monitoring antipsychotic drug treatment Flashcards
if a patient is on clopazine, they must be registered with
clozapine patient monitoring service
when prescribing an antipsychotic drug for admin in emergency siutation (e.g. for rapid tranquilisation), how often do you need to monitor pt
monitor for SE and vital signs at least every hour until no further concerns about physical health status
monitor every 15 mins if high dose antipsychotic has been given
pt with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) ….
atleast annually
monitoring for olanzapine
Patients taking olanzapine require more frequent monitoring of these parameters:
weight and lipids: baseline, at 3 months (regularly during this period), every 3 months for the first year, then yearly.
Patients taking olanzapine should have fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.
requires more frequent monitoring than other antipsychotics.
usually, lipids & weight: baseline, at 3 months (weight should be measured at frequent intervals during the first 3 months), and then yearly with antipsychotic drugs
usually,FBG:baseline, at 4–6 months, and then yearly.
treatment cessation for all antipsychotic drugs
high risk of relapse if medication is stopped after 1–2 years
Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse
Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse
clozapine planned wtihdrawal - reduce dose over
1-2 weeks to prevent rebound psychosis
there is high risk of relapse if antipsychotic drug is stopped after. ..
1-2 yrs
patients should be monitored for …. after withdrawal of antipsychotic meds for signs and symptoms of relapse
2 yrs
why should patients be advised to avoid direct sunlight with all antipsychotics
because photosensitisation can occur with higher dosages
it is advisable to monitor prolactin conc …
start of therapy, at 6 months, then yearly
when to monitor prolactin conc in pt who are not normally associated with symptomatic hyperprolactinaemia
should be considered for prolactin monitoring if they show symptoms of hyperprolactinaemia (such as breast enlargement and galactorrhoea)
do you need to monitor BP with amisulpride or aripiprazole
does not affect blood pressure to the same extent as other antipsychotic drugs and so blood pressure monitoring is not mandatory for this drug
monitoring of weight with antipsychotics
Weight should be measured at the start of therapy with antipsychotic drugs, then weekly for the first 6 weeks, then at 12 weeks, at 1 year, and then yearly.
FBG, HBA1C, blood lipid conc monitoring with antipsychotics
should be measured at baseline, at 12 weeks, at 1 year, and then yearly.
before initating antipsychotic drugs, an ECG may be required, esp if …
physical examination identifies cardiovascular risk factors (e.g. high blood pressure), if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient.
Blood pressure monitoring for antipsychotics
advised before starting therapy, at 12 weeks, at 1 year and then yearly during treatment and dose titration of antipsychotic drugs.
expert sources advise to monitor full blood count, urea and electrolytes, and liver function tests ….
at the start of therapy with antipsychotic drugs, and then yearly thereafter.
in children, regular clinical monitoring of endocrine function should be considered when children are taking an antipsychotic known to increase prolactin levels - this includes monitoring
- weight and height
- assessing sexual maturation
- monitoring menstrual function
Standard monitoring of weight for antipsychotic drugs
Weight should be measured at the start of therapy with antipsychotic drugs, then weekly for the first 6 weeks, then at 12 weeks, at 1 year, and then yearly.
Standard monitoring of FBG, HBA1C and blood lipids for antipsychotics
Fasting blood glucose, HbA1c, and blood lipid concentrations should be measured at baseline, at 12 weeks, at 1 year, and then yearly.
Standard BP monitoring for antipsychotic
Blood pressure monitoring is advised before starting therapy, at 12 weeks, at 1 year and then yearly during treatment and dose titration of antipsychotic drugs.
(Amisulpride and aripirazole do not require this)
Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
Which other drugs are included in this?
amisulpride, aripiprazole, clozapine, olanzapine, olanzapine embonate, quetiapine, risperidone, and sulpiride
Following fatal cases involving toxicity of clozapine and other antipsychotic medicines, the MHRA advises that monitoring blood concentration of these drugs may be helpful in certain circumstances, such as patients presenting symptoms suggestive of toxicity, or when concomitant medicines may interact to increase blood concentration of amisulpride.
What are the 2nd gen depot
aripiprazole, paliperidone, risperidone and olanzapine embonate.
How do they affect diabetes
can raise BG levels
Standard measuring of prolactin
It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.
Patient has started gambling. Which drug and what to do?
Aripiprazole
MHRA
Healthcare professionals are advised to counsel patients and their carers about this risk and to be alert for the development of new or increased urges to gamble and other impulse control symptoms, such as excessive eating or spending, or hypersexuality. The prescriber should consider reducing the dose or stopping the drug if these symptoms occur.
What condition can antipsyhcotics exacerbate
parkinsons
