Therapeutic Drug Monitoring, Calcium, Enzymes and Cardiac Markers Flashcards Preview

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Flashcards in Therapeutic Drug Monitoring, Calcium, Enzymes and Cardiac Markers Deck (39)
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1

Phenytoin
- used to treat?
-signs of toxicity?

-Seizures
-Ataxia and nystagmus

2

Phenytoin
-interactions and cautions?
-treatment?

-At high levels liver becomes saturated -> surge in blood levels
-Omit/ reduce dose

3

Digoxin
- used to treat?
- signs of toxicity?

-Arrythmias
- Arrythmias, heart block, confusion, xanthophsia (seeing yellow)

4

Digoxin
- Interactions and cautions?
- Treatment?

-Levels increased with hypokalaemia. Reduce dose in renal failure and in elderly
-Digibind AKA Digoxin immune Fab

5

Lithium
- used to treat?
- Signs of toxicity?

- Mood disorders eg bipolar
-Tremor (early), lethargy, fits, arrhythmia, renal failure

6

Lithium
-Interactions and cautions?
-Treatment?

-Excretion impaired by hyponatreamia, decreased renal function and diuretics
- Renal failure may need heamodialysis

7

Gentamicin
- Used to treat?
- Signs of toxicity?

- Infection
- Tinnitus, deafness, nystagmus, renal failure

8

Gentamicin
-Interactions and cautions?
-Treatment?

-Mostly use single daily dosing. Monitor peak and trough level before next dose
-Omit/ Reduce dose

9

Theophyline
- Used to treat?
- Signs of toxicity?

- COPD, Asthma - Bronchodilator
- Arrythmias, anxiety, tremor convulsions

10

Theophyline
- Interactions and cautions?
-Treatment?

- Variation in 1/2 life; e.g. 4hr for smokers, 8hrs for non smokers, 30hrs in liver disease. Level increased by erythromycin, cimetidine and phenytoin
- Omit/ Reduce dose

11

Normal range for Calcium and body composition? (can't think of the correct way of saying it)

2.2-2.6mmol/l
-45% isonised (free- biologically active form)
-50% bound to albumin, therefore affected by albumin level- use corrected calcium

12

What are the two main hormones involved in calcium metabolism?

PTH
1,25 (OH)2D - Calcitriol

13

PTH - Parathyroid Hormones - how does it have its effects?

- Increases tubular 1alpha hydroxylation of vitamin D (25(OH)D) leading to increased intestinal absorption via calbindin
-Mobilises calcium from bone
- Increase renal calcium reabsorption
- Increase renal phosphate excretion

14

1,25 (OH)2D - Calcitriol -how does it have its effects?

-Increase calcium and phosphate absorption from the gut
-Bone remodelling

15

Disorders of Calcium Balance
- Primary Hyperparathyroidism
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

- Increase in PTH (80% parathyroid adenoma)
- Ca = HIGH
- PO4 = LOW
- PTH = HIGH/NORM
- Alk Phos = HIGH/NORM
- Vit D = NORM

16

Disorders of Calcium Balance
- Secondary Hyperparathyroidism
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

- Renal Osteodystrophy
- Ca = LOW/NORM
- PO4 = HIGH
- PTH = HIGH
- Alk Phos = HIGH
- Vit D = NORM

17

Disorders of Calcium Balance
- Tertiary Hyperparathyroidism
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

- Autonomous PTH secretion post renal transplant
- Ca = HIGH
- PO4 = LOW
- PTH = HIGH
- Alk Phos = HIGH/NORM
- Vit D = NORM

18

Disorders of Calcium Balance
- Hypoparathyroidism
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

- Low levels of PTH. Primary = DeGeorge Syndrome. Secondary = Post Thyroid Surgery
- Ca = LOW
- PO4 = HIGH
- PTH = LOW
- Alk Phos = LOW/NORM
- Vit D = NORM

19

Disorders of Calcium Balance
- Rickets/ Osteomalacia
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

-Vitamin D deficiency
- Ca = LOW
- PO4 = LOW
- PTH = HIGH
- Alk Phos = HIGH
- Vit D = LOW

20

Disorders of Calcium Balance
- Paget's Disease
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

- Re-modelling of bone
- Ca = NORM
- PO4 = NORM
- PTH = NORM
- Alk Phos = HIGH
- Vit D = NORM

21

Disorders of Calcium Balance
- Osteoporosis
- primary defect?
- Ca, PO4, PTH, Alk Phos, Vit D levels?

- Bone loss
- Ca = NORM
- PO4 = NORM
- PTH = NORM
- Alk Phos = NORM
- Vit D = NORM

22

Causes of Hypercalcaemia with High Albumin?

Urea high = Dehydration
Urea normal = Cuffed (left the tourniquet on too long when taking blood)

23

Causes of Hypercalcaemia with Low/Norm Albumin and Low phosphate?

Primary or Tertiary hyperparathyroidism - confirm with ++ PTH

24

Causes of Hypercalcaemia with Low/Norm Albumin and High phosphate?

- High ALP (increased bone turnover) - Bone metastasis, Thyrotoxicosis, Sarcoidosis (increased 1alpha OH)
-Normal ALP - Myeloma, Excess Vit D, Sarcoid, Milk alkali syndrome ( + high HCO3)

25

Symptoms of Hypercalcaemia?

Stones (renal)
Bones (pain)
Groans (psych)
Moans (abdo pain)
Polyuria
Muscle Weakness

26

Treatment for Hypercalcaemia?

Correct dehydration
Bisphosphonates
Correct cause e.g. chemo for cancer

27

Causes of hypocalcaemia with High Phosphate?

Chronic Kidney Disease
Hypoparathyroidism (inc post thyroid surgery)
Pseudohypoparathyroidism
Hypomagnesaemia

28

Causes of hypocalcaemia with Norm/Low Phosphate?

Osteomalacia
Acute pancreatitis
Over hydration
Respiratory alkalosis (low ionised/active Ca)

29

Symptoms of Hypocalcaemia?

Perioral paraesthesia
carpopedal spasm
neuromuscular excitability
(Trousseau's and Chvostek's sign)

30

Treatment for Hypocalcaemia?

Mild - Give calcium
Chronic Kidney Disease - Alfacalcidol
Severe - 10% calcium gluconate IV