DRUG SAFETY + MONITORING – Beginner’s Breakdown (FOR EXAM 1) Flashcards
(31 cards)
What is the therapeutic range for Lithium?
0.6–1.2 mEq/L = safe
1.5+ = early toxicity
2.0+ = serious brain/heart danger!
Lithium is the gold standard for treating Bipolar I but can be toxic at high levels.
What are the early signs of Lithium toxicity?
- Nausea
- Vomiting
- Tremor
Late signs include slurred speech, confusion, and seizures.
What labs should be checked before starting Lithium?
- BUN/Creatinine
- TSH
- Pregnancy test
These tests monitor kidney function, thyroid function, and potential risks for pregnancy.
What is the therapeutic level for Depakote (Valproate)?
50–100 mcg/mL
Depakote is a mood stabilizer with a narrow therapeutic window.
What are the signs of toxicity for Depakote?
- Tremors
- Confusion
- Liver or pancreas inflammation
Pain and nausea can also occur with liver or pancreas inflammation.
What labs should be monitored when starting Depakote?
- LFTs
- Platelets
- Ammonia if mental status changes
Hyperammonemia can lead to confusion, sleepiness, and tremor.
What is Carbamazepine known for?
It interacts with EVERYTHING
Carbamazepine is a CYP inducer, which speeds up liver enzymes and affects the clearance of other medications.
What labs should be checked before starting Carbamazepine?
- CBC
- LFTs
Screening for HLA-B*1502 is also important in Asian patients to assess risk for SJS.
What is the biggest danger associated with Clozapine?
Agranulocytosis = drop in WBCs
This poses a risk of deadly infection.
What lab should be monitored for Clozapine?
ANC = Absolute Neutrophil Count
Monitoring is required weekly for the first 6 months, biweekly for the next 6 months, and then monthly for life.
What does REMS stand for?
Risk Evaluation & Mitigation Strategy
Clozapine requires this due to its high risk.
What is the narrow therapeutic index for Digoxin?
0.5–2 ng/mL
Low potassium (K+) increases the risk of Digoxin toxicity.
What are the potential interactions with Warfarin?
- CYP inducers (like Carbamazepine) = clears it too fast
- CYP inhibitors (like Fluoxetine) = builds up
This affects clotting risk and bleeding risk.
What is AIMS?
Abnormal Involuntary Movement Scale
Used to monitor for Tardive Dyskinesia when patients are on antipsychotics.
What is the reason for combining Depakote with Clozapine?
- Seizure protection
- Mood benefits
Clozapine lowers seizure threshold and Depakote helps prevent seizures.
What is HLA-B*1502?
A genetic marker linked to increased risk of deadly skin reactions to certain medications
Particularly relevant for Carbamazepine.
What serious skin reactions are associated with Carbamazepine?
- Stevens-Johnson Syndrome (SJS)
- Toxic Epidermal Necrolysis (TEN)
These conditions can cause blistering, skin peeling, and organ damage.
Who should be tested for HLA-B*1502 before starting Carbamazepine?
- People of Asian descent
- Han Chinese
- Thai
- Filipino
- Indian
- Vietnamese
Testing is crucial for those at higher risk of severe reactions.
What mnemonic can help remember the risk of HLA-B*1502?
1502 = face melt 💥💀
Indicates high risk of skin melting reactions with Carbamazepine.
What is Lamictal?
Lamictal = Lamotrigine. It’s an anticonvulsant that’s also used as a mood stabilizer, especially in bipolar disorder.
What does Lamictal treat?
- Bipolar depression (not mania!)
- Seizures
- Mood stabilization over time
What is a key consideration when using Lamictal?
Not great for acute mania. Think of it like a mood vitamin — slow and steady, not fast-acting.
Why do people care so much about Lamictal?
Because it comes with a serious risk if you start it too fast: Stevens-Johnson Syndrome (SJS).
What is Stevens-Johnson Syndrome?
A life-threatening skin reaction: blisters, peeling, mucosal involvement. Can happen if you increase the dose too quickly.
