Prescribing and clinical monitoring

What are the key monitoring parameters in paediatric patients?

• Growth (height/weight/HC)

• vital signs (age-specific)

• renal/liver function

• electrolytes

• behavioural changes

• allergies

• appetite

• sleep.

Why is polypharmacy risky in elderly patients?

Increased drug interactions, ADRs, and reduced organ function → higher toxicity risk.

What pharmacokinetic changes occur in elderly patients?

• Reduced renal clearance

• slower hepatic metabolism

• increased body fat

• reduced GI motility

• increased gastric pH.

Key monitoring parameters for elderly patients?

• Vital signs: temperature, pulse (heart rate), breathing (respiratory rate), and blood pressure, plus oxygen saturation

• renal/liver function

• electrolytes

• therapeutic drug levels

• bone health

• frailty

• cognition

• nutritional status

• adherence.

What are the main adverse pregnancy outcomes from medicines?

• Malformations

• miscarriage

• intestinal- uterine growth restriction (IUGR)

• prematurity

• stillbirth

• neonatal withdrawal

• toxicity

• neural tube defects (NTDs)

• cancer risk (rare).

What is the safest approach to prescribing in pregnancy?

• Use non-drug options first

• prescribe only if essential

• avoid new drugs

• mono-therapy

• lowest effective dose.

When is the highest risk of teratogenicity?

During organogenesis: 2–9 weeks gestation.

What factors influence placental drug transfer?

• Molecular size

• ionisation

• protein binding

• lipid solubility.

What considerations when prescribing in pregnancy?

• Timing of exposure

• trimester

• comorbidities

• alternative treatments

• risks vs benefits.

Which antiemetic should be avoided in the 1st trimester?

Ondansetron.

Which antibiotics are considered safe in pregnancy?

Amoxicillin, flucloxacillin

avoid tetracyclines & aminoglycosides.

What is the preferred 1st-line treatment for hypertension in pregnancy?

Labetalol (1st), nifedipine (2nd), methyldopa (3rd).

What should be avoided for hypertension in pregnancy due to teratogenicity?

ACE inhibitors and ARBs.

What are the safest antiepileptic agents in pregnancy?

Lamotrigine and levetiracetam.

What folic acid dose is needed pre-conception in epilepsy?

5 mg daily from 12 weeks before conception.

Key monitoring in pregnant patients?

• Vital signs: temperature, pulse (heart rate), breathing (respiratory rate), and blood pressure, plus oxygen saturation

• BP & proteinuria

• glucose control

• seizure monitoring,

• fetal growth scans

• mental health assessment.

Name three major benefits of breastfeeding for the baby.

• Reduced infections (UTI, chest, ear)

• lower risk of obesity

• lower sudden infant death (SIDS) risk.

Name benefits of breastfeeding for the mother.

Reduced risk of:

• breast cancer

• ovarian cancer

• diabetes

• postnatal depression.