Monitoring Drug Therapy

Question 1

Why do we monitor

Answer 1

aids diagnosis

allows us to assess severity of disease

Question 2

what does it allow us to do

Answer 2

allows us to review response to treatment

dose adjustments identified can be made

Question 3

What are two main categories of monitoring

Answer 3

bloods tests and clinical observations

Question 4

what blood tests can be taken

Answer 4

urea and electrolytes

haematology

renal function

liver function

cardia enzymes

TDM

Question 5

what clinical observations can be taken

Answer 5

BP and pulse

Oxygen saturations

Respiratory rate

Urine output

Fluid balance

Daily weights

Pain score

Blood Glucose

Temperature

Question 6

what do electrolyte help indicate

Answer 6

Renal function
Hydration status
Assess disease status
Identify possible ADRs

Question 7

what do abnormal levels of sodium indicate

Answer 7

water loss

Question 8

how does sodium indirectly affect blood pressure

Answer 8

low sodium level is associated with hypotension conversely a large intake of salt from the diet can cause hypertension

Question 9

what is hypernatraemia

Answer 9

Na+ > 146mmol/L

Question 10

what are the main causes of hypernatraemia

Answer 10

insufficient fluid intake

excessive water loss

Question 11

what can hypernatremia be caused by

Answer 11

sodium retention
excess adrenocorticoid
pharmacological agents

Question 12

what are the consequences of Hypernatraemia

Answer 12

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

Question 13

How can hypernatraemia be treated

Answer 13

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

Question 14

what are the symptoms of hyponatraemia

Answer 14

headache
nausea
vomiting
cramps
circulatory failure
confusion
convulsions
postural hypotension
fatigue

Question 15

what is hyperkalaemia

Answer 15

when potassium is >5.5 mmol/l

Question 16

what are the consequences of hyperkalaemia

Answer 16

arrythmia
muscle weakness
tachycardia
ventricular fibrillation
Asystole

Question 17

how do we treat hyperkalaemia

Answer 17

stop offending medication
restrict potassium intake
Iv calcium gluconate
insulin + glucose
beta agonists
ion exchange resins

Question 18

what is hypokalaemia

Answer 18

K+<3.5mmol/L

Question 19

what are the symptoms of hypokalaemia

Answer 19

muscular weakness
tetany
respiratory failure
paralysis
constipation
cardiac arrhythmias
sudden death

Question 20

how can we treat hypokalaemia

Answer 20

pottassium effervescent tablets
intravenous potassium
bananas

Question 21

what is the normal range for calcium

Answer 21

2.12 - 2.65

Question 22

what hormones are involved in calcium homeostasis

Answer 22

parathyroid hormone
vitamin d metabolites
calcitonin

Question 23

what is hypercalcaemia

Answer 23

calcium >2.65 mmol/L

Question 24

what are some common causes of hypercalcaemia

Answer 24

primary hyperparathyroidism
excessive secretion of PTH
stimulating calcium uptake in kidneys and intestines as well as promoting reabsorption into bones

Question 25

what are some symptoms of hypercalcaemia

Answer 25

bone pain
fractures
kidney stones
nephrocalcinoisis
neurological symptoms
Gi disturbances

Question 26

what is hypocalcaemia

Answer 26

calcium levels <2.1

Question 27

what are common causes hypocalcaemia

Answer 27

low it d
hypoparathyroidism
early stage CKD
pharmacological

Question 28

what are some symptoms of hypocalcaemia

Answer 28

Tends to be asymptomatic if hypocalcaemia is mild.

In severe cases – paraesthesia of face, muscle spasms,
convulsions and cardiac dysrhythmias

Question 29

how do you treat sever hypocalcaemia

Answer 29

IV calcium gluconate 10% as a slow bolus

Question 30

how do you treat mild hypocalcaemia

Answer 30

oral calcium replacement