MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
LFTs at baseline, 3 mo and 12 mo - What monitoring do you need for statins?
If AST goes up x3 from baseline and persists. Stop the statin and restart at a lower
dose if symptoms resolve - An AST rise of what level is enough to discontinue a
statin? What do you do?
- U&E at start, when increasing treatment or annually
- Rise in creatinine up to 30%, and K+ up to 5.5mol is allowed - What monitoring
do you need for ACE-I? What is an acceptable change in function?
- TFTs, U&E, LFTs and CXR prior to treatment
- TFTs and LFTs at 6 months - What monitoring do you need for amiodarone? (4/2)
Continue it if required and add levothyroxine - What happens if amiodarone
causes hypothyroidism?
- AIT1 = excess iodine causes a goitre and therefore tx with carbimazole
- AIT2 = destructive thyroiditis due to amiodarone = no goitre and tx with steroids
- What are the two types of amiodarone induced hyperthyroidism?
,MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
- Check LFTs, FBC & U&E before treatment, and then every two weeks for 2
months, then every month then every 3 months - What monitoring do you need
for methotrexate? (3)
Folate 5mg on a separate day - What drug needs to be given with methotrexate?
12h after the dose when starting the drug, at each dose change and at 3 months -
When does lithium level need to be taken?
0.4-0.8 - What is a normal lithium level?
TFTs/U&E at baseline and 6 months - Apart from lithium level, what blood tests
need to be done for monitoring lithium? (2)
LFTs - What montoring is needed for Glitazones?
CBG at baseline and regular intervals - What monitoring is needed for olanzapine?
,MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
Calcium levels at 1 month and vitamin D
- if Vit D >50 = okay
- if Vit D25-50 = deficient for some of the population
- if Vit D <25 = deficient - What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - What monitoring, and when, is needed for
levothyroxine?
FBC = risk of agranulocytosis - What monitoring is needed for carbimazole or
clozapine?
Concentration dependant killing
- Check peak level 1h after the 3rd dose and trough level before next dose
- Peak level should be 3-5
- Trough level should be <1
As concentration dependant killing, ;need to alter the time between each dose if
trough level is raised BUT need to lower dose if the peak level is high
, MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
C/G like DNA base pairs - When do you need to check the dose of Gentamicin?
What time of killing does it have? How do you alter the dose
Check BP before starting - What monitoring is required for the COCP?
Check trough level immediately before dose - What monitoring is required for
ciclosporin?
TPMT - What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
- Suspected toxicity
- Non-Adherence to medication - What monitoring is required for phenytoin?
Time dependant killing
- Check U&E before prescribing
questions and answers
LFTs at baseline, 3 mo and 12 mo - What monitoring do you need for statins?
If AST goes up x3 from baseline and persists. Stop the statin and restart at a lower
dose if symptoms resolve - An AST rise of what level is enough to discontinue a
statin? What do you do?
- U&E at start, when increasing treatment or annually
- Rise in creatinine up to 30%, and K+ up to 5.5mol is allowed - What monitoring
do you need for ACE-I? What is an acceptable change in function?
- TFTs, U&E, LFTs and CXR prior to treatment
- TFTs and LFTs at 6 months - What monitoring do you need for amiodarone? (4/2)
Continue it if required and add levothyroxine - What happens if amiodarone
causes hypothyroidism?
- AIT1 = excess iodine causes a goitre and therefore tx with carbimazole
- AIT2 = destructive thyroiditis due to amiodarone = no goitre and tx with steroids
- What are the two types of amiodarone induced hyperthyroidism?
,MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
- Check LFTs, FBC & U&E before treatment, and then every two weeks for 2
months, then every month then every 3 months - What monitoring do you need
for methotrexate? (3)
Folate 5mg on a separate day - What drug needs to be given with methotrexate?
12h after the dose when starting the drug, at each dose change and at 3 months -
When does lithium level need to be taken?
0.4-0.8 - What is a normal lithium level?
TFTs/U&E at baseline and 6 months - Apart from lithium level, what blood tests
need to be done for monitoring lithium? (2)
LFTs - What montoring is needed for Glitazones?
CBG at baseline and regular intervals - What monitoring is needed for olanzapine?
,MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
Calcium levels at 1 month and vitamin D
- if Vit D >50 = okay
- if Vit D25-50 = deficient for some of the population
- if Vit D <25 = deficient - What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - What monitoring, and when, is needed for
levothyroxine?
FBC = risk of agranulocytosis - What monitoring is needed for carbimazole or
clozapine?
Concentration dependant killing
- Check peak level 1h after the 3rd dose and trough level before next dose
- Peak level should be 3-5
- Trough level should be <1
As concentration dependant killing, ;need to alter the time between each dose if
trough level is raised BUT need to lower dose if the peak level is high
, MRCP - Pharmacology Part 1 (Toxicity)
questions and answers
C/G like DNA base pairs - When do you need to check the dose of Gentamicin?
What time of killing does it have? How do you alter the dose
Check BP before starting - What monitoring is required for the COCP?
Check trough level immediately before dose - What monitoring is required for
ciclosporin?
TPMT - What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
- Suspected toxicity
- Non-Adherence to medication - What monitoring is required for phenytoin?
Time dependant killing
- Check U&E before prescribing
