TDM🌵

Question 1

What should be monitored with TERBINAFINE and how often should it be monitored

Answer 1

HEPATIC FUNCTION

Before tx, then periodically after 4-6 weeks of tx

• discontinue if LFT’s are abnormal!

Question 2

What should be monitored with AMINOSALICYLATES and how often should they be monitored

AS = balsalazide, mesalazine, sulfasalazine, osalazine

Answer 2

RENAL FUNCTION

Before starting tx, then at 3 months, then annually thereafter

-monitor renal impairment pts more frequently

Question 3

Can you give ketoconazole in hepatic impairment?

Answer 3

NO

Avoid in acute or chronic impairment

Do not initiate if liver enzymes are greater than 2X the normal upper limit

Question 4

Ketoconazole monitoring?

Answer 4

ECG - before, ONCE a week after Initiation - then as clinically indicated

Adrenal insufficiency- monitor adrenal function within 1 week of initiation, then regularly thereafter.
When cortisol levels normal/close to target - monitor every 3-6 months (risk of autoimmune/exacerbation)
If symptoms of adrenal insufficiency occur discontinue temporarily/or reduce dose

Hepatotoxicity- LFT - before, weekly for 1 month, then monthly for 6 months
Reduce dose if liver enzymes increase less than 3 X normal upper limit
If > 3 X normal upper limit = discontinue!