Medications appropriateness determination

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. 

Clients with bipolar disorders cannot be helped until they have been thoroughly assessed for appropriate medication. Once the need for medication is determined, the goal is to identify the appropriate medication and dosage. Clients with bipolar disorder, and for Aat matter any client with a serious psychiatric illness, should not be prescribed medication as the sole treatment intervention. Although major advances have been made in the field of psychotropic medication, clinical practice and the literature have always emphasized the multifaceted approach for multidimensional problems. It is important to remember that all mental illnesses impact on the biological, social, and psychological spheres of a client s life and functioning (Walsh, 1989). 

Ordering The clinician should select the appropriate medication and determine the dose and frequency of administration. 

As medically appropriate for each employee either removed from exposure to lead due to a risk of sustaining material impairment to health, or otherwise limited pursuant to a final medical determination. 

Once it is concluded that the patient has seizures, the type of seizure and epilepsy syndrome, if any, must be determined. Proper identification and classification of the seizure type is most helpful in selecting appropriate pharmacotherapy. Without an accurate classification of the seizure type, it is possible to select a medication that is ineffective or even harmful to the patient. 

When sufficient evidence is available to determine that the patient has real seizures and is at risk for another seizure, pharmacotherapy is usually started (Fig. 27-2). The patient should be in agreement with the plan, be willing to take the medication, and be able to monitor seizure frequency and adverse drug effects in some way. Design of an appropriate pharmacotherapeutic plan is based on the patient s seizure type, the common adverse-effect profile of possible AEDs, and economic factors (e.g., cost of the drug, insurance formulary, and ability to pay). Other patient factors such as gender, concomitant drugs, age, and lifestyle also need to be considered. 

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

Almost no one dies from opioid withdrawal per se however, underlying medical complications (e.g., hypertension or recent myocardial infarction) increase the risk of death. Therefore, it is important to manage and stabilize any medical issues (i.e., uncontrolled blood pressure or diabetes, among others), and then determine if hospitalization is appropriate. Patients with... 

If the patient does not respond, determine if the patient is taking the appropriate medication and dose. 

As discussed later in this chapter, contraindications exist for various forms of contraception. Patients must be evaluated completely by a health care professional to rule out any medical contraindications to certain contraceptives. The physical examination also will allow health care professionals to determine if there are other medical concerns, such as hypertension, diabetes, or liver disease, that need to be considered when determining the appropriate contraceptive agent. Clinicians also should review family history for potential risks with certain forms of birth control. 

Develop a plan to assess safety and efficacy of the pharmacologic treatment plan. Determine if the appropriate doses of antirheumatic medications were used and if all medication were given a sufficient trial to achieve therapeutic benefit. 

Assess nutritional needs and recommend appropriate supplementation. When the patient is tolerating an oral diet, determine if any parenteral medications can be switched to the oral route. 

Assess the patient s symptoms to determine if selftreatment with OTC antifungal therapy is appropriate or whether the patient should be evaluated by a practitioner. Exclusions for self-treatment include infection of nails or hair, unsuccessful initial treatment, worsening condition, signs of secondary bacterial or systemic infection, or chronic medical conditions such as diabetes, immunosuppression, or impaired circulation. 

The premarket notification application, 510(k), is reviewed by the FDA scientific staff. This evaluation takes into consideration tumor-associated analytes, test requirements, medical usefulness of the test system for a particular clinical claim, and its application (i.e., monitoring or treatment follow-up). The FDA determines the appropriate performance requirements for each tumor analyte category. The agency s staff considers factors, such as consequences of a false positive or false negative, and the importance or impact of an absolute versus a significant change in the results or values of the tumor marker tests. The performance criteria (parameters) of a particular tumor marker test are compared with those of previously... 

Over thirty different elements have been determined in medical and biological materials by atomic absorption spectroscopy. The popularity of the technique is due to a number of factors, including sensitivity, selectivity, and ease of sample preparation. With biological fluids, often no preparation at all is required. The techniques employed usually involve simple dilution of the sample with water or with an appropriate reagent to eliminate interference. Alternatively, the element to be determined is separated by solvent extraction. Either an untreated sample, a protein free filtrate, or an ashed sample is extracted. 

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