12

Leucocyte and differential WBC testing weekly for 18 weeks then fortnightly for up to 1 yr then monthly.

Blood lipids, weight and fasting BM should also be monitored

Question 13

Lithium

Answer 13

Before: Renal, cardiac, thyroid function, BMI, serum electrolytes, FBC
During: serum conc 12hrs after dose weekly until stable then every 3m
+ BMI / electrolytes / eGFR / thyroid every 6 months.

Question 14

Nitrofurantoin

Answer 14

LFTs if on long term therapy

Question 15

Methotrexate

Answer 15

FBC, renal and liver function every 1 - 2 weeks whilst stabilising tx then every 3m.
Don’t start tx if LFTS abnormal

Question 16

Sulfasalazine / Aminosalicylates

Answer 16

Renal function before and every 3m during then yearly
FBC and LFTs before and every month for 3m

Question 17

Hydroxychloroquine

Answer 17

Annual eye checks if been on for > 5yrs

Question 18

Metformin

Answer 18

Renal function before and annually (2 x a year if other RF)

Question 19

Alendronic acid

Answer 19

Correct Ca and Vit D prior to starting
Monitor serum Ca conc during tx

Question 20

Zoledronic acid

Answer 20

Correct Ca and Vit D prior to starting
Monitor serum electrolytes, Ca, phosphate and Mg during
Renal function in those at risk

Question 21

When should gentamicin levels be checked?

Answer 21

OD regimen:
Trough @ 6 - 14 hrs post dose or 1hr pre next dose.

Multiple dose regimen:
1 hr pre and 1 hr post dose

Question 22

What needs to be checked prior to and during vancomycin / gentamicin?

Answer 22

renal function

Question 23

What do you measure for dose adjustment of vancomycin?

Answer 23

Creatinine clearance NOT eGFR

Question 24

When do you measure serum IV vancomycin levels?

Answer 24

36 - 72hrs in to treatment (between 3rd and 6th dose)

Oral do not need testing

Question 25

What needs to be measured for amiodarone?

Answer 25

Baseline CXR
T3 and T4 during tx
monitor LFTs before and during
Commence with caution in those with hypokalaemia (serum K+ before tx)
Renal function does not need to be checked.

Question 26

Monitoring sodium valporate?

Answer 26

LFTs prior to and during tx