Key Medicines Monitoring Flashcards
(26 cards)
ACE/ARBs
Baseline:
- BP
- eGFR/serum creatinine
- Serum Potassium
- Serum Sodium
- Urea
ongoing once stable- annually
- Electrolytes
- BP
- Creatinine
Acetylcholinesterase inhibitors e.g. Donepezil
Baseline
- Estimated glomerular filtration rate · for galantamine and rivastigmine only
- Liver function tests
- Serum potassium · for galantamine
Alfacalcidiol
Baseline:
Alkaline Phosphatase
Parathyroid hormone
Serum calcium · ideally corrected calcium for protein binding
Serum creatinine (for creatinine clearance)
Serum phosphate
Urea and electrolytes
Vitamin D · (25-hydroxy vitamin D level)
Ongoing once stable:
Every 3 months
Alkaline Phosphatase
Parathyroid hormone
Serum calcium · ideally corrected calcium for protein binding
Serum creatinine (for creatinine clearance)
Serum magnesium
Serum phosphate
Amiodarone
Baseline:
Chest x-ray
ECG
Urea and electrolytes
Serum potassium
Liver function tests · particularly transaminases
T3
T4
Thyroid stimulating hormone
ongoing once stable- 6 monthly
Liver function tests
Thyroid function tests
Urea and electrolytes · especially if patient takes concomitant diuretics
Annually:
Chest x-ray
ECG
Azathioprine
Baseline:
ALT or AST
Blood pressure
Calculated glomerular filtration rate or Serum creatinine (for creatinine clearance)
Cervical screening · check this is up to date
Full blood count
Height
Liver function tests
TPMT assay
Weight
Vaccination status
Varicella Zoster Virus Immunity · if no history of chicken pox, shingles or varicella vaccination
ongoing once stable- every 3 months
Albumin
ALT or AST
Full blood count
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Liver function tests
Full blood count
Carbamazepine
Baseline:
Body mass index
Full blood count
Liver function tests
Urea and electrolytes
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
ongoing once stable- 6 monthly
6 monthly
Urea and electrolytes · more frequently if clinically indicated
Periodically
Liver function tests · particularly in patients with a history of liver disease and in elderly patients
Carbimazole
Baseline
Free T3
Free T4
Full blood count · including white cell count (WCC)
Thyroid stimulating hormone
Liver function tests
White blood cell differential
ongoing once stable- every 3 months
Thyroid stimulating hormone
Ciclosporin
Baseline
Blood pressure · required at least twice before starting treatment
Serum creatinine (for creatinine clearance) · required at least twice before starting treatment or Calculated glomerular filtration rate
Cervical screening · check up-to-date
Lipids
Liver function tests
Serum magnesium
Serum potassium · especially in renal dysfunction (risk of hyperkalaemia)
Vaccination status
Ongoing once stable
Every 1 - 3 months
Albumin
ALT or AST
Blood pressure
Blood glucose
Full blood count
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Corticosteroids
Baseline
Blood pressure
Body mass index
Bone mineral density · in adults expected to be on prednisolone at a dose equal or greater than 5mg/day, or equivalent, for over 3 months
Height · in children and adolescents
Optometrist exam · for glaucoma or cataract
Risk factor assessment · check for pre-existing conditions potentially exacerbated by steroids
Serum potassium
Weight
Ongoing once stable
Every 3 months
HbA1c · monitor people with confirmed diabetes mellitus more closely, depending on clinical judgement
Every 6 - 12 months
Optometrist exam · earlier for those with symptoms of cataracts
Serum potassium
Triglycerides
At 12 months; then annually or every 2-3 years depending on risk
Bone mineral density
Periodically at appointments
Blood pressure
Falls risk assessment · where appropriate
Signs of adrenal suppression · follow advice if long-term or regular oral corticosteroids
Weight
DOACs
Baseline
Baseline clotting screening
Body weight
Full blood count
Liver function tests
Serum creatinine (for creatinine clearance)
Urea and electrolytes
ongoing once stable
Every 3 months
DOAC review appointment
Annually; more frequently if clinical concerns
Full blood count
Liver function tests
Urea and electrolytes
Serum creatinine (for creatinine clearance)
Digoxin
Baseline
Serum calcium
Serum creatinine (for creatinine clearance)
Serum magnesium
Serum potassium
Thyroid function tests · digoxin may require dose amendment in thyroid disease
Urea and electrolytes
Ongoing once stable
Annually
Serum calcium
Serum creatinine (for creatinine clearance)
Serum magnesium · increased frequency may be required if long-term PPI, other medicine pre-disposing to hypomagnesaemia, or low calcium level
Serum potassium
Urea and electrolytes
Eplerenone
Baseline
Estimated glomerular filtration rate · contraindicated if eGFR less than 30mL/min/1.73m2; reduce starting dose to 25 mg on alternate days if eGFR 30–60 mL/minute/1.73 m2
Serum potassium · contraindicated if over 5.0 mmol/L
Electrolytes
