MRCP - Pharmacology Part 1 (Toxicity)
LFTs at baseline, 3 mo and 12 mo - ANS 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 - ANS 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 - ANS 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 - ANS What monitoring do you need for amiodarone? (4/2)
Continue it if required and add levothyroxine - ANS 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 - ANS What are the
two types of amiodarone induced hyperthyroidism?
- Check LFTs, FBC & U&E before treatment, and then every two weeks for 2 months, then every month
then every 3 months - ANS What monitoring do you need for methotrexate? (3)
Folate 5mg on a separate day - ANS What drug needs to be given with methotrexate?
12h after the dose when starting the drug, at each dose change and at 3 months - ANS When does
lithium level need to be taken?
,0.4-0.8 - ANS What is a normal lithium level?
TFTs/U&E at baseline and 6 months - ANS Apart from lithium level, what blood tests need to be done for
monitoring lithium? (2)
LFTs - ANS What montoring is needed for Glitazones?
CBG at baseline and regular intervals - ANS What monitoring is needed for olanzapine?
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 - ANS What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - ANS What monitoring, and when, is needed for levothyroxine?
FBC = risk of agranulocytosis - ANS 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
C/G like DNA base pairs - ANS 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 - ANS What monitoring is required for the COCP?
Check trough level immediately before dose - ANS What monitoring is required for ciclosporin?
TPMT - ANS What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
- Suspected toxicity
- Non-Adherence to medication - ANS What monitoring is required for phenytoin?
Time dependant killing
- Check U&E before prescribing
- Change concentration if trough level is wrong - ANS What type of killing does vancomycin undergo?
When do you need to check the dose? How do you change it?
1. HR whilst on the drug
2. U&E as renal excreted
3. Dose level at least 6h after most recent dose if suspecting toxicity - ANS What monitoring is required
for digoxin? (3)
, I've a date at 6 (digoxin 6h), so ill be late at 12 (lithium at 12h),
Call before you go (ciclo/gent as trough just before), and phone just before if in doubt (phenytoin just
before if worried about toxicity)
Check your bike just before you ciclo off - ANS What is the pneumonic for remembering when to check
drug levels?
- No solids/non-clear fluids 6h before
- No clear fluids 2h before: allow routine medications with this - ANS What are the rules regarding food
in surgery?
Omit on the day of surgery as risk of post-op hypotension - ANS When do ACE-I need to be omitted for
surgery?
7 days before surgery - ANS When do antiplatelets need to be stopped for surgery?
- Stop 4-5 days before; bridge onto LMWH.
- Stop this 24h before surgery - ANS What are the rules regarding Warfarin and surgery?
- Stop 24h before surgery, and start 48/72h after surgery - ANS What are the rules with DOACs before
surgery?
ONLY when there is a high risk of post-op DVT e.g. major surgery or lower limb surgery
Stop 4 weeks before surgery and start again 2 weeks after - offer POP instead - ANS When does COCP
need to be stopped for surgery?
- Reduce long acting insulin by 20% on the day of surgery
LFTs at baseline, 3 mo and 12 mo - ANS 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 - ANS 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 - ANS 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 - ANS What monitoring do you need for amiodarone? (4/2)
Continue it if required and add levothyroxine - ANS 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 - ANS What are the
two types of amiodarone induced hyperthyroidism?
- Check LFTs, FBC & U&E before treatment, and then every two weeks for 2 months, then every month
then every 3 months - ANS What monitoring do you need for methotrexate? (3)
Folate 5mg on a separate day - ANS What drug needs to be given with methotrexate?
12h after the dose when starting the drug, at each dose change and at 3 months - ANS When does
lithium level need to be taken?
,0.4-0.8 - ANS What is a normal lithium level?
TFTs/U&E at baseline and 6 months - ANS Apart from lithium level, what blood tests need to be done for
monitoring lithium? (2)
LFTs - ANS What montoring is needed for Glitazones?
CBG at baseline and regular intervals - ANS What monitoring is needed for olanzapine?
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 - ANS What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - ANS What monitoring, and when, is needed for levothyroxine?
FBC = risk of agranulocytosis - ANS 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
C/G like DNA base pairs - ANS 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 - ANS What monitoring is required for the COCP?
Check trough level immediately before dose - ANS What monitoring is required for ciclosporin?
TPMT - ANS What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
- Suspected toxicity
- Non-Adherence to medication - ANS What monitoring is required for phenytoin?
Time dependant killing
- Check U&E before prescribing
- Change concentration if trough level is wrong - ANS What type of killing does vancomycin undergo?
When do you need to check the dose? How do you change it?
1. HR whilst on the drug
2. U&E as renal excreted
3. Dose level at least 6h after most recent dose if suspecting toxicity - ANS What monitoring is required
for digoxin? (3)
, I've a date at 6 (digoxin 6h), so ill be late at 12 (lithium at 12h),
Call before you go (ciclo/gent as trough just before), and phone just before if in doubt (phenytoin just
before if worried about toxicity)
Check your bike just before you ciclo off - ANS What is the pneumonic for remembering when to check
drug levels?
- No solids/non-clear fluids 6h before
- No clear fluids 2h before: allow routine medications with this - ANS What are the rules regarding food
in surgery?
Omit on the day of surgery as risk of post-op hypotension - ANS When do ACE-I need to be omitted for
surgery?
7 days before surgery - ANS When do antiplatelets need to be stopped for surgery?
- Stop 4-5 days before; bridge onto LMWH.
- Stop this 24h before surgery - ANS What are the rules regarding Warfarin and surgery?
- Stop 24h before surgery, and start 48/72h after surgery - ANS What are the rules with DOACs before
surgery?
ONLY when there is a high risk of post-op DVT e.g. major surgery or lower limb surgery
Stop 4 weeks before surgery and start again 2 weeks after - offer POP instead - ANS When does COCP
need to be stopped for surgery?
- Reduce long acting insulin by 20% on the day of surgery
