Laboratory monitoring

Moreover, new technologies such as LC/MS/MS should be considered and their potential should be recognized in the future. Currently food control laboratories monitor only a part of the pesticides used in their routine work. They prefer active ingredients that can be analyzed by multi-methods or some group-specific methods, because resources to check all relevant pesticides are normally not available. Therefore, many a.i. are monitored only on a case-by-case basis or not at all. An LC/MS multi-residue method, which may be developed in the future, could cover this gap to a large extent. 

O Warfarin requires frequent laboratory monitoring to ensure optimal outcomes and minimize complications. The prothrombin... 

Lithium and other mood-stabilizing drugs require baseline and routine laboratory monitoring to help determine medical appropriateness for initiation of therapy and monitoring of potential adverse effects. Guidelines for such monitoring are outlined in Table 36-6. 

Patients should be educated and periodically reminded about the importance of adherence and long-term tight control, the need for periodic clinical and laboratory monitoring, and the importance of staying on one LT4 product. 

Patients with hyperthyroidism also must undergo periodic clinical and laboratory monitoring, with more frequent monitoring if there is a change in the patient s clinical status. 

Stress importance of adherence with therapeutic regimen (including required laboratory monitoring, medication dosing and administration). Recommend a therapeutic regimen that is convenient and consistent with the patient s lifestyle. 

Identify the necessary laboratory monitoring parameters for patients on antituberculosis medications. 

Laboratory monitoring is performed before initiating therapy and before each cycle of chemotherapy. A complete blood count should be obtained prior to each course of chemotherapy to ensure that hematologic values are adequate. In particular, white blood cell counts and absolute neutrophil counts can be decreased in patients receiving chemotherapy such as irinote-can and 5-FU and increase the risk of infection. Baseline liver function tests and an assessment of renal function should be done prior to and periodically during therapy. Other selected laboratory tests include checking for the presence of protein in the urine in patients receiving oxaliplatin and bevacizumab. 

When initiating PN, patients should have important baseline laboratory values checked to assess electrolyte status, organ function, and nutritional status (Table 97-8). Baseline laboratory monitoring should include... 

Such a string may be useful when two types of variables independently affect the quality of a solution. Suppose that an analytical laboratory monitors the air quality at a downtown site, measuring the level of fifteen different pollutants. A theoretical model is established that links the amount of these pollutants measured at the monitoring point with the amounts of each pollutant released at twenty different sites around the city. Because there are fifteen pollutants and twenty pollution sources, a 15 x 20 matrix is required to model the problem and GA strings can be constructed in this form. 

Laboratory monitoring is of little value in monitoring response to therapy but is essential for detecting and preventing adverse drug effects (see Table 4-2). 

Advantages of LMWHs over UFH include (1) more predictable anticoagulation dose response (2) improved SC bioavailability (3) dose-independent clearance (4) longer biologic half-fife (5) lower incidence of thrombocytopenia and (6) less need for routine laboratory monitoring. 

Women taking valproate may breast-feed, but mother and infant should have identical laboratory monitoring. 

Guidelines for baseline and routine laboratory monitoring of mood stabilizers are shown in Table 69-8. 

A system of laboratory monitoring has been organized in the district which controls indications for pesticides and other chemical substances in objects of the environment, raw material supplies and food products. 

V. Tabulated Patient Data, Including CUnical and Laboratory Monitoring Results... 

The dose of gabapentin should be started at 600-900 mg/day in two or three doses per day. The usual effective dose is 900-4800 mg/day. Laboratory monitoring is not needed when prescribing gabapentin. It is well tolerated with the most common side effects being drowsiness and headache. 

The mainstay of therapy, a mood stabilizer, should be continued at the same dose that was used to achieve remission during acute phase therapy. Ongoing use of the mood stabilizer requires periodic monitoring of medication levels to ensure compliance. In addition to other laboratory evaluations such as complete blood counts, liver, kidney, and thyroid studies are needed to ensure that the mood stabilizer is being well tolerated. Lamotrigine is the only mood stabilizer that does not require periodic laboratory monitoring. 

Mood stabilizers are not, in general, as easy to manage as other medications. Most require periodic laboratory monitoring including drug levels. Mood stabilizers are typically not used except in severe cases of ADHD when several other medications have failed. 

Carbamazepine is believed to be effective in BPD, though the data is far less robust than with valproic acid. It is prescribed at doses up to 1200mg/day. Like valproic acid, it can also canse birth defects and requires laboratory monitoring including serum levels. For more information on the use of carbamazepine, please refer to the discussion of bipolar disorder treatment in Chapter 3. 

The requirements of the standard can be split into four major groups, which are those mentioned as activities in the quality management process. A fifth group is the quality management system per se. The model shown in the slide, taken from the ISO 9004 2000 standard, illustrates the process linkages as well as the interactions between the interested parties and the laboratory. Monitoring the satisfaction of interested parties requires the evaluation of information as to whether the laboratory has met their requirements. 

As previously mentioned, the actual acquisition cost of a drug or service should not be used in isolation to determine the value of a drug. Value should be assessed in an analysis that takes into account all consequences (both positive and negative) that result from use of the therapy. For example, if a therapy eliminates the need for surgery, the cost of the surgery would be eliminated from the overall treatment pathway. However, if the same therapy results in an adverse event that requires specific laboratory monitoring, the cost of the laboratory tests would be added into the treatment pathway. The accurate identification and valuation of resource items that result from the use of that therapy are extremely important components of economic analysis. 

Laboratory monitoring includes complete blood count, especially the absolute neutrophil count, platelet count, and the appearance of the peripheral smear. Thrombocytopenia induced by ticlopidine is occasionally unrelated to TTP. Further investigate for a diagnosis of TTP with the occurrence of any acute, unexplained reduction in hemoglobin or platelet count. Discontinue ticlopidine if there are laboratory signs of TTP or the neutrophil count is less than 1200/mm. ... 

Monitoring Obtain baseline measurements of hepatic enzymes, bilirubin, a CBC, and a platelet count (or estimate). Assess patients at least monthly during therapy. Routine laboratory monitoring for toxicity in people with normal baseline measurements is generally not necessary. 

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