Newest medication oddity

[50960]

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I saw a pt the other day who has been on 20 mg Zyprexa (bipolar) for over 1 year. She has gained 60 lbs, and is 5'1". Her meds are managed by a PA. No lipid panel, no CBC, no fasting glucose...nothing. I usually assume medical providers are aware of when and what labs to order for these meds and why, but I guess I should not. Anybody else see stuff like this?

 

[primadonna22274]

Call the PA and discuss your concerns with him/her.
Perhaps the PA is truly clueless and doesn't know about the hyperglycemia & dyslipidemia with atypical antipsychotics. I hope to hell not, but this could be your turn to do some thoughtful teaching.
OTOH, it could be that the patient either (1) doesn't see the PA like, ever, unless s/he has an acute complaint or (2) the patient has so many other concerns which muddy the picture (the laundry list of complaints) and makes it difficult to focus on routine health maintenance like monitoring serum glucose & lipid status on the olanzapine.
Now, IMHO, if this PA is actually PRESCRIBING the Zyprexa (20 mg/d is a HEFTY dose), s/he has no business Rx'ing without being totally knowledgeable of the drug's effects and its management.
FWIW, you'll find plenty of other providers who miss this one too. Try to address this concern one patient at a time, one provider at a time. You'll get somewhere, I think.
Lisa PA-C

I saw a pt the other day who has been on 20 mg Zyprexa (bipolar) for over 1 year. She has gained 60 lbs, and is 5'1". Her meds are managed by a PA. No lipid panel, no CBC, no fasting glucose...nothing. I usually assume medical providers are aware of when and what labs to order for these meds and why, but I guess I should not. Anybody else see stuff like this?

 

[50960]

Fortunately this PA is excellent. I told her my concerns, and ideas for protocols, and all were ordered. This is not an anti PA post. I have seen equal or worse by MD's. I actually prefer working with midlevels as they often spend more time to get things right, rather than assuming they know. She had no idea this med caused hyperlipidemia, or diabetes. The rep said diabetes is the risk, but only with a positive fam hx.......sigh.