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Advanced Pharmacy Practice > Monitoring for Common Medications > Flashcards

Monitoring for Common Medications Flashcards

1
Q

What are the monitoring requirements for ACEi?

A
  1. Urea
  2. Electrolytes (Hyperkaleamia)
  3. Creatinine and eGFR at baseline.

And regulary.

A 20% drop in renal function upon initiation is acceptable.

BP - might limit how far dose can be increased.

Stop when K+ >6mmol/L, if cough develops etc.

Risk factors for adverse renal effects: diabetes, NSAIDs, dehydration (sick day rules).

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2
Q

What are the things to be aware with ACEi other than monitoring? [4]

A
  1. A 20% drop in renal function upon initiation is acceptable.
  2. BP - might limit how far dose can be increased.
  3. Stop when K+ >6mmol/L, if cough develops etc.
  4. Risk factors for adverse renal effects: diabetes, NSAIDs, dehydration (sick day rules).
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3
Q

When do we stop ACEi?

A
  1. Contraindicated etc.
  2. When K+ >6mmol/L
  3. IF renal function drops more than 20%.
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4
Q

What is the monitoring for Aldosterone antagonists? [4]

A
  1. Renal function
  2. U+Es as can cause hyperkalaemia.
  3. Weight loss if to treat oedema
  4. BP
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5
Q

What are the monitoring requirements with antibiotic use? [5]

A
  1. Temp
  2. Heart rate
  3. CRP, WBC, ESR
  4. TDM: gentamicin, vancomycin, teicoplanin.

Also remember the IV/ORal switch - review if possible every 48 hours.

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6
Q

What are the monitoring requirements for ACHinhibitors? [3]

A
  1. Baseline renal
  2. Baseline liver
  3. Monitor for side effects.
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7
Q

What are the monitoring requirements for amiodarone? [5]

A
  1. TSH, T3/4
  2. LFTS
  3. U+Es
  4. ECG
  5. All the above at baseline and every 6 months

Need to monitor TSH every 6 months and then after amiodarone is discontinued for 3 months.

WARFARIN - more frequent INR monitoring will be needed - consider switching to a DOAC if possible?

Many drug interactions and a long halflife.

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8
Q

Apart from monitoring requirements, what else should we be aware of for amiodarone? [3]

A
  1. Can cause hypo and hyperthyroidism
  2. Warfaring interaction! more frequent INR monitoring needed.
  3. Has many drug interactions and a long half-life.
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9
Q

What are the monitoring requirements for antipsychotics? [12]

A

At baseline:

  1. BP
  2. HbA1c
  3. FBC
  4. LFTs
  5. U+Es
  6. Lipids
  7. Smoking status
  8. Weight
  9. BMI
  10. TSH
  11. Prolactin
  12. ECG

Monitoring needs to occur until the patient is stablised and then ever 6/12 weeks.

Every 12 months repeat those needed for each specific patient.

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10
Q

What needs to be monitored with beta blockers?

What are the cardioselective ones?

A
  1. Heart rate
  2. BP
  3. Clinical status

Cardioselective: bisoprolol, atenolol.

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11
Q

What CIs with BBs? [3]

A 
Asthma = nope.
COPD = nope, UNLESS for AF or HF and then it should be a cardioselective one.

Diabetes: use a cardioselective one, they can mask the symptoms of hypos and worsen peripheral neuropathy.

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12
Q

What monitoring is needed for CCB? [3]

A
  1. BP
  2. Development of oedema.
  3. Avoid rate limiting CCB in HF. Amlodipine or felodipine can be used if essential.
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13
Q

Carbimazole monitoring [4]

A
  1. Baseline FBC, WBC, LFTs, TFTs
  2. Warn patient to tell doctor immediately if sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops
  3. Ongoing TSH monitoring every 4-6 weeks after initiation, once maintenance dose achieved every 3moths.
  4. Since carbimazole is a vitamin K antagonist, the effect of anticoagulants could be intensified. Additional monitoring of PT/INR should be considered, especially before surgical procedures.
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14
Q

Why does additional monitoring of PT/INR need to be considered when using carbimazole and anticoagulants?

A

Since carbimazole is a vitamin K antagonist, the effect of anticoagulants could be intensified. Additional monitoring of PT/INR should be considered, especially before surgical procedures.

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15
Q

Clopidogrel monitoring

A

Signs and symptoms of bleeding

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16
Q

Corticosteroid monitoring [5]

A
  1. Osteoporosis - especially post menopausal women and the elderly in general.
  2. Diabetes - prednisolone can raise BG levels.
  3. Depression
  4. Infection.
  5. Use the lowest dose possible for shortest time in patients with HF
17
Q

Digoxin monitoring [2]

A

Not rountinely done.

Electrolytes and renal function due to risk of

  1. Hypercalceamia
  2. Hypokalaemia

And the signs of toxicity are nausea, vomiting and visual disturbances.