ongoing once stable
Periodically
Estimated glomerular filtration rate
Serum potassium · adjust dose to level
Furosemide
Baseline
Blood pressure
Electrolytes
Serum creatinine (for creatinine clearance)
Ongoing once stable
6 monthly
Electrolytes
Serum creatinine (for creatinine clearance)
Hydroxychloroquine
Baseline
Albumin
ALT or AST
Blood pressure
Full blood count
Height
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Weight
Vaccination status
Ongoing once stable
Annually if increased risk; otherwise once after 5 years and then annually
Ophthalmological examination
Levothyroxine
Baseline
ECG
Free T4
Thyroid function tests
Thyroid stimulating hormone
ongoing once stable
Annually
Thyroid stimulating hormone · used to monitor both adherence and to ensure dose remains correct
Lithium
Baseline
Body mass index
Cardiac function · ECG recommended for patients with cardiovascular disease or cardiovascular risk factors
Estimated glomerular filtration rate
Full blood count
Serum calcium
Thyroid function tests · patients should be euthyroid before initiation
Urea and electrolytes
Exclude pregnancy
ongoing once stable
Every 3 - 6 months
Lithium levels · take sample just prior to time of next dose (i.e. trough level 12 hours following last dose)
6 monthly
Body weight or Body mass index
Estimated glomerular filtration rate
Serum calcium
Thyroid function tests
Urea and electrolytes
Baseline
Albumin
Blood pressure
Body weight
Chest x-ray or Screening for lung disease · physical examination and lung function may also be necessary on case-by-case basis
Full blood count
Height
Hepatitis B · consider antiviral treatment prior to initiation if chronic viral hepatitis
Hepatitis C · consider antiviral treatment prior to initiation if chronic viral hepatitis
HIV
Liver function tests · consider delayed initiation if results abnormal
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate · avoid in severe renal impairment; reduce dose if moderate
ongoing once stable
Every 2 -3 months
Full blood count
Liver function tests
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
Mycophenolate
Baseline
Pregnancy test · two tests 8-10 days apart in women of child bearing potential; exclude before initiating
Albumin
ALT or AST
Blood pressure
Full blood count
Height
Liver function tests
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Vaccination status
Weight
Ongoing once stable
At least every 12 weeks
Albumin
ALT or AST
Full blood count
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Phenytoin
Baseline
Full blood count
HLAB* 1502 allele · in Han Chinese or Thai origin patients
Liver function tests
Urea and electrolytes
Vitamin D
ongoing once stable
Every 2-5 years
Bone metabolism e.g. calcium or ALP
Full blood count
Liver function tests
Urea and electrolytes
Vitamin D
6 monthly
Bone metabolism e.g. calcium or ALP
Periodically
Plasma phenytoin concentration
Spironolactone
Baseline
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
Urea and electrolytes
ongoing once stable
Every 3 - 6 months
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
Urea and electrolytes
Statins
Baseline
ALT or AST
Blood pressure
Body mass index
HDL cholesterol (non-fasting)
non-HDL cholesterol (non-fasting)
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
Total cholesterol (non-fasting)
Triglycerides (non-fasting)
HbA1c
Continued until stable
Between months 2 and 3
ALT or AST
HDL cholesterol (non-fasting)
non-HDL cholesterol (non-fasting)
Total cholesterol (non-fasting)
Triglycerides (non-fasting)
At 3 months
HbA1c or Blood glucose · if high risk of diabetes mellitus
Creatine kinase · If persistent muscle symptoms (pain, tenderness, weakness) but do not measure after strenuous exercise or after possible cause of increase (e.g. fall)
ongoing once stable
ALT or AST · repeat after first year only if indicated
non-HDL cholesterol (non-fasting) · to inform annual review
HDL cholesterol (non-fasting) · to inform annual review
Total cholesterol (non-fasting) · to inform annual review
Triglycerides (non-fasting) · to inform annual review
Sulfasalazine
Baseline
Albumin
ALT or AST
Blood pressure
Full blood count · to include differential white cell count and platelet count
Height
Weight
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
ongoing once stable
At least every 12 weeks for first 12 months
Albumin
ALT or AST
Full blood count
Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
Tacrolimus
Baseline
Blood pressure
Clotting screening
ECG · for hypertropic changes
Fasting blood glucose
Full blood count
Liver function tests
Plasma proteins
Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
Urea and electrolytes · potassium particularly important
Theophylline
Ongoing once stable
Every 6 - 12 months
Plasma theophylline concentration · increase frequency or monitor one-off for some patients; for MR preparations, take levels 4-6 hours after dose
