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Tiotropium counselling — GPhC CRA MCQ

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HardRespiratory TherapeuticsTiotropium counsellingGPhC CRA

A patient started mesalazine three months ago for ulcerative colitis. Baseline eGFR was 82 mL/min/1.73 m²; it is now 54, with a confirmed upward creatinine trend and no dehydration. Liver tests and blood count are stable. What is the most appropriate medicines-monitoring response?

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Correct answer: D — Contact gastroenterology with mesalazine withheld because renal function has deteriorated

SPS requires renal function and U&Es at baseline, at three months and then annually, with more frequent monitoring in renal impairment. It specifically advises stopping mesalazine if renal function deteriorates. The confirmed fall from eGFR 82 to 54 is therefore not deferred for a year. Liver-test thresholds address a different toxicity and do not negate renal concern. Routine urine dipstick monitoring was removed from the SPS recommendation, and increasing the dose would expose the patient to further risk rather than correct the problem.

Reference: NHS SPS: Mesalazine monitoring. https://www.sps.nhs.uk/monitorings/mesalazine-monitoring/