QuestionSBA
QuestionChoice
Monitoring of blood co-trimoxazole concentrations may be useful for planning dose adjustments but aberrant levels do not necessarily correspond with development of adverse effects
34331
b
Co-trimoxazole levels
QuestionChoice
Co-trimoxazole is known to cause hyperkalaemia in patients who are at risk of or have pre-existing renal impairment
34330
a
Urea and electrolytes
QuestionChoice
Hypoglycaemia is a very rare side effect of treatment with co-trimoxazole but it is not routine to monitor blood glucose whilst on this drug
34332
c
Blood glucose monitoring
QuestionChoice
It is advised to avoid using co-trimoxazole in patients with severe hepatic impairment but monitoring liver function is not routinely done
34334
e
Liver function tests
QuestionChoice
Co-trimoxazole has anti-folate activity and monitoring haematics could be considered if taken for an extended period of time or in combination with another anti-folate drug such as methotrexate. However the planned treatment course here is only for 7 days and is unlikely to result in a significant effect
34333
d
Haematinics (ferritin, B12, folate)
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2809
Trimethoprim side effects
Topic
9
Internal Medicine
6877
Case Presentation: A 67 year old man is admitted to the medical ward for treatment of a diabetic foot ulcer. **PMH** type 2 diabetes, hypertension, diabetic nephropathy. **DH** metformin hydrochloride MR tablets 2g PO OD, insulin glargine (Lantus) 9 units SC BD, doxazosin 4mg PO OD. Allergic to penicillin – urticarial rash. Allergic to gentamicin – anaphylaxis.


**Investigations**

FBC: Hb 130, WCC 17.3, Plts 235 x 10^9, MCV 87

U&Es: Na 145, K 4.8, Cl 96, Ur 3.1, Cr 197, eGFR 48mL/min/1.73m^2

LFTs: AST 16, ALT 23, ALP 54

CRP 155

Ulcer swab MCS: mixed growth. Primary species Staphylococcus aureus and Staphylococcus epidermidis, isolated Elizabethkingia meningoseptica

Based on the sensitivities and advice from microbiology, the patient’s consultant decides to start co-trimoxazole 960mg IV BD for 7 days.

Question: Select the most appropriate option to monitor for adverse effects of this treatment.
a