Medication monitoring guidelines

Key elements to be covered in the medication followup visit include (2) a change in target symptoms from baseline, (2) a review of side effects, (3) compliance and resistance, and (4) discussion of the concerns of the child and the parents (see Table 31.1). The medication follow-up visit also includes dosage adjustment and laboratory monitoring. Guidelines for specific disorders and medications are contained in the relevant chapters in this text. 

Exposure standards and guidelines usually provide numerical exposure levels for various media (e.g., food, consumer products, water, and air) that cannot be exceeded. Alternatively, these standards may be preventive measures for reducing exposure (e.g., labeling, special ventilation, protective clothing and equipment, and medical monitoring). 

Pharmacists serve as members of the healthcare system s Pharmacy and Therapeutics Committee which directs the review process for considering medication additions to and deletions from the drug formulary. The committee may review and manage data from the ADR reporting program and from medication usage evaluations and reviews, and may monitor policies for medication use guidelines. 

OSHA recommends that laboratories that have not previously provided commercial analyses of CDB, CDU and/or B2MU (or have done so for a period less than 2 years), or which have provided these analyses for 2 or more years but have not conformed previously with these protocol guidelines, should satisfy the following provisions for each analyte for which determinations are to be made prior to being selected to analyze biological samples under the medical monitoring program ... 

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. 

General guidelines are as follows (1) use reduced doses, (2) monitor closely, (3) titrate dosage slowly, (4) document carefully, and (5) periodically attempt to reduce medication in minimally symptomatic patients. 

Centers for Medicare and Medicaid Services Guidelines for Monitoring Medication Use... 

Clearly, therefore, those involved in drug safety monitoring need to liase closely with both clinical research and medical information scientists. In addition, those responsible for clinical drug safety must undertake periodic safety update reports (PSURs) at predetermined intervals, in accordance with current International Conference on Harmonisation (ICH) guidelines. Such routine analyses can identify new safety signals as soon as they become detectable. 

Discontinuation of antidepressant medication should be concordant with the guidelines for treatment duration (see Acute Major Depression subsection in the preceding section). It is advisable to taper the dose while monitoring for signs and symptoms of relapse. Abrupt discontinuation is also more likely to lead to antidepressant discontinuation symptoms, often referred to as withdrawal symptoms. The occurrence of these symptoms after medication discontinuation does not imply that antidepressants are addictive. 

The 2004 Practice Guideline for the Treatment of Patients With Schizophrenia recommends indefinite maintenance treatment for patients who have had at least two episodes of psychosis within 5 years or who have had multiple previous episodes (Lehman et al. 2004). Maintenance therapy should involve the lowest possible doses of antipsychotic drugs, and patients should be monitored closely for symptoms of relapse. If the patient is compliant with treatment, oral medications are usually sufficient. However, if the patient s treatment history suggests that the patient may not reliably take daily oral medication, a long-acting depot preparation may be indicated. 

Because pharmacists are responsible for all phases of medication use, processes in the pharmacy can refer to any phase of the medication use process (e.g., prescribing, dispensing, administering, or monitoring). Examples of process measures include, but are not limited to, adherence to clinical guidelines or pathways, percent of prescriptions assessed for appropriateness, and percent of patients counseled. 

Create a supply list (see Table 24.6) for the entire jurisdiction. Maintain centralized inventory of items that are difficult to obtain. Identify appropriate storage facilities. Ensure that personnel and protocols are in place for quality assurance monitoring and maintaining appropriate storage temperatures checking lot numbers and expiration dates. Develop guidelines for vaccine/prophylactic medication distribution... 

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