ABLE IV Quiz 1 Monitoring Parameters

Allopurinol Efficacy Monitoring Parameters

Resolution of clinical signs of gout (pain, stiffness), serum uric acid concentrations measured after 48 h of therapy (goal <6 mg/d​L).

Allopurinol Safety Monitoring Parameters

LFTs, renal function, CBC. HLA-B*5801 testing in high-risk patients (African American, Southeast Asian).

Alprazolam Efficacy Monitoring Parameters

Reduction in anxiety symptoms.

Alprazolam Safety Monitoring Parameters

Severe drowsiness, thoughts of suicide, seizures, slow or irregular heartbeat; monitor BP, HR.

Amitriptyline Efficacy Monitoring Parameters

Improvement in target symptoms of depression. Reduction or improvement in pain or decreased frequency of migraines.

Amitriptyline Safety Monitoring Parameters

Worsening of depression, suicidality, or unusual changes in behavior, especially at initiation or with dosage changes. Altered mentation, seizures, autonomic dysregulation, muscle spasms, gastrointestinal symptoms. Monitor ECGs, LFTs, blood glucose, BP, and HR.

Aripiprazole Efficacy Monitoring Parameters

Improvement in symptoms of schizophrenia, bipolar disorder, depression, or irritability.

Aripiprazole Safety Monitoring Parameters

Fasting plasma glucose and CBC at baseline and periodically in high-risk patients; ECG monitoring; weight at weeks 4, 8, and 12, then quarterly; monitor for abnormal involuntary movements and suicidality.

Atomoxetine Efficacy Monitoring Parameters

Improvement of attention, behavior, and overall symptoms of attention deficit hyperactivity disorder.

Atomoxetine Toxicity Monitoring Parameters

Blood pressure and heart rate. Monitor for clinical worsening, suicidality, or unusual behavior changes, particularly during initiation or dose adjustments. Monitor liver function tests and serum sodium.

Baclofen Efficacy Monitoring Parameters

Reduction in muscle spasm, passive limb movement, pain relief, or hiccups.

Baclofen Safety Monitoring Parameters

Seek medical attention if severe dizziness, confusion, hallucination, sedation, or rebound spasticity occurs. Routine EEG monitoring in patients with seizure disorder.

Buprenorphine/Naloxone Efficacy Monitoring Parameters

Urine drug screening tests that are negative for illicit drugs. Relief of signs and symptoms associated with narcotic addiction.

Buprenorphine/Naloxone Safety Monitoring Parameters

Severe skin rash, excessive drowsiness, decreased breathing, severe constipation. Monitor LFTs at baseline and throughout treatment. Report any changes in dentation.

Bupropion Efficacy Monitoring Parameters

Improvement in depressive symptoms, may require 4-6 wk. Abstinence from tobacco products.

Bupropion Safety Monitoring Parameters

Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases. BP and heart rate in patients using concomitant nicotine replacement therapy. Incidence of seizure. LFTs and SCr at baseline and periodically. Monitor body weight during treatment.

Buspirone Efficacy Monitoring Parameters

Reduction in symptoms of anxiety or depression.

Buspirone Safety Monitoring Parameters

Signs and symptoms of withdrawal upon abrupt dose reduction or discontinuation. Monitor for involuntary movements, altered mental status, seizures, and tremors or myoclonus

Carbamazepine Efficacy Monitoring Parameters

Reduction in number of seizures, decreased pain, therapeutic concentrations for epilepsy and bipolar disorder: 4-12 mcg/m​L.

Carbamazepine Safety Monitoring Parameters

Emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior; baseline CBC, serum sodium, LFTs, complete urinalysis, and BUN; thyroid function test at baseline and during therapy, eye examinations at baseline and during therapy.

Carisoprodol Efficacy Monitoring Parameters

Reduction in pain and muscle spasms.

Carisoprodol Safety Monitoring Parameters

Seek medical attention if idiosyncratic symptoms such as extreme weakness, transient quadriplegia, dizziness, or confusion occur within minutes or hours after 1st dose.

Celecoxib Efficacy Monitoring Parameters

Decreased pain and improved range of motion.

