Drug monitoring Flashcards
(24 cards)
What antibiotics require monitoring?
Vanc
Gent
What are some common drugs that require monitoring?
Warfarin Digoxin Lithium Valproate Clozapine Amiodarone Thyroxine, carbimazole
When should Vanc be avoided?
Severe renal impairment
What is the dose of vanc?
15-20mg/kg
What are the goal trough levels of vanc?
10-15mg/L
15-20mg/L in severe infection
When should gent be avoided?
Renal impairment
Pregnancy and breastfeeding
What is the dose of gent?
5mg/kg
Half in renal failure
When should gent be monitored?
After 3 doses, then every 3 days
When and what are peak levels of gent?
1 hour post dose
5-10mg/L
When and what are trough levels of gent?
<2mg/L
What should you do if gent levels are high?
High peak= decrease dose
High trough= increase time between doses
What is the initial monitoring of warfarin?
Daily or every other day until stable
Then increasing intervals
What is the max amount of time between warfarin INR checks?
12 weeks
What is the management of a major bleed on warfarin?
Stop warfarin
vit K
Prothrombin
What is the management of an INR >8?
Stop warfarin
Vit K
What is the management of INR 5-8?
Minor bleeding= stop warfarin, vit K
No bleed= withhold until INR <5
What is monitored with lithium?
Lithium levels
U&Es, TFTs
How often are lithium levels monitored?
Weekly until stabilised then 3 monthly
When are U&Es and TFTs monitored with lithium?
6 monthly
What monitoring is required with clozapine?
FBC
How often is FBC monitoring with clozapine?
<6mo= weekly
6mo-1year= fortnightly
>1 year= monthly
What is monitored with valproate and when?
LFTs, FBC
6 months then annual
What is the monitoring in thyroxine and carbimazole?
6-8 weeks, 4-6 months then annual
What is monitored with amiodarone?
TFTs, LFTs 6 monthly
CXR and K before commencing
ECG
