Assessment for pharmacotherapy

The aims of this chapter are to (1) describe a contemporary approach to assessment for pharmacotherapy (2) describe clinical principles of pediatric psychopharmacology (3) describe clinical decision making in pediatric psychopharmacology and (4) describe current approaches to the medical monitoring of children treated with psychotropic medications. 

Monitoring parameters for pharmacotherapy of narcolepsy include reduction in daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations, and sleep paralysis. Patients should be evaluated regularly during medication titration, then every 6 to 12 months to assess adverse drug events (e.g., mood changes, sleep disturbances, and cardiovascular abnormalities). If symptoms increase during therapy, PSG should be done. 

Control of existing risk factors and the presence of new risk factors for IHD should also be assessed regularly. Routine screening for the presence of metabolic syndrome will help in assessing the control of known major risk factors and identifying new risk factors. If new risk factors are identified and/or the presence of metabolic syndrome is detected, modify the pharmacotherapy regimen, as discussed previously, to control these risk factors and lower the risk of IHD and IHD-related adverse events. 

FIGURE 6-6. Decision algorithm for long-term ventricular rate control with oral drug therapy for patients with paroxysmal or permanent atrial fibrillation, bpm, beats per minute CCB, calcium channel blocker (diltiazem or verapamil) HF, heart failure LV, left ventricular function LVEF, left ventricular ejection fraction. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE, Dunsworth TS, et al. (eds.) Pharmacotherapy Self-Assessment Program, 4th ed. Kansas City American College of Clinical Pharmacy 2001 ... 

Describe the components of a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for dyslipidemias. 

Institute appropriate pharmacotherapy based on lipid abnormality. Obtain appropriate baseline labs to monitor for adverse drug effects. Assess potential disease and drug interactions that may affect choice or intensity of pharmacotherapy. 

Formulate a monitoring plan to assess the effectiveness and safety of pharmacotherapy for GERD. 

Re-evaluate the pharmacotherapy regimen at each visit to assess effectiveness, adverse events, and need for drug titration. 

Assess the patient s symptoms and level of functional impairment to determine if pharmacotherapy is appropriate for the anxiety disorder. 

Pharmacotherapy of SAD should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being.26 Many patients may not achieve full remission of symptoms but should have significant improvement. Monitor patients weekly during acute treatment (e.g., initiation and titration of pharmacotherapy). Once patients are stabilized, monitor monthly. Inquire about adverse effects and SAD symptoms at each visit. To aid in assessing improvement, ask patients to keep a diary to record fears, anxiety levels, and behaviors in social situations.26 You may administer the Leibowitz Social Anxiety Scale (LSAS) to rate SAD severity and change, and the Social Phobia Inventory can be used as a self-assessment tool for SAD patients. 

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