Monitoring drug therapy Flashcards
Why do we monitor drug therapy?
- See if its working
- See if dose needs adjusting/stopping
- Drug interactions
- Any adverse effects
- Check patient compliance
You have monitored someones response to a drug and seen they show adverse effects. What are some things you can do?
- Reduce dose
- Stop drug
- Change drug
- Treat the adverse effect
- Watch and wait
What can be monitored from a blood test
What things can we monitor from clinical observations
Why do we monitor BP?
Why monitor pulse?
- Indicative of health of patient
- Low pulse (bradycardia <50bpm) – heart failure, arrhythmia – action needed?
- Fast resting pulse (tachycardia >100bpm) - sepsis, anxiety, pain, arrhythmia, hypovolaemia, PE
- Monitor efficacy of treatment – beta blockers, digoxin, amiodarone
- Monitor adverse effects of drugs e.g. beta blockers for heart failure, beta agonists
What is a normal pulse
60-70bpm as a resting pulse
What is the normal temperature range? what does a high or low temp indicate
- Normal is 36.1-37.2
- Higher: pyrexia (fever) usually caused by infection
- Below: hypothermia - medical emergency
Why monitor urine output and whats the normal amount
- Normal amount is 1.5 litres a day
- It indicates renal function
- Fluid status e.g. dehydration
How do we monitor fluid balance?
Use the 24 hour fluid balance chart
FLUIDS IN:
- Food/drinks in
- Parenteral fluids in
FLUIDS OUT:
- Urine
- Diarrhoea/vomit
- Stoma output
Causes of high respiratory rate
- Asthma or COPD excerbation
- Anxiety
- Anaemia
- Pneumonia
Define respiratory rate and whats the normal range
Breaths taken per minute
12-20
When CO2 rises, it increases to counterbalance this
What is the norm oxygen saturation levels
98-100%
What indications/info does urea and electrolytes tests tell us?
- Renal function
- Hydration status
- Disease status
- Possible ADRs
How much should sodium and potassium be in U&E test
What is creatine? And why do we monitor it?
- Its a waste product from digestion of proteins, and breakdown of muscle tissue
- Kidneys remove creatine from blood so: kidney function ↓, creatinine in the blood ↑
- Used to assess renal function
What are some causes of high and low creatine levels?
What is GFR?
- Filtration rates of the functioning nephrons in the kidneys to remove waste from the blood
- Indicator of renal disease: kidney function ↓, creatinine in the blood ↑, GFR ↓
Equation to calculate creatine clearance.
What are the principles behind a liver function test
- LFTs look at the expression of several enzymes in the liver, which may raise due to damage
- Each enzyme should never be considered singularly
Name some enzymes in the liver and their functions x4
Liver function test - name some proteins
C Reactive Protein
Protein made by the liver and released into the blood after tissue injury, infection or other inflammation
Shows progress of inflammation
Level rises within 6 hours of fever, inflammation and trauma
Used to monitor infection – response to antibiotics (but need to be mindful of other factors that cause an increase e.g. trauma)
