CHAPTER 22: COMPLEXITIES OF MANAGING PSYCHIATRIC PHARMACOTHERAPY
As the inpatient clinical pharmacist, you want to determine when the patient last took a dose of clozapine. Which of the following resources would be best to determine this information based on the patient?
B. Call the patient’s parents and ask
C. Call the pharmacy that dispenses the clozapine
D. Obtain the medication administration records from the group home
Rationale: Answer D is the best option because the pharmacist would be able to determine exactly when the patient last took a dose of clozapine. The patient has stated that he has stopped taking his medications, and his thoughts are disorganized and illogical because he is in an acute episode of schizophrenia. In this case, the patient may not be able to accurately tell the healthcare team when he last took his medications (answer A). Calling the patient’s parents (answer B) could be an ideal option if the patient lived with his parents, but he currently lives in a group home. Calling the pharmacy that dispenses the clozapine (answer C) could be useful to determine medication adherence but will not tell you when the patient last took a dose.
You determine that LM last took a dose of his clozapine 3 days prior to admission. What dose of clozapine would you recommend restarting on admission for LM?
Rationale: Because the treatment with clozapine has been interrupted for more than 2 days, clozapine should be restarted at the starting dose of 12.5 mg once or twice daily (rules out answers B, C, and D).1 Starting at this low dose will reduce the risk of orthostatic hypotension, bradycardia, and syncope.
Clozapine should be restarted at the starting dose after how many days without taking the medication?
Rationale: If clozapine treatment is interrupted for more than 2 days, it should be restarted at the starting dose to reduce the risk of orthostatic hypotension, bradycardia, and ...