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9 reasons to monitor therapeutic drug levels
- wide variation on individual metabolism (Theophylline)
- saturation kinetics occur - increased dose does not increase effectiveness (Dilantin)
- therapeutic level is close to toxic level (Lithium)
- signs of toxicity are difficult to recognize
- when GI, hepatic, or renal disease is present
- drug interactions are possible
- non-compliance is suspected
- when OD of an unknown substance has occurred
- to detect abuse of drugs
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Reasons not to monitor therapeutic drug levels
- cost
- effect is more important than actual serum level (Heparin, Warfarin)
- timing of drug draw
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Antibiotics commonly monitored:
- Aminoglycosides (-mycin)
- ototoxicity - can cause dizziness and hearing loss
- nephrotoxicity - renal damage
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Anticonvuslant side effects
- ataxia
- gait disturbances
- dizziness
- drowsiness
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Lithium toxicity
- diarrhea
- vomiting
- muscle weakness
- lack of coordination
- hypothyroidism
- keep salt intake consistant
- do not use diuretics
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Antidepressant side effects
- cardiotoxicity (arrhythmias, prolonged QRS)
- orthostatic hypotension
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Theophylline toxicity
- early symptom is 'coffee jag'
- tachycardia
- nervous, jittery
- HA
- dizziness
- vomiting
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Digitalis/Digoxin toxicity
- visual disturbances (yellow, halo)
- n/v/d
- HA
- keep an eye on pts w/ poor renal function
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Antiarrhythmic toxicity (like quinidine)
- (toxicity called cinchoism)
- brady/tachycardia
- hypotension (VS!)
- HA
- dizziness
- tinnitus
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Aspirin toxicity
- mild: tinnitus, GI upset
- severe: respiratory alkalosis, metabolic acidosis (d/t respiratory stimulant)
- most common OD in children
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Barbituate toxicity
- respiratory failure
- circulatory collapse
- coma
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Bromide toxicity
- (found in sleeping aids, nerve tonic)
- toxicity is called bromism
- muscle incoordination
- decreased mental status
- vomiting
- rash
- (careful use with renal pts)
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