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Monitoring Flashcards

1
Q

What risk are statins associated with?

A

Myopathy

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2
Q

What are the classic side effects of vancomycin?

A

Ototoxicity and nephrotoxicity

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3
Q

What is a rare side effect of vancomycin?

A

Thrombocytopenia and neutropenia

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4
Q

What do you check before starting statins in patients with risk factors for myopathy

A

Creatinine kinase

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5
Q

What do you check before starting statins for patients with no risk factors for myopathy? Why?

A

Statins are metabolised by the liver, so contraindicated in liver disease or 3x normal transaminases (ALT and AST)

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6
Q

How often should LFTs be checked after starting statins?

A

At 3 months, then 12 months

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7
Q

What longterm complication is methotrexate associated with?

A

Liver cirrhosis

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8
Q

How is methotrexate excreted?

A

Renally

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9
Q

How does sodium depletion affect lithium?

A

Increases risk of toxicity

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10
Q

What can carbimazole cause?

A

Acute pancreatitis

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11
Q

What should be measured in a thyroid assessment for patients on amiodarone?

A

T3, TSH and T4

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12
Q

What is a known side effect of amiodarone?

A

Raised serum transaminases and acute liver dysfunction

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13
Q

How is gentamicin excreted?

A

Renally so monitoring is required

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14
Q

How does hypokalaemia affect digoxin?

A

Increases the risk of toxicity

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15
Q

What can valproate cause?

A

Pancreatitis

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16
Q

What is sodium valproate associated with?

A

Hepatotoxicity

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17
Q

How should FBC be monitored for clozapine?

A

Weekly for first 18 weeks, then fortnightly for up to one year, and then monthly

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18
Q

What are the causes of microcytic anaemia?

A

Iron deficiency
Thalassaemia
Sideroblastic anaemia

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19
Q

What are the causes of normocytic anaemia?

A

Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure (chronic)

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20
Q

Causes of macrocytic anaemia

A 
B12/folate deficiency
Excess alcohol
Liver disease
Hypothyrodism
Myleloproliferative, myelodysplastic, multiple myeloma
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21
Q

What are the causes of high neutrophils?

A

Bacterial infection
Tissue damage
Steroids

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22
Q

Causes of low neutrophils

A

Viral infection
Chemotherapy or radiotherapy
Clozapine
Carbimazole

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23
Q

Causes of high lymphocytes

A

Viral infection
Lymphoma
Chronic lymphocytic leukemia

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24
Q

Causes of thrombocytopenia

A 
Reduced production:
infection
drugs (penicillamine)
myelodysplasia, myelofibrosis
myeloma