Celecoxib Safety Monitoring Parameters

CBC, LFTs, SCr, fecal occult blood tests, BP, severe skin rash, black tarry stools, swelling or weight gain, severe pain, yellowing of eyes or skin, change in urination.

Citalopram Efficacy Monitoring Parameters

Improvement in symptoms of depression, panic disorder, vasomotor symptoms, OCD.

Citalopram Safety Monitoring Parameters

Worsening of mental health symptoms, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases; signs/symptoms of abnormal bleeding. Monitor serum sodium. Monitor ECG if concomitant QTc-prolonging medications or at increased risk for prolongation.

Clobazam Efficacy Monitoring Parameters

Decrease in the frequency of seizures. Reduction in anxiety.

Clobazam Safety Monitoring Parameters

Signs and symptoms of CNS depression, suicidal thoughts or behaviors, unusual changes in mood or behavior. Seek medical attention immediately if rash occurs, as significant risk of Stevens-Johnson syndrome.

Clonazepam Efficacy Monitoring Parameters

Reduction in anxiety symptoms or seizures.

Clonazepam Safety Monitoring Parameters

Severe drowsiness, thoughts of suicide, seizures, slow or irregular heartbeat; monitor BP, HR.

Codeine Efficacy Monitoring Parameters

Decreased pain or alleviation of cough.

Codeine Safety Monitoring Parameters

LFTs, SCr, pain levels, HR, BP, and frequency of bowel movements. If chronic use, severe skin rash, black tarry stools, excessive drowsiness, yellowing of eyes or skin, change in urination. Educate family/friends to immediately report any signs or symptoms of excessive somnolence, decreased alertness, slowed respiratory rate.

Colchicine Efficacy Monitoring Parameters

Resolution of clinical signs and symptoms of gout (pain, stiffness, swelling).

Colchicine Safety Monitoring Parameters

CBC, LFTs, and SCr at baseline and periodically during treatment. Instruct patients to discontinue the medication immediately and seek medical attention if signs and symptoms of agranulocytosis (severe neutropenia), or myotoxicity (including rhabdomyolysis).

Conjugated Estrogens Efficacy Monitoring Parameters

Resolution of clinical signs of abnormal bleeding or hot flashes or other symptoms, prevention of osteoporosis.

Conjugated Estrogens Safety Monitoring Parameters

Monitor BMD; conduct diagnostic evaluation to rule out malignancy in the event of persistent or recurring vaginal bleeding or new palpable breast mass.

Cyclobenzaprine Efficacy Monitoring Parameters

Reduction in pain and muscle spasms.

Cyclobenzaprine Safety Monitoring Parameters

Seek medical attention if symptoms of hepatic failure occur during therapy with this agent. Monitor for change in mental status, autonomic changes (increased HR, sweating, fluctuating BP), tremors, nausea/vomiting, and seizures.

Desvenlafaxine Efficacy Monitoring Parameters

Improvement in symptoms of depression (suicidal thoughts or intent, change in appetite, lack of energy, change in sleep patterns, etc.).

Desvenlafaxine Safety Monitoring Parameters

Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases; signs/symptoms of abnormal bleeding; monitor BP, LFT, serum sodium, and serum cholesterol levels, in case of severe impairment at baseline and periodically during therapy; signs/symptoms of hyponatremia, especially in patients on concomitant diuretics, volume-depleted patients, and elderly. Monitor renal function.

Dexmethylphenidate Efficacy Monitoring Parameters

Resolution of signs of ADHD (improved attention span and reduced impulsivity).

Dexmethylphenidate Safety Monitoring Parameters

Monitor BP, HR, weight, CBC. Growth rate and appetite change in children. Intraocular pressure if pre-existing glaucoma.

Diazepam Efficacy Monitoring Parameters

Reduction in anxiety symptoms, alcohol withdrawal symptoms (HTN, tremor), muscle spasticity/rigidity, or seizures.

Diazepam Safety Monitoring Parameters

Severe drowsiness, thoughts of suicide, yellowing of eyes, seizures, SCr, LFT changes, HR, BP, diminished respiration rate.

Diclofenac Efficacy Monitoring Parameters