Monitoring Drug Therapy Flashcards
Why do we monitor
aids diagnosis
allows us to assess severity of disease
what does it allow us to do
allows us to review response to treatment
dose adjustments identified can be made
What are two main categories of monitoring
bloods tests and clinical observations
what blood tests can be taken
urea and electrolytes
haematology
renal function
liver function
cardia enzymes
TDM
what clinical observations can be taken
BP and pulse
Oxygen saturations
Respiratory rate
Urine output
Fluid balance
Daily weights
Pain score
Blood Glucose
Temperature
what do electrolyte help indicate
Renal function
Hydration status
Assess disease status
Identify possible ADRs
what do abnormal levels of sodium indicate
water loss
how does sodium indirectly affect blood pressure
low sodium level is associated with hypotension conversely a large intake of salt from the diet can cause hypertension
what is hypernatraemia
Na+ > 146mmol/L
what are the main causes of hypernatraemia
insufficient fluid intake
excessive water loss
what can hypernatremia be caused by
sodium retention
excess adrenocorticoid
pharmacological agents
what are the consequences of Hypernatraemia
CNS changes from lethargy stupor to deep coma
Dependant on level >170 mmol/l life threatening
symptoms may include: fever, tachycardia, hypertension, dizziness, increased thirst, oedema
How can hypernatraemia be treated
rapid water replacement is very dangerous as can cause cerebral oedema, convulsions and brain injury
so we use a slow fluid deficit over 48-72 hours
what are the symptoms of hyponatraemia
headache nausea vomiting cramps circulatory failure confusion convulsions postural hypotension fatigue
what is hyperkalaemia
when potassium is >5.5 mmol/l
what are the consequences of hyperkalaemia
arrythmia muscle weakness tachycardia ventricular fibrillation Asystole
how do we treat hyperkalaemia
stop offending medication restrict potassium intake Iv calcium gluconate insulin + glucose beta agonists ion exchange resins
what is hypokalaemia
K+<3.5mmol/L
what are the symptoms of hypokalaemia
muscular weakness tetany respiratory failure paralysis constipation cardiac arrhythmias sudden death
how can we treat hypokalaemia
pottassium effervescent tablets
intravenous potassium
bananas
what is the normal range for calcium
2.12 - 2.65
what hormones are involved in calcium homeostasis
parathyroid hormone
vitamin d metabolites
calcitonin
what is hypercalcaemia
calcium >2.65 mmol/L
what are some common causes of hypercalcaemia
primary hyperparathyroidism
excessive secretion of PTH
stimulating calcium uptake in kidneys and intestines as well as promoting reabsorption into bones
what are some symptoms of hypercalcaemia
bone pain fractures kidney stones nephrocalcinoisis neurological symptoms Gi disturbances
what is hypocalcaemia
calcium levels <2.1
what are common causes hypocalcaemia
low it d
hypoparathyroidism
early stage CKD
pharmacological
what are some symptoms of hypocalcaemia
Tends to be asymptomatic if hypocalcaemia is mild.
In severe cases – paraesthesia of face, muscle spasms,
convulsions and cardiac dysrhythmias
how do you treat sever hypocalcaemia
IV calcium gluconate 10% as a slow bolus
how do you treat mild hypocalcaemia
oral calcium replacement
