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Does anyone know if there is a concise/high-yield list of labs one should order when either initiating pharma-tx w/ a psychotropic (e.g., lithium & BUN/Cr, TFT) , monitoring therapy (e.g., clozapine & CBC)?
 

Psai

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I don't know about labs but I pretty much always get an ecg for qtc at the very least
 
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Nasrudin

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Does anyone know if there is a concise/high-yield list of labs one should order when either initiating pharma-tx w/ a psychotropic (e.g., lithium & BUN/Cr, TFT) , monitoring therapy (e.g., clozapine & CBC)?
It depends on the setting. From your statement it seems like you're indicating a presumed diagnosis and then you're ready to initiate therapy, seemingly in an OP setting.

There are AMS/psych disturbance labs for an inpatient admission that are a semi-standard panel.

If in the OP setting. It might me easier to think about the potential adverse effects or how a drug is metabolized and then measure those systems. Lithium you think, thyroid, kidney, so TSH, BMP/CBC plus level for narrow therapeutic range. Depakote is liver toxic so CMP/CBC plus level. Atypical antipsychotics derange metabolism so add HBA1C, Lipid Profile to CMP/CBC, maybe a prolactin level for Risperidone. SSRI's/TCA's you can just think generally about Na+ and Acid/base balance, with some liver concerns in particular case so, just blanket it with a CBC/CMP vs BMP.

I can't imagine test items where you would miss a question based on a CMP vs a BMP. But maybe.

More testable items might be knowing clozapine lowers ANC and so you need a CBC with diff.

idk.

I guess it depends on setting and who's asking you. Psych shelf? Psychiatrist attending? etc.
 

sloop

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Antipsychotics- waist circumference, hba1c, ecg
Clozapine-absolute neutrophil count monitoring per REMS guidelines
I think some people recommend a slit lamp evaluation with quetiapine because it can cause cataracts but nobody actually does this
Lithium-TSH, BUN, Cr, Lithium levels
Tegretol-not routine, but CBC (leukopenia)

The classic AMS panel I've seen is CBC, TSH, B12, Folate, RPR +/- ammonia, etc. depending on clinical situation.

These are the ones that spring to mind right now.
 

Nasrudin

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Antipsychotics- waist circumference, hba1c, ecg
Clozapine-absolute neutrophil count monitoring per REMS guidelines
I think some people recommend a slit lamp evaluation with quetiapine because it can cause cataracts but nobody actually does this
Lithium-TSH, BUN, Cr, Lithium levels
Tegretol-not routine, but CBC (leukopenia)

The classic AMS panel I've seen is CBC, TSH, B12, Folate, RPR +/- ammonia, etc. depending on clinical situation.

These are the ones that spring to mind right now.

U-tox. All day long U-tox.
 

sloop

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U-tox. All day long U-tox.
I've been on a rotation at a CRC and I've come to the realization that the UTox is often what I call the "malingerer panel."

"I need my Xanax, I take 2mg TID prescribed by my pcp"
"Do you do any other drugs?"
"No, just the Xanax."
"So, your UDS came back positive for heroin and cocaine but negative for benzos."
"That's not possible, Your test is wrong."
 
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Nasrudin

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I've been on a rotation at a CRC and I've come to realization that the UTox is often what I call the "malingerer panel."

"I need my Xanax, I take 2mg TID prescribed by my pcp"
"Do you do any other drugs?"
"No, just the Xanax."
"So, your UDS came back positive for heroin and cocaine but negative for benzos."
"That's not possible, Your test is wrong."
haha. yes. in those cases. but also for psychotic symptoms. k-2/spice/pcp/sherm/cocaine and whatever other chemical is being used that we'll find out has a lovely street moniker make people crazy as F. And we want to know if a person is delirious from alcohol withdrawal, bombed on pcp, or is crackacidal...in other words post-binge cocaine, on the street with a Come To meeting with reality and now they want hole up in the ED or a hospital bed. These people don't need psych admission typically. Despite that every ED intern/sometimes resident/and pitifully often Attending who thinks that's all they need.

So, get the U-tox. Before you call psych. Get the labs. Do something to rule out something. Stop using your divine powers of ED mental scan to determine why you want these addicts off your service and onto mine, and do a few quick basic actual medical rule outs.

Also. some of these chemicals are not on the utox. but it still helps to know they have PCP/cocaine on board. Because once you're f'n with those, it's basically anything goes to get you high and/or crazy/and maybe post high/crazy crashing and suicidal for natural secondary gain. I mean look. I'd say something vague about wanting to end it all in those situations too. if i was in those situations. thankfully it hasn't come to that yet.
 
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Nasrudin

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Is it just me or do the computers tend to calculate the QT interval wrong in a lot of cases?
They do tend to do that. Which I fully expect them to do. When sky net is here and we're all underground trying to survive the machine apocalypse then they can farm out my energetic systems for biofuels. until then they can suck it. and calculate that Qtc because nobody's got time for that shiz.

That phantom that is the overblown concern for it is all us....
 

hamstergang

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"I need my Xanax, I take 2mg TID prescribed by my pcp"
"Do you do any other drugs?"
"No, just the Xanax."
"So, your UDS came back positive for heroin and cocaine but negative for benzos."
"That's not possible, Your test is wrong."
I know your post is about more than this, but it's worth knowing that not all benzos show up on a UDS. Xanax and Klonopin, for instance, may give a false negative.
 
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sloop

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I know your post is about more than this, but it's worth knowing that not all benzos show up on a UDS. Xanax and Klonopin, for instance, may give a false negative.
Yeah, and synthetic opiates don't always show up without special tests if they don't get metabolized to morphine derivatives.

The UDS isn't perfect but it can add to the clinical picture, esp in certain cases of malingering.
 

clausewitz2

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U-tox. All day long U-tox.
Rotating through psych ED, we don't even document that we did a UDS anymore because everyone gets one reflexively. I have genuinely ordered one on a seven year old. I think our five year olds generally don't get one but usually in those circumstances I wish very much that I could administer one to the parents.
 
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Perfect Hair Day

Perfect Hair Day

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Rotating through psych ED, we don't even document that we did a UDS anymore because everyone gets one reflexively. I have genuinely ordered one on a seven year old. I think our five year olds generally don't get one but usually in those circumstances I wish very much that I could administer one to the parents.
Then how do you bill for it?


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Rotating through psych ED, we don't even document that we did a UDS anymore because everyone gets one reflexively. I have genuinely ordered one on a seven year old. I think our five year olds generally don't get one but usually in those circumstances I wish very much that I could administer one to the parents.
Wish I could like this twice.