PSA Monitoring

Question 1

Methotrexate Bloods

Answer 1

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

Question 2

Methotrexate Symptoms

Answer 2

Sore throat
fever
bruising

Question 3

Carbamazepine

Answer 3

Plasma concentration at 1-2 weeks
Blood count
hepatic function
renal function tests

Question 4

Digoxin

Answer 4

Plasma concentration at least 6 hours after the dose (not measured unless toxicity, non-compliance, inadequate effect)
Monitor serum electrolytes and renal function

Question 5

Aminophylline

Answer 5

Sample for level

18 hours after starting treatment

Question 6

Gentamicin monitoring

Answer 6

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

Question 7

Gentamicin management

Answer 7

If the trough is high, increase the interval between dose

If the peak is high, reduce the dose

Question 8

Haloperidol

Answer 8

Monitor electrolytes

ECG before and during treatment

Question 9

UF Heparin

Answer 9

Platelet counts before treatment and during treatment longer than 4 days
Potassium concentration before and regularly

Question 10

Phenytoin

Answer 10

plasma concentrations

Question 11

Vancomycin

Answer 11

serum measurement on the second day of treatment immediately before the next dose

Question 12

Warfarin

Answer 12

Baseline INR
INR daily/alternate days then at longer intervals of up to 12 weeks
More frequent testing if a change in clinical condition

Question 13

Warfarin INR 5-9

Answer 13

Stop warfarin
Daily INR till normal
Restart when <5

Question 14

Warfarin INR >9 no bleeding

Answer 14

Stop warfarin
give vitamin K 2.5 to 5 mg
INR in 24 hours
Restart when <5

Question 15

Gentamicin monitoring

Answer 15

Peak 1 hr post-dose

Trough just before next dose

Question 16

Gentamicin peak ranges

Answer 16

5-10 mg/L

Question 17

Gentamicin peak ranges in Bacterial Endocarditis

Answer 17

3-5 mg/L

Question 18

Gentamicin peak out of range

Answer 18

adjust dose

Question 19

Gentamicin tough ranges

Answer 19

<2

Question 20

Gentamicin trough ranges In bacterial endocarditis

Answer 20

<1

Question 21

Gentamicin trough ranges out of range

Answer 21

adjust dose interval

Question 22

Gentamicin once-daily regimen sampling

Answer 22

6-14 hr after the last infusion started

Use nomogram to adjust the frequency

Question 23

Managing Paracetamol OD

Answer 23

If staggered OD
time of ingestion unknown
start NAC

Paracetamol levels at least 4 hours after ingestion to use nomogram

Question 24

What to do with warfarin when there is major bleeding

Answer 24

Stop warfarin
give 5-10 mg IV vitamin K
Give prothrombinex

Question 25

What to do with warfarin when | INR <6

Answer 25

Reduce warfarin dose

Question 26

What to do with warfarin when | INR>5 and there is minor bleeding

Answer 26

IV vitamin K 1-3 mg

Question 27

What to do with warfarin when | INR 6-8

Answer 27

Omit warfarin for 2 days and then reduce dose

Question 28

What to do with warfarin when | INR >8

Answer 28

Omit warfarin and give 1-5 mg oral vitamin K

Question 29

TSH is <0.5

Answer 29

Decrease thyroxine dose (smallest increment offered unless grossly hyperthyroid)

Question 30

TSH is 0.5-5

Answer 30

Nil action

Question 31

TSH is >5

Answer 31

Increase thyroxine dose (smallest increment offered unless grossly hypothyroid)

Question 32

Inadequate clinical response and low serum level

Answer 32

Increase dose by smallest possible increment

Question 33

Adequate clinical response but low serum level

Answer 33

No change: clinical response is more important

Question 34

Adequate clinical response but high serum levels

Answer 34

Decrease the dose EXCEPT gentamicin where the frequency is decreased in the absence of toxicity

Question 35

Evidence of toxicity and high serum levels

Answer 35

Omit drug for a few days

Question 36

Lithium monitoring

Answer 36

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

Question 37

Antipsychotic monitoring

Answer 37

fasting blood glucose must be tested at baseline and at regular intervals baseline ECG in patients with cardiac disease or risk factors

Question 38

COCP monitoring

Answer 38

Check BP as hypertension increases the risk of arterial disease associated with CP

Question 39

Amiodarone monitoring

Answer 39

pulmonary function tests before starting | liver and thyroid function 6 monthly

Question 40

Sodium valproate monitoring

Answer 40

Associated with hepatotoxicity, measure LFT at baseline

Question 41

Clozapine monitoring

Answer 41

``` 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 ```

Question 42

Tacrolimus levels

Answer 42

should be a trough level before morning or evening dose

Question 43

Monitoring resolution of DKA

Answer 43

Measure serum ketones after 2 hours of treatment (NOT urinary ketones) blood pH pCO2 continue to monitor every 4 hours

Question 44

Vancomycin monitoring

Answer 44

pre dose= trough should be 10-15 mg/L post-dose levels are not routinely required

Question 45

Response to treatment in polymyalgia rheumatica

Answer 45

Symptoms respond rapidly and are the principle guide

Question 46

Vancomycin trough is elevated

Answer 46

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

Question 47

Azothiorpine

Answer 47

Cytotoxic can cause bone marrow suppression and neutropenia, thrombocytopenia FBC must be regularly checked regular LFT monitoring

Question 48

Theophylline

Answer 48

optimal 55-110 micromol/L measure concentration 4-6 hours after a dose 5 days after oral treatment 3 days after dose adjustment

Question 49

Addison's

Answer 49

Treatment is titrated to symptoms | mineralocorticoids- potassium levels