Drug monitoring and side effects

Question 1

What monitoring is required for Methotrexate?

Answer 1

FBC, LFTs, U&E every 2 weeks until stable, then every 2–3 months.

Question 2

What are the key side effects of Methotrexate?

Answer 2

Sore throat, mouth ulcers, bruising, liver cirrhosis, pneumonitis.

Question 3

What monitoring is required for Sulfasalazine?

Answer 3

FBC, LFTs every 2 weeks for 3 months, then monthly for 3 months, then every 3 months.

Question 4

What are the key side effects of Sulfasalazine?

Answer 4

Sore throat, mouth ulcers, rash, headaches, dizziness, nausea.

Question 5

What monitoring is required for Hydroxychloroquine?

Answer 5

Baseline and annual eye exam (visual acuity and retinal screening).

Question 6

What are the key side effects of Hydroxychloroquine?

Answer 6

Blurred vision, reduced visual acuity (risk of retinopathy).

Question 7

What monitoring is required for Azathioprine?

Answer 7

TPMT before starting, FBC & LFTs weekly for 4 weeks, then monthly for 3 months, then every 3 months.

Question 8

What are the key side effects of Azathioprine?

Answer 8

Sore throat, mouth ulcers, bruising, rash.

Question 9

What monitoring is required for Amiodarone?

Answer 9

TFTs, LFTs, U&E, ECG baseline and every 6 months; CXR baseline and annually.

Question 10

What are the key side effects of Amiodarone?

Answer 10

Hypo-/hyperthyroidism, phototoxicity, weight gain, fatigue, cold intolerance.

Question 11

What monitoring is required for Digoxin?

Answer 11

U&E, digoxin level if toxicity suspected.

Question 12

What are the key side effects of Digoxin?

Answer 12

Nausea, vomiting, diarrhoea, disorientation, weakness.

Question 13

What monitoring is required for Lithium?

Answer 13

TFTs, U&E, lithium level every 3 months (12 hrs post-dose).

Question 14

What are the key side effects of Lithium?

Answer 14

GI upset, tremor, ataxia, blurred vision, seizures, coma. Prescribe by brand.

Question 15

What monitoring is required for ACE inhibitors/ARBs?

Answer 15

U&E before starting, then 1–2 weeks after dose change.

Question 16

What monitoring is required for Spironolactone?

Answer 16

U&E at 1 week, 1 month, then regularly.

Question 17

What monitoring is required for Statins?

Answer 17

LFTs at baseline, 3 months, and 12 months.

Question 18

What monitoring is required for Antipsychotics?

Answer 18

Fasting glucose, lipids, weight, BP at baseline, then every 3–4 months.

Question 19

What are key risks of Antipsychotics?

Answer 19

Cardiovascular risk (QT prolongation), weight gain, diabetes – monitor CV health.

Question 20

What monitoring is required for Clozapine?

Answer 20

FBC weekly for 18 weeks, then fortnightly to 1 year, then monthly.

Question 21

What monitoring is required for Sodium Valproate?

Answer 21

LFTs, FBC before and during treatment.

Question 22

What monitoring is required for Carbimazole?

Answer 22

TFTs monthly initially; FBC if sore throat (risk of agranulocytosis).

Question 23

What monitoring is required for Levothyroxine?

Answer 23

TFTs 6–12 weeks after starting or dose change, then yearly.

Question 24

What monitoring is required for Diabetes medications?

Answer 24

HbA1c every 3–6 months; U&E annually (esp. metformin or SGLT2).

Question 25

What monitoring is required for Warfarin?

Answer 25

INR monitoring – frequency depends on stability.

Question 26

What monitoring is required for DOACs (e.g. apixaban)?

Answer 26

Renal function, weight, U&E at least annually or more often if needed.

Question 27

What monitoring is required for Ciclosporin?

Answer 27

BP, U&E, LFTs, lipids.

Question 28

What monitoring is required for Gold and Penicillamine?

Answer 28

Urinalysis for proteinuria, FBC.

Question 29

What are general safety notes for immunosuppressive drugs?

Answer 29

Infection risk, avoid live vaccines, annual flu/pneumococcal, beware renal/hepatic toxicity and drug interactions.

Question 30

What are the interactions with lithium?

Answer 30

NSAIDs, diuretic and ACEi

Question 31

You should always prescribe lithium by brand. True or false

Answer 31

True

Question 32

With lithium toxicity can occur at normal levels. True or false

Answer 32

True - especially in renal impairment

Question 33

What is the recommended subcutaneous morphine dose compared to the oral dose?

Answer 33

S/c Morphine is ½ oral dose ## Footnote This indicates the conversion factor used when prescribing morphine in different administration routes.

Question 34

What is the subcutaneous diamorphine dose relative to the oral morphine dose?

Answer 34

S/C Diamorphine is 1/3 of the oral dose of morphine ## Footnote Important for calculating appropriate doses for patients receiving different forms of opioid medication.

Question 35

What is the breakthrough dose of opioids?

Answer 35

1/6th of the 24-hour intake of MR opioid ## Footnote This is crucial for managing pain effectively in patients on regular opioid therapy.

Question 36

Who qualifies for free prescriptions?

Answer 36

Under 16, over 60, 16-18 in full time education, listed medication conditions with exemption certificates ## Footnote Conditions such as epilepsy, cancer, and endocrine disorders are included.

Question 37

What is a PGD in the context of non-medical prescribing?

Answer 37

Legal framework for AHP to deliver medications ## Footnote This includes administering vaccines like flu jabs under specific guidelines.

Question 38

What is a PSD?

Answer 38

Written instruction signed by prescriber for a specific patient ## Footnote It allows medications to be given by someone other than the prescriber.

Question 39

What substances are included in Schedule 2 drugs?

Answer 39

Most opioids, subject to safe custody requirements ## Footnote These drugs require strict storage and handling regulations.

Question 40

What are the safe custody requirements for Schedule 2 drugs?

Answer 40

Locked metal cabinet, anchored to wall or floor by unexposed bolts, no labels ## Footnote Ensures security and compliance with regulations for controlled substances.

Question 41

How long are scripts for Schedule 2/3/4 drugs valid?

Answer 41

28 days ## Footnote This is important for maintaining proper medication management and patient care.

Question 42

What is the recommended storage temperature for vaccines?

Answer 42

2-8 degrees Celsius, never frozen ## Footnote Vaccines must be protected from light and should ideally come directly from the fridge.