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Gentamicin monitoring — GPhC CRA MCQ

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HardAdverse Drug Reactions and Drug SafetyGentamicin monitoringGPhC CRA

An 84-year-old taking digoxin has acute renal deterioration, nausea, yellow-green visual disturbance and a new bradyarrhythmia. The last dose was at 08:00. Which sampling and interpretation plan best follows national SPS guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Sample at 16:00; interpret the concentration with the clinical and ECG findings

SPS advises sampling no less than six hours—and ideally eight to twelve hours—after the last digoxin dose. After an 08:00 dose, 14:00 is the earliest acceptable time and 16:00–20:00 is preferred. Renal deterioration and the symptom cluster are specific reasons to measure a level, but concentration does not replace clinical interpretation: toxicity may occur within the quoted therapeutic range, and serious manifestations require urgent specialist management without waiting for a conveniently timed sample.

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