Increased destruction:
Heparin
Hypersplenism
DIC
ITP
Haemolytic uraemic syndrome / thrombotic thrombocytopenic purpura
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25
Causes of thrombocytosis
``` Reactive: bleeding tissue damage Primary: myeloproliferative disorders ```
26
When would you discontinue statins in someone with no myalgia risk factors?
serum transaminases can be raised by up to 3x the upper limit of normal before statins should be discontinued
27
Causes of hypovolaemic hyponatraemia
Fluid loss Addison's disease Diuretics
28
Causes of euvolaemic hyponatraemia
SIADH Psychogenic polydipsia Hypothyrodism
29
Causes of hypervolaemic hyponatraemia
``` Heart failure Renal failure Liver failure Nutritional failure Thyroid failure ```
30
Causes of SIADH?
Remember SIADH!! ``` Small cell lung tumours Infection Abscess Drugs (carbamazepine and antipsychotics) Head injury ```
31
Causes of hypokalaemic
DIRE Drugs (loop and thiazide diuretics) Inadequate intake or intestinal loss (diarrhoea/vomiting) Renal tubular acidosis Endocrine (Cushing's and Conn's syndromes)
32
Causes of hyperkalaemic
DREAD Drugs (potassium sparing diuretics and K sparing diuretics) Endocrine (Addison's disease) Artefact (clotted samples) DKA (however, this drops when given insulin so requires hourly monitoring)
33
What does raised urea indicate?
Kidney injury or upper GI haemorrhage. (Urea is a product of amino acid breakdown). If patient is not dehydrated and creatinine is normal, suspect upper GI bleed and check Hb)
34
Causes of prerenal AKI
Dehydration Renal artery stenosis Indicated by urea rise >> creatinine rise
35
Causes of intrinsic renal AKI
INTRINSIC ``` Ischaemic (due to prerenal AKI causing acute tubular necrosis) Nephrotoxic antibiotics Tablets (ACEi, NSAIDS) Radiological contrast Injury (rhabdomyolisis) Negatively bifringent crystals (gout) Syndromes (glomerulonephridities) Inflammation (vasculitis) Cholesterol emboli ``` Urea rise << creatinine rise Bladder or hydronephrosis not palpable
36
Post-renal AKI
In lumen: stone or sloughed papilla In wall: tumour (renal cell, transitional cell), fibrosis External pressure: BPH, prostate cancer, lymphadenopathy, aneurysm. Urea rise << creatinine rise. Bladder or hydronephrosis may be palpable
37
What does raised urea alone indicate?
Pre-renal AKI or upper GI bleed
38
What does raised bilirubin alone indicate?
Pre-hepatic dysfunction Haemolysis or gilberts or crigler-najjar syndrome
39
What does raised bilirubin and AST/ALT indicate?
Intrahepatic problem ``` Fatty liver hepatitis cirrhosis malignancy wilson's disease or haemochromatosis Heart failure causing hepatic congestion ```
40
What does high bilirubin and ALP indicate?
Posthepatic (obstructive) picture. In lumen: stone (gallstone) or drugs causing cholestasis In wall: tumour (cholangiocarcinoma), primary biliary cirrhosis, schlerosing cholangitis Extrinsic pressure: pancreatic or gastric cancer, lymph node
41
What can cause hepatitis or cirrhosis?
Alcohol Viruses (Hep A-E, CMV and EBV) Drugs (paracetamol overdose, statins, rifampicin) Autoimmune (primary biliary cirrhosis, primary schlerosing cholangitis, and autoimmune hepatitis)
42
What drugs cause cholestasis?
Flucloxacillin, co-amoxiclav, nitrofurantoin, steroids, and sulphonyureas
43
What are common causes of a high ALP?
ALK PHOS ``` Any fracture Liver damage (posthepatic) Kancer Pagets disease of bone and Pregnancy Hyperparathyrodism Osteomalacia Surgery ```
44
What is the target range for TSH?
0.5 - 5
45
What are causes of primary hypothyrodism?
Hashimoto's thyroditis | Drug-induced hypothyrodism
46
What are causes of secondary hypothyrodism?
Pituitary damage or tumour
47
What are causes of primary hyperthyrodism?
Grave's disease Toxic multi-nodular goitre Drug-induced
48
What are the causes of secondary hyperthyrodism?
Pituitary tumour
49
What are the most common drugs with narrow therapeutic indexes?
Phenytoin, gentamicin, warfarin, lithium, theophylline, digoxin, vancomycin.
50
What are the signs of digoxin toxicity?
Confusion, nausea, visual halos, and arrythmias
51
What are the signs of lithium toxicity?
Early: tremour Intermediate: tiredness Late: arrythmias, seizures, coma, renal failure, and diabetes insipidus
52
What are the signs of phenytoin toxicity?
Gum hypertrophy, ataxia, nystamus, peripheral neuropathy, and teratogenicity
53
What are the signs of vancoymcin and gentamicin toxicity?
Ototoxicity and nephrotoxicity
54
What is the normal range for genamicin (not in infective endocarditis)
Peak: 5-10 Trough: <2
55
What is the normal range for gentamicin in infective endocarditis?
Peak: 3-5mg Trough: <1
56
What do you do if peak gentamicin is out of range?
Adjust dose
57
What do you do if trough gentamicin is out of range?
Adjust dose interval
58
What do you do for a major bleed on warfarin?
Stop warfarin Give 5-10mg vitamin K Give prothrombin complex
59
What do you do if the INR is 5-8?
If not bleeding, omit warfarin for 2 days then reduce dose. If bleeding, omit warfarin and give vitamin K IV
60
What do you do if INR is over 8?
Omit warfarin and give PO vitamin K if not bleeding

medicine emergency (3 decks)

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