Monitoring - mental health drugs
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How often should non-suicide risk patients on fluoxetine be reviewed?
After 2 weeks Then every 2-4 weeks for first 3 months Longer intervals thereafter
How often should suicide risk/U30 patients on fluoxetine be reviewed?
After 1 week Then frequently until risk no longer clinically important
What concomitant treatment is acceptable in the short term for S/E of anxiety?
Benzodiazepine as long as it is only short term anxiety (not for longer than 2 weeks)
What should be monitored for Clozapine?
Hepatic Function Differential WBC Blood lipids Weight Fasting Blood Glucose
Why is close monitoring on initiation of clozapine required?
Risk of collapse from hypotension/convulsion
How often is a differential WBC required for clozapine patients?
Weekly for first 18 weeks Fortnightly thereafter up to 1 year Monthly after 1 year onwards
How often should blood lipids be monitored in clozapine patients?
Baseline, 3 monthly, then yearly
How often should weight be monitored in clozapine patients?
Baseline, frequent intervals in first 3 months, 3 monthly then yearly
How often should FBG be checked in clozapine patients?
Baseline 1 month then every 4-6 months
Why is close monitoring of serum lithium required in pregnancy?
Risk of toxicity to neonate
When should serum lithium be closely monitored?
Pregnancy Renal Impairment
What is the lower end of serum lithium concentration and when is this often used?
0.4-1 mmol/litre Maintenance and treatment of elderly
What is target serum lithium concentration and when is this normally used?
0.8-1.0 mmol/litre Acute episodes of mania Relapsed patients Sub-syndromal symptoms
How often after new dose, dose adjustment should serum lithium first be checked?
12 hours
How often should patients on lithium have serum lithium checked?
weekly post initiation After each dose change until stable then every 3 months thereafter If patient develops intercurrent disease Significant change in patients sodium or fluid intake
What should be assessed before treatment with lithium is started?
Renal Cardiac Thyroid
After commencing lithium how often should renal ?
Baseline, thereafter every 6 months
How often should cardiac and thyroid function be assessed on lithium?
Before initiating and every 6 months