Health Promotion and Lab Monitoring Flashcards
Folate in Mental health treatment.
Patients may have a deficiency of folate
L-5-Methyltetrahydrofolate
Monoamine modulator
Activates synthetic enzymes requiring BH4 as a cofactor include tryptophan and tyrosinehydroxylase
Monoamine synthesis can be enhanced
L-5 Methyltetrahydrofolate
A reduced monoamine synthesis may limit the presence of serotonin even with administrationof SSRI and SNRIs
One potential mechanism of action consists in enhancing monoamine synthesis
It can be used in combination with other antidepressants
Improvement of symptoms of depression
S-adenosyl-methionine(SAMe)
Augmenting antidepressants efficacy
L-Methylfolate converted into methionine, then SAMe
A deficiency may be present in certain patients
High doses of SAMe may be administered to augment antidepressants
Improvement of symptoms of depression may occur
Omega 3 Fatty Acids, Fish Oild, DHA, EPA Fatty Acids
A deficiency may be present in certain patients
The deficiency may potentially lead to depression
Replacement of Omega-3 Fatty Acids
Augmenting antidepressants efficacy
Improvement of symptoms of depression may occur
Melatonin
FDA Approved forInsomnia
A product of tryptophan metabolism/Metabolite of serotonin
May improve thermoreglation and immune defense
Improves Circadian rhythm disorders
Jet Lag
Shift work
Delayed sleep onset
Improves sleep in children with autism and ADHD
Hypericum Perforatum(St.John’s Wort)
Used as antidepressant and anxiolytic
The mechanism of action is unknown
Can be as effective as some SSRIs in mild to moderate depression
Limited research onefficacy insevere depression
Onset of antidepressant action can be 4 weeks from start of treatment.
Daily doses of 500-1,800 mg
Must avoid direct sunlight
Hypericum Perforatum Drug interactions
Severe drug/drug interactions associated due to CYP 3A4, 2C9, 2C19 metabolism.
Alprazolam (Xanax),Amitriptyline,Nortriptyline
Nifedipine
Omeprazole
Oral contraceptives
Simvastatin
Verapamil
Contraindicated in pregnancy, strong abortifacient
Ginkgo Biloba (ginkgo)
One of the oldest trees in the world
FDA approved as a supplement
Used for memory disorders
Asthma, inflammatory disease, GI disturbance
Induces CYP3A drugs in Asians
“Z” drugs
Sedatives/Hypnotics
Quetiapine (Seroquel)
Bupropion (Wellbutrin)
Usual doses for memory function 120mg to 240mg 3 times daily
Actaea Racemose (Black Cohosh)
Non-hormonal treatment to vasomotor symptoms to treat:
Dysmenorrhea
Menopause
Premenstrual Syndrome (Analgesic properties)
Fertility (post IVF and PCOS)
Osteoporosis
Prostate and breast cancer
GI upset
Dosed at 40mg to 80mg daily
May take 2 weeks to see intended effect
Drug/drug interactions: antihypertensive, cardiac drugs, estrogen
Contraindicated in pregnancy, pts with cardiac history
Valeriana Officinalis
Has high amounts of GABA, though it does not cross the blood brain barrier
Used as a sleep aid and mild anxiolytic
Increases time in deep sleep
May experience improvement in 10 days after onset of treatment
No known toxicity, drug/drug interactions
Contraindicated in pregnancy due to adverse effects on embryo
Reasons to monitor blood levels of medications:
Clinical Applications
Increased efficacy of using an optimal amount ofmedications
Increased safety, decreased side effects and likelihood oftoxicity
Monitor patient adherence
Protection against potential legal actions
Lithium monitoring
-0.6-1.2 meq/L, Toxic at >1.5 meq/L
-Clinical Applications
-Increased efficacy of using an optimal amount ofmedications
-Increased safety, decreased side effects and likelihood oftoxicity
-Monitor patient adherence
-Protection against potential legal actions
Get a Lithium Level
-5 days after first dose, then at 3 months and 6 months
-EKG: Baseline and annually
-CBC: Baseline and annually
-Thyroid Panel: TSH every 6 months
-CMP
-Weight
-Urinalysis (kidney monitoring)
Carbamazepine Blood level Monitoring
-Check 5-7 days after initial dose then at 1-4 weeks.
-Goal level 4-12 micrograms/L. Toxic levels are more than 12 mg/L or 10 mg/kg.
-Labs should be drawn Baseline and annually
-CBC with differential
-CMP
-Hepatic function test
-HLA-B1502 or HLA-A3101
(Asians, Native Amer, European, Latin America)
Monitor for Maculopapular Exanthema
Maculopapular Exanthema
Valproic Acid monitoring
85-125 mcg/ml, toxic >150 mcg/ml.
CBC with differential
CMP (creatinine, electrolytes)
Weight
VPA level
1-2 weeks after first dose, then after dose changes
Gabapentin Monitoring
Neurontin serum levels not required
Renal function test
Lamictal monitoring
Lamictal serum levels not required
Renal function test
Hepatic function test
CBC
Monitor for Stephen Johnson Syndrome
Topiramate monitoriong(Topamax)
Topiramate (Topamax)
Baseline and annually
CBC with differential
Renal function
Hepatic function test
Eye Exam
Weight (q 3 months)
Monitoring during Antipsychotic Treatment
EKG
Baseline and annually
Monitor for QT prolongation (>450ms)
BMI and Waist Circumference
Weight (in pounds) X 703/height (in inches)
AIMS Test
Baseline and q 3 months
Vision
Annually
AIMS Test
Clozaril monitoring
-250-350 mcg/ml, toxic more than 350 mcg/ml.
Weekly X 6 months
Every 2 weeks 6 months to 12 months
Monthly after 12 months
Antipsychotic monitoring
CBC
Baseline and ongoing
Clozapine (Clozaril) Monitoring Guidelines
Weekly X 6 months
Every 2 weeks 6 months to 12 months
Monthly after 12 months
BMI and Waist Circumference
Weight (in pounds) X 703/height (in inches)
AIMS Test
Baseline and q 3 months
Vision: Annually
Nortriptyline blood levels
50-150 mg/ml
Imipramine blood levels
200-250 mg/ml, toxic more than 450 mg/ml
Desipramine blood levels
110-180 mg/ml
Amitriptyline blood levels.
150-250 mg/ml.
How to get serum blood levels of psychotropics
-Instruct the patient to take the medication consistently forat least 4 days
-Measure the drug levels 12 hours after last medicationdose
-Do not take the medication the morning a blood draw is scheduled
-Fasting is not required prior to blood draw
When to change frequency of blood monitoring
Clinical relapse
Addition or discontinuation a new medication that may interact with the prescribed psychotropic
Onset of new side effects
Hospitalization or institutionalization
Non-compliance
PMHNP application of clinical judgment in medication monitoring
-Clinical observation is critical
-Monitor patient’s functioning status
-Monitor patient’s emotional state
-Assess for side effects on each visit
-Evaluate the need for higher doses
-Subtherapeutic levels may work for certain patients