18
Q

DOAC monitoring [4]

A

Baseline:

  1. PT
  2. LFT
  3. BP
  4. Renal function (DABIGATRAN - 80% renally cleared)

Not monitored after that but be aware of signs and symptoms of bleeding e.g. aneamia.

19
Q

When would we reduce the dose of DOAC? [3]

A

two of the followiing apply:

  1. > 80 yrs
  2. Renal impairment
  3. <60kg

AVOID in pregnancy: LMWH.

20
Q

What levothyroxine monitoring is needed? [4]

A

Baseline:
1. TSH then every 6-8 weeks until euthyroid and at a further 6-12 months after.

  1. Closer monitoriing in patients with cardiac disease.
  2. Patients taking warfarin will need to have more frequent/vigilant INR checks as it can alter anticaogulant.
  3. Diabetics: Insulin of OHA doses may need to be increased.
21
Q

What LMWH monitoring is there? [5]

A

Baseline:
1. Renal function and weight to determine dose.

  1. FBCs, U+Es, LFts and clotting screen.
  2. If patient is taking for longer than 4 days then we should monitor the platelet counts due to risk of HIT.
  3. Anti factor Xa assay is only appropriate in certain cases: renal impairment, obese, pregnancy, children.
  4. Common side effects: bleeding and injection site reactions.
22
Q

All heparins increase

A

Potassium levels: hyperkaleamia

23
Q

Why should we monitor platelet counts if using lmwh longer than 4 days?

A

HIT

24
Q

Loop diuretics such as furosemide and bumetanide require what monitoring? [3]

A

U+Es: can cause hyponatremia and hyperkalaemia.

Monitor weight loss.

Issues with renal function.

25
Q

What monitoring accompanies metformin use? [2]

A
  1. Serum creatinine baseline and then annually.

Renal impairment can cause metformin accumulation and lactic acidosis - 0.1% occurence but like 50% fatality.

  1. HbA1c obvo.
26
Q

What monitoring accompanies NSAID use? [2]

A
  1. Creatine clearance: PG inhibition reduces renal blood flow.
  2. High risk of AKI in renal impairment/failure, concurrent use with ACEI/Diuretic/ARB, elderly or with long term monotherapy.
27
Q

What monitoring and issues accompany PPI use? [3]

A
  1. U+Es due to hyponatreamia risk.
  2. Osteoporisis -> increased risk of bone fractures.
  3. Risk of C.diff when used with broad spectrum antibiotics.
28
Q

What monitoring accompanies opioid use? [3]

A
  1. Adverse effects: constipation and nausea: prescribe appropriately.
  2. Pain relief effectiveness
  3. Respiratory depression signs for patient and carers to recognise.
29
Q

SSRI monitoring requirements [8]

A
  1. Potential risk of increased suicidal ideation initially – inform patient of this and monitor patients at high risk closely.
  2. Check for response – may get a response in first week, usually patients get some response within first 2 weeks. If no response by 2-4 weeks, switch to a different antidepressant – caution with tapering and cross over.
  3. Bleeding risk – monitor for signs of bleeding.
  4. Serotonin syndrome
  5. Medications that increase bleeding should be identified and this risk managed – SSRIs may potentiate by inhibiting serotonin uptake by platelets.
  6. Lower doses may be required in elderly patients.
  7. Can cause withdrawal symptoms if stopped abruptly.
  8. TCA might be more appropriate in pregnancy.
30
Q

Statins monitoring [8]

A
  1. LFTs
  2. CK
  3. Lipids: TC, non-HDL, HDL, triglycerides
  4. Smoking
  5. BP
  6. BMI
  7. TSH: hypothyroidism predisposes to myopathy
  8. Discontinue if ALT/AST levels 3x upper limit.

Other things:
CI in preg
Caution in patients with history of alcohol/liver disease

31
Q

What monitoring is there with UFH? [5]

A
  1. Baseline: LFTs, renal function, clotting screen, APTT, FBC, (platelets).
  2. Efficacy monitoring via APPT. Dose adjusted according to response.
  3. Higher risk of HIT than in LMWH so need to monitor platelet count after 4 days of treatment.
  4. Risk of hyperkaleamia so U+Es.
  5. Can use in renal impairment due to very short half life.
32
Q

What monitoring needs to accompany warfarin use?

A

Check baseline INR, FBC, LFTs and clotting screen

INR monitoring – every ½ days initially, weekly, 4 weeks and then every 12 weeks once stable.

Target INR is 2-3 or 2.5-3.5 in patients with mechanical heart values.

In AF – should calculate patientsC TTR, if not appropriate consider adherence problems and switching patient to a DOAC.

Tetarogenic in pregnancy.

Slower loading in patients with AF.

Advanced Pharmacy Practice (29 decks)

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