Questions and Answers
What is the primary measure of hepatocellular damage in liver function testing?
Which laboratory test is primarily used to assess cholestasis?
Which of the following laboratory values often indicates liver damage and can be elevated during valproate therapy?
What is a significant consideration regarding creatinine levels in elderly patients?
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Which laboratory test is considered the best measurement of kidney function?
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What is the recommended frequency for liver panel testing after the initial months of therapy with valproate?
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What is considered a therapeutic valproate level?
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Which complication is most commonly associated with valproate and select AEDs?
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What should patients be educated to report while on valproate?
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Which genetic screening is recommended for patients of Asian ancestry before starting carbamazepine?
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Which of the following medications can increase lithium levels?
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What is a potential side effect of lithium that affects the thyroid?
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Which medication is known to decrease lithium levels?
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What should be considered if a patient on lithium has unpredictable medication interactions?
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What is a common renal effect of lithium?
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What is a noted cardiac effect related to lithium use?
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Which of the following medications has an unpredictable effect on lithium levels?
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What is a recommended practice when monitoring patients on lithium?
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Which side effect is NOT typically associated with lithium use?
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What type of diuretics can unpredictably increase or decrease lithium levels?
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What is the recommended initial laboratory testing for a patient starting lithium therapy?
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Why is lithium contraindicated in certain renal conditions?
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What is the target lithium serum concentration for maintenance therapy?
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How often should lithium levels be monitored during the initial therapy phase?
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What symptom might indicate lithium toxicity at higher levels?
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What is the minimum absolute neutrophil count (ANC) required to initiate therapy with Clozapine?
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When should treatment with Clozapine be interrupted based on ANC levels?
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What is the recommended monitoring schedule for ANC when a patient is on Clozapine?
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Which of the following statements about the ANC monitoring for Clozapine is accurate?
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What resource is referenced for the management of Clozapine prescriptions?
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Study Notes
Common Laboratory Values
- Aspartate aminotransferase (AST): Normal range 0-40 units/L; indicators of hepatocellular damage; elevated in valproate therapy, hepatitis, cirrhosis; decreased in chronic alcoholic liver disease.
- Alanine aminotransferase (ALT): Normal range 0-40 units/L; measures hepatocellular damage; similar elevation and decrease patterns as AST.
- γ-Glutamyl transferase (GGT): Normal range 0-30 units/L; indicates cholestasis; elevated in alcohol abuse and chronic alcoholic liver disease.
- Alkaline phosphatase (ALP): Normal range 30-120 international units/L; measures cholestasis; elevation seen in gallbladder disease, liver disease, and conditions involving rapid bone growth or injury.
- Creatine kinase (CK): Best measurement of kidney function; normal GFR is 90 mL/min/1.73m², with lower levels common in elderly due to reduced muscle mass; no dose adjustment necessary for psychotropics with GFR >60 mL/min.
Psychotropic Medications & Laboratory Testing
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Clozapine: Requires absolute neutrophil count (ANC) monitoring; therapy initiation when ANC ≥1500/mm³; interrupt if ANC falls below this value.
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Lithium:
- Interactions can increase lithium levels (e.g., ACE inhibitors, NSAIDs) or decrease (e.g., Theophylline); close monitoring recommended.
- Associated side effects include thyroid issues (elevated TSH in ~23%), cardiac conduction problems, renal effects (polyuria, polydipsia), tremors, and weight gain.
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Valproate and select AEDs:
- Laboratory tests should include liver panel and CBC; initial testing at baseline, monthly for the first few months, then every 6-24 months.
- Therapeutic valproate level is 50-120 mcg/mL; elevated transaminases occur in 2% to 44% of patients, especially within the first 6 months; discontinue if AST/ALT >2-3x ULN.
- Monitor for signs of liver dysfunction and hematologic complications; genetic screening recommended for carbamazepine in Asian ancestry patients due to Stevens-Johnson syndrome risk.
Lithium Therapy Monitoring
- Initial Testing: Requires thorough baseline assessment (creatinine, GFR, TSH, CBC, urinalysis, and baseline EKG).
- Long-term Monitoring: Regular checks for kidney function, CBC, and lithium levels; specific frequency depends on patient reliability and kidney status.
- Therapeutic Range: Acute treatment levels between 0.8-1.2 mmol/L, maintenance levels between 0.6-1.0 mmol/L; contraindicated in acute renal failure or significant dehydration; safe in chronic kidney disease with monitoring.
General Notes
- Early signs of liver dysfunction include abdominal pain, nausea, vomiting, jaundice, and hematologic issues like easy bruising or excessive bleeding.
- Educate patients on the medications they are taking, the potential for drug interactions, and the importance of monitoring for side effects throughout their treatment.
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Description
Test your knowledge on common laboratory values including aspartate aminotransferase (AST) and alanine aminotransferase (ALT). This quiz will cover their normal ranges, significance, and implications in various medical conditions. Perfect for students in healthcare-related fields!
