Blood monitoring

Note that only a 1-week supply of clozapine is dispensed at a time. The drug is obtained through a special program designed to ensure the required blood monitoring. Weekly WBC laboratory tests are required. Immediately report any signs of weakness, fever, sore throat, malaise, or flu-like symptoms to the primary care provider. 

Since the initial report of the pH responsive CHEMFET in 1970, CHEMFET s for other species such as Ca , Na", and penicillin have been descril d. In addition, some of these devices have been tested for in vivo or on-line continuous whole blood monitoring. While problems associated with mass production of the more complex CHEMFET s such as those employing enzymes (for example, with the penicillin CHEMFET) have not yet been fully solved, the technology for mass production of the relatively simple pH CHEMFET is api rently now available and problems noted with early devices attributable to irreversible SiO changes and... 

J.S. Suidan et al. 1983 Fiber optic pH sensor for blood monitoring... 

Carbamazepine is more widely used for treating chronically agitated dementia patients. Its onset of action is delayed by several days to a couple of weeks therefore, other tranquilizing medications such as antipsychotics may need to be used when first starting carbamazepine. Carbamazepine doses have problematic side effects that require blood monitoring, and it also interacts with many medications. 

Of the mood stabilizers, valproic acid (Depakene, Depakote) is the most widely used. Like the other mood stabilizers, its onset of action can be delayed by several days. Valproic acid is a reasonably well tolerated mood stabilizer. It does occasionally cause tremor, and it can on rare occasion lower platelet counts or cause liver problems. For this reason, blood monitoring is required when starting this medication. In addition, valproic acid can irritate the stomach lining, but this problem is largely overcome by using the buffered form sodium divalproex (Depakote or Depakote ER). Finally, valproic acid can also cause hair loss or drowsiness. 

Which of the following antidepressants requires therapeutic blood monitoring for safe use ... 

C. Nortriptyline (Pamelor) is a TCA, and as a class these drugs require at least one steady-state blood level to safely and effectively use the medication. Paroxetine, venlafaxine, and bupropion have not had blood levels correlated to response, and their relatively low toxicity does not require therapeutic blood monitoring. Nardil is a MAOI, which can be... 

Zober MA, Ott MG, Paepke O, et al. 1992. Morbitity study of extruder personnel with potential exposure to brominated dioxins and furans I Results of blood monitoring and immunological tests. Br J Ind Med 49(8) 532-544. 

Blanco, E. E., and Samadani, R. Automatic blood monitoring for medication delivery method and apparatus, U.S. Patent 5109850, 1992. 

Quinn, M.J. Delves, H.T. (1987) UK blood monitoring programme 1984-1987 protocol and results for 1984. Human Toxicology, 6, 459-74. 

Ex vivo blood monitoring experiments with human volunteers were performed by placing a device comprising two glucose and two lactate sensors into the sampling line of a double lumen catheter. Venous blood was continuously withdrawn and in line heparinized with a dilution of less then 5 %. 

Experiences in uncontrolled open studies in Chinese patients have been summarized (7). The most common adverse effect of clozapine was hypersalivation, followed by sedation. Mandatory blood monitoring is considered an obstacle in persuading some patients to undergo a trial of clozapine, mainly for cultural reasons, summed up by the Chinese proverb that a hundred grains of rice make a drop of blood. ... 

ASPIRIN ANTI EPILEPTICS Possible t levels of phenytoin and valproate Possibly t unbound phenytoin or valproate fraction in the blood Monitor phenytoin or valproate levels when co-administering high-dose aspirin... 

L.Rivera-Calimlim, Problems in Therapeutic Blood Monitoring of Chlorpromazme, Then Drug Monit., 1982, <41-49 B.Scoggins, Measurement of Tncyclic Antidepressants Part II, Applications of Methodology, Clin.Chem, 1980,26,805-815... 

Takagi H, Uchida K, Takahara S, Takahashi K. 12th quality assessment of cyclosporin blood monitoring by 56 Japanese laboratories. Transplant Proc 1998 30 1706-8. 

Bone marrow suppression is the single most important dose-limiting factor with cytotoxic agents. Repeated blood monitoring is essential and transfusion of any/all formed elements of the blood may be needed, e.g. platelet transfusion for thrombocytopenic bleeding or where the platelet count falls below 10 x 10 /1. Cell growth factors. 

Lithium ion selective electrodes (ISEs) have been developed (67) and may he used to provide rapid serum lithium estimations at the time of contact with the patient, for example, in the lithium clinic, as well as in clinical laboratories (68). The therapeutic advantage of this procedure is that patient compliance with medication may be improved if the results of blood monitoring are obtained on the spot. Instant results also reduce the number of times a patient needs to visit the hospital or clinic, thus saving the patient inconvenience. The psychiatrist needs fewer appointments for feedback and dosage regulation (69). 

Unfortunately, potentially fatal agranulocytosis appears in 1-2% of patients treated with clozapine (7). This necessitates frequent blood monitoring, which can be inconvenient and expensive. Furthermore, despite its low potential for causing EPS and TD, clozapine causes other, dose-related side effects that can limit its effectiveness in some patients. The precise pharmacological actions of clozapine responsible for its clinical effectiveness are still being debated. Attempts to duplicate elements cf its complex pharmacological profile have led to the discovery of several new atypical antipsychotic drugs that have been approved in the United States for the treatment of schizophrenia. 

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