Pharmacotherapy monitoring

A validated 10-item assessment tool used to monitor the severity of withdrawal and monitor pharmacotherapy... 

Devise a pharmacotherapy treatment and monitoring plan for a patient with non-ST-segment elevation acute coronary syndrome given patient-specific data. 

Create a care plan for SD for hospital discharge which includes pharmacotherapy, desired treatment outcomes, and monitoring for efficacy and adverse effects. 

TABLE 5-5. Therapeutic Drug Monitoring for Adverse Effects of Pharmacotherapy for Acute Coronary Syndromes... 

To determine the efficacy of nonpharmacologic and pharmacotherapy for both STE and NSTE ACS, monitor patients for (1) relief of ischemic discomfort (2) return of ECG changes to baseline and (3) absence or resolution of heart failure signs. 

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. 

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. 

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. 

Discuss the pharmacotherapy of Graves disease, including the advantages and disadvantages of antithyroid drugs versus radioactive iodine, adverse effects, and patient monitoring. 

Develop a plan to monitor the outcomes of anemia pharmacotherapy. 

Prepare a monitoring plan to evaluate the efficacy and toxicity of pharmacotherapy for oncologic emergencies. 

As pharmacists engage in pharmaceutical care and increasingly in the monitoring of pharmacotherapy in... 

Deborah DeEugenio, Pharm.D., B.C.P.S., is a 2001 graduate of the Philadelphia College of Pharmacy at the University of the Sciences (Philadelphia). She completed a residency in Pharmacy Practice at Thomas Jefferson University Hospital (Philadelphia). Dr. DeEugenio is a member of the Temple University School of Pharmacy faculty as a Clinical Assistant Professor and a Certified Antithrombotic Provider and a Board Certified Pharmacotherapy Specialist. Her clinical activity takes place at Jefferson Heart Institute as part of the Jefferson Antithrombotics Therapy Service. The ambulatory clinic serves 400 patients on chronic anticoagulation therapy and provides continuous monitoring and education to these patients. The clinic also provides drug information and pharmacy support to the physicians and other health-care providers at the Institute. 

Amphotericin B Azoles Nephrotoxins (e.g, aminoglycosides, cidofovir, cyclosporine, foscarnet, pentamidine) See Chap. 125 in Pharmacotherapy A Pathophysiologic Approach, seventh edition, page 1998. Additive adverse effects Monitor renal function... 

Patients should be seen weekly for the first month, then biweekly through the second month. During months 3 to 6, patients can be seen monthly, then every 1 to 2 months from months 6 to 12. Responders after 1 year of pharmacotherapy can be seen every 3 months. Patients should be monitored for symptom response, side effects, and treatment adherence. 

Management includes identifying the cause of insomnia, education on sleep hygiene, stress management, monitoring for mood symptoms, and elimination of unnecessary pharmacotherapy. 

Goode, M.A., and Gums, J.G., Therapeutic drug monitoring in ambulatory care, Annal. Pharmacotherapy, 27 502—505 (1993). 

Clozapine was the first atypical antipsychotic released in the United States. However, clozapine is associated with the risk of leukopenia and, potentially, lethal agranulocytosis. Because of these concerns, hematological monitoring during clozapine pharmacotherapy is required (Alphs and Anand, 1999). Due to these hematological risks, clozapine is indicated only for patients with treatment-resistant schizophrenia. The other atypical antipsychotics, risperidone, olanzapine, quetiapine, and ziprasidone, that are marketed in the United States can be used as first-line treatments for adults with schizophrenia. 

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. 

Inattentiveness, impulsivity, hyperactivity 50% will continue to manifest the disorder into adulthood Stimulants (70% response for uncomplicated ADHD caution in patients with tic disorders) TCAs (70% response, first line for patients with comorbid MD or anxiety disorders, and for patients with ADHD + tics) requires serum levels and cardiovascular monitoring Bupropion Clonidine, guan-facine (first line for patients with ADHD + tics) MAOIs Combined pharmacotherapy for treatment-resistant cases... 

During the 6-12 weeks of acute pharmacotherapy, the physician usually sees patients weekly or biweekly for monitoring of symptoms, side effects, and dose adjustments, and for support and education. Supportive or more specific forms of psychotherapy such as CBT or IPT should be added to address comorbid conditions or other problems, such as conflicts at home or with peers or academics. 

Even though the pharmacotherapy of adolescent addictions is a relatively new field, it appears to have a role in the treatment of many youth with SUD. Pharmacological agents have been shown to reduce excessive craving, to reduce associated comorbid psychopathology, and to prevent the future development of SUD in certain at-risk youth. Despite the present lack of empirical evidence, opiate substitution therapy should be considered in youth with heroin addiction. As with all treatments, the expectations, risks, and benefits should be reviewed with the patient and their caretakers. For SUD treatment to be successful, the provider should closely monitor and address the patient s SUD and psychiatric symptoms, treatment compliance, and social stressors. 

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