Monitoring drug therapy

Question 1

Why do we monitor drug therapy?

Answer 1

• See if its working
• See if dose needs adjusting/stopping
• Drug interactions
• Any adverse effects
• Check patient compliance

Question 2

You have monitored someones response to a drug and seen they show adverse effects. What are some things you can do?

Answer 2

• Reduce dose
• Stop drug
• Change drug
• Treat the adverse effect
• Watch and wait

Question 3

What can be monitored from a blood test

Answer 3

Question 4

What things can we monitor from clinical observations

Answer 4

Question 5

Why do we monitor BP?

Answer 5

Question 6

Why monitor pulse?

Answer 6

• 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

Question 7

What is a normal pulse

Answer 7

60-70bpm as a resting pulse

Question 8

What is the normal temperature range? what does a high or low temp indicate

Answer 8

• Normal is 36.1-37.2
• Higher: pyrexia (fever) usually caused by infection
• Below: hypothermia - medical emergency

Question 9

Why monitor urine output and whats the normal amount

Answer 9

• Normal amount is 1.5 litres a day
• It indicates renal function
• Fluid status e.g. dehydration

Question 10

How do we monitor fluid balance?

Answer 10

Use the 24 hour fluid balance chart
FLUIDS IN:
- Food/drinks in
- Parenteral fluids in
FLUIDS OUT:
- Urine
- Diarrhoea/vomit
- Stoma output

Question 11

Causes of high respiratory rate

Answer 11

• Asthma or COPD excerbation
• Anxiety
• Anaemia
• Pneumonia

Question 12

Define respiratory rate and whats the normal range

Answer 12

Breaths taken per minute
12-20
When CO2 rises, it increases to counterbalance this

Question 13

What is the norm oxygen saturation levels

Answer 13

98-100%

Question 14

What indications/info does urea and electrolytes tests tell us?

Answer 14

• Renal function
• Hydration status
• Disease status
• Possible ADRs

Question 15

How much should sodium and potassium be in U&E test

Answer 15

Question 16

What is creatine? And why do we monitor it?

Answer 16

• 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

Question 17

What are some causes of high and low creatine levels?

Answer 17

Question 18

What is GFR?

Answer 18

• 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 ↓

Question 19

Equation to calculate creatine clearance.

Answer 19

Question 20

What are the principles behind a liver function test

Answer 20

• LFTs look at the expression of several enzymes in the liver, which may raise due to damage
• Each enzyme should never be considered singularly

Question 21

Name some enzymes in the liver and their functions x4

Answer 21

Question 22

Liver function test - name some proteins

Answer 22

Question 23

C Reactive Protein

Answer 23

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)