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Flashcards in Monitoring Deck (6):

What info needs to be given to a pt starting methotrexate?

Sore throat, fever or unexplained bruising may result from methotrexate-induced bone marrow suppression causing neutropenia or decreased platelet production. Other serious potential adverse effects include cirrhosis and pulmonary toxicity.
FBC, LFT, U+E at baseline, every 1-2 weeks until dosage is stabilised + every 2-3 months thereafter.
Once weekly
Folic acid taken on a different day once weekly
NSAIDs interact so avoid self medication


What info is needed when starting a pt on digoxin?

Measure levels 8-10days after initiating treatment or changing dose (esp in elderly)
Therapeutic range of 1.0-2.0 nmol/L. Measurements should be made 6 hours post-dose
Dose reduced in renal impairment (monitor renal function)


How do you monitor levothyroxine treatment in someone with hypothyroidism?

TSH measured in 2-3months (allows for resolution of pituitary hyperplasia)
Target concentration 0.4-2.5 mU/L (0.4-5.0) Dose adjusted by 12.5-25 micrograms daily to achieve this.
Symptomatic relief is the ultimate aim of thyroid replacement therapy and fatigue, drowsiness and subtle cognitive impairment are sensitive markers of suboptimal treatment


What drugs have their concentrations monitored?

Gentamicin + digoxin (to avoid toxicity, especially in patients with renal failure)
Phenytoin and IV theophylline/aminophylline (to achieve therapeutic concentrations whilst avoiding toxicity)
Vancomycin (to avoid renal toxicity and ototoxicity)


When is a steady state plasma level usually achieved?

After 4-5 drug half lives


What happens to TSH levels if too much or too little levothyroxine is given?

Too much levothyroxine: complete suppression of TSH
Too little: TSH rises