PSA Monitoring Flashcards
Methotrexate Bloods
FBC, LFT, and Renal function before treatment and every 1-2 weeks until a stable dose Monitoring FBC at regular intervals (2-4 weeks) but once therapy is stabilized 2-3 months risk of liver cirrhosis is really excreted
Methotrexate Symptoms
Sore throat
fever
bruising
Carbamazepine
Plasma concentration at 1-2 weeks
Blood count
hepatic function
renal function tests
Digoxin
Plasma concentration at least 6 hours after the dose (not measured unless toxicity, non-compliance, inadequate effect)
Monitor serum electrolytes and renal function
Aminophylline
Sample for level
18 hours after starting treatment
Gentamicin monitoring
Measure serum concentrations after 3-4 doses
1 hour after IM/IV for peak
just before next dose for trough
every 3 days after a dose change
Monitor renal function before and during
The auditory and vestibular function should be monitored
Gentamicin management
If the trough is high, increase the interval between dose
If the peak is high, reduce the dose
Haloperidol
Monitor electrolytes
ECG before and during treatment
UF Heparin
Platelet counts before treatment and during treatment longer than 4 days
Potassium concentration before and regularly
Phenytoin
plasma concentrations
Vancomycin
serum measurement on the second day of treatment immediately before the next dose
Warfarin
Baseline INR
INR daily/alternate days then at longer intervals of up to 12 weeks
More frequent testing if a change in clinical condition
Warfarin INR 5-9
Stop warfarin
Daily INR till normal
Restart when <5
Warfarin INR >9 no bleeding
Stop warfarin
give vitamin K 2.5 to 5 mg
INR in 24 hours
Restart when <5
Gentamicin monitoring
Peak 1 hr post-dose
Trough just before next dose
Gentamicin peak ranges
5-10 mg/L
Gentamicin peak ranges in Bacterial Endocarditis
3-5 mg/L
Gentamicin peak out of range
adjust dose
Gentamicin tough ranges
<2
Gentamicin trough ranges In bacterial endocarditis
<1
Gentamicin trough ranges out of range
adjust dose interval
Gentamicin once-daily regimen sampling
6-14 hr after the last infusion started
Use nomogram to adjust the frequency
Managing Paracetamol OD
If staggered OD
time of ingestion unknown
start NAC
Paracetamol levels at least 4 hours after ingestion to use nomogram
What to do with warfarin when there is major bleeding
Stop warfarin
give 5-10 mg IV vitamin K
Give prothrombinex
What to do with warfarin when
INR <6
Reduce warfarin dose
What to do with warfarin when
INR>5 and there is minor bleeding
IV vitamin K 1-3 mg
What to do with warfarin when
INR 6-8
Omit warfarin for 2 days and then reduce dose
What to do with warfarin when
INR >8
Omit warfarin and give 1-5 mg oral vitamin K
TSH is <0.5
Decrease thyroxine dose (smallest increment offered unless grossly hyperthyroid)
TSH is 0.5-5
Nil action
TSH is >5
Increase thyroxine dose (smallest increment offered unless grossly hypothyroid)
Inadequate clinical response and low serum level
Increase dose by smallest possible increment
Adequate clinical response but low serum level
No change: clinical response is more important
Adequate clinical response but high serum levels
Decrease the dose EXCEPT gentamicin where the frequency is decreased in the absence of toxicity
Evidence of toxicity and high serum levels
Omit drug for a few days
Lithium monitoring
sampled at 12 hours after last dose
normal is 0.4-0.8
toxic effect above 1.5
weekly and then every 3 months
renal function, thyroid, hyperparathyroid, cardiac function and weight every 6 months after starting treatment
sodium depletion increases the risk of lithium toxicity
Antipsychotic monitoring
fasting blood glucose must be tested at baseline and at regular intervals
baseline ECG in patients with cardiac disease or risk factors
COCP monitoring
Check BP as hypertension increases the risk of arterial disease associated with CP
Amiodarone monitoring
pulmonary function tests before starting
liver and thyroid function 6 monthly
Sodium valproate monitoring
Associated with hepatotoxicity, measure LFT at baseline
Clozapine monitoring
Routine FBC is required weekly for 18 weeks then 2 weekly for the remainder of the first year of treatment. If stable then 4 weekly CVD assessment signs of hypoglycemia Signs of myocarditis and heart failures monitor for constipation Regular LFTs
Tacrolimus levels
should be a trough level before morning or evening dose
Monitoring resolution of DKA
Measure serum ketones after 2 hours of treatment (NOT urinary ketones)
blood pH
pCO2
continue to monitor every 4 hours
Vancomycin monitoring
pre dose= trough
should be 10-15 mg/L
post-dose levels are not routinely required
Response to treatment in polymyalgia rheumatica
Symptoms respond rapidly and are the principle guide
Vancomycin trough is elevated
wait till concentration is within therapeutic range before further dosing
increase dosage interval from 12 hours to 24 hours in patients >85 or with egfr 10-50 mL/min
Azothiorpine
Cytotoxic
can cause bone marrow suppression and neutropenia, thrombocytopenia FBC must be regularly checked
regular LFT monitoring
Theophylline
optimal 55-110 micromol/L
measure concentration 4-6 hours after a dose
5 days after oral treatment
3 days after dose adjustment
Addison’s
Treatment is titrated to symptoms
mineralocorticoids- potassium levels
