MRCP - Pharmacology Part 1 (Toxicity)
Questions And Answers 100% Guaranteed
Success.
LFTs at baseline, 3 mo and 12 mo - correct answer. 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 - correct answer. 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 - correct answer.
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 - correct answer. What monitoring do you need for
amiodarone? (4/2)
Continue it if required and add levothyroxine - correct answer. 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 -
correct answer. 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 - correct answer. What monitoring do you
need for methotrexate? (3)
Folate 5mg on a separate day - correct answer. What drug needs to be given with
methotrexate?
,12h after the dose when starting the drug, at each dose change and at 3 months -
correct answer. When does lithium level need to be taken?
0.4-0.8 - correct answer. What is a normal lithium level?
TFTs/U&E at baseline and 6 months - correct answer. Apart from lithium level, what
blood tests need to be done for monitoring lithium? (2)
LFTs - correct answer. What montoring is needed for Glitazones?
CBG at baseline and regular intervals - correct answer. 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 - correct answer. What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - correct answer. What monitoring, and
when, is needed for levothyroxine?
FBC = risk of agranulocytosis - correct answer. 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 - correct answer. 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 - correct answer. What monitoring is required for the
COCP?
Check trough level immediately before dose - correct answer. What monitoring is
required for ciclosporin?
TPMT - correct answer. What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
, - Suspected toxicity
- Non-Adherence to medication - correct answer. What monitoring is required for
phenytoin?
Time dependant killing
- Check U&E before prescribing
- Change concentration if trough level is wrong - correct answer. 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 - correct answer.
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 - correct answer. 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 - correct answer.
What are the rules regarding food in surgery?
Omit on the day of surgery as risk of post-op hypotension - correct answer. When
do ACE-I need to be omitted for surgery?
7 days before surgery - correct answer. When do antiplatelets need to be stopped
for surgery?
- Stop 4-5 days before; bridge onto LMWH.
- Stop this 24h before surgery - correct answer. What are the rules regarding
Warfarin and surgery?
- Stop 24h before surgery, and start 48/72h after surgery - correct answer. 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 - correct
answer. When does COCP need to be stopped for surgery?
- Reduce long acting insulin by 20% on the day of surgery
Questions And Answers 100% Guaranteed
Success.
LFTs at baseline, 3 mo and 12 mo - correct answer. 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 - correct answer. 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 - correct answer.
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 - correct answer. What monitoring do you need for
amiodarone? (4/2)
Continue it if required and add levothyroxine - correct answer. 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 -
correct answer. 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 - correct answer. What monitoring do you
need for methotrexate? (3)
Folate 5mg on a separate day - correct answer. What drug needs to be given with
methotrexate?
,12h after the dose when starting the drug, at each dose change and at 3 months -
correct answer. When does lithium level need to be taken?
0.4-0.8 - correct answer. What is a normal lithium level?
TFTs/U&E at baseline and 6 months - correct answer. Apart from lithium level, what
blood tests need to be done for monitoring lithium? (2)
LFTs - correct answer. What montoring is needed for Glitazones?
CBG at baseline and regular intervals - correct answer. 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 - correct answer. What monitoring is needed for vitamin D?
- Check TFTs in 6-8 weeks
- Check yearly if on maintenance dose - correct answer. What monitoring, and
when, is needed for levothyroxine?
FBC = risk of agranulocytosis - correct answer. 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 - correct answer. 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 - correct answer. What monitoring is required for the
COCP?
Check trough level immediately before dose - correct answer. What monitoring is
required for ciclosporin?
TPMT - correct answer. What test is needed before starting Azathioprine?
Check trough level immediately before dose if:
- Adjustment of dose
, - Suspected toxicity
- Non-Adherence to medication - correct answer. What monitoring is required for
phenytoin?
Time dependant killing
- Check U&E before prescribing
- Change concentration if trough level is wrong - correct answer. 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 - correct answer.
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 - correct answer. 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 - correct answer.
What are the rules regarding food in surgery?
Omit on the day of surgery as risk of post-op hypotension - correct answer. When
do ACE-I need to be omitted for surgery?
7 days before surgery - correct answer. When do antiplatelets need to be stopped
for surgery?
- Stop 4-5 days before; bridge onto LMWH.
- Stop this 24h before surgery - correct answer. What are the rules regarding
Warfarin and surgery?
- Stop 24h before surgery, and start 48/72h after surgery - correct answer. 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 - correct
answer. When does COCP need to be stopped for surgery?
- Reduce long acting insulin by 20% on the day of surgery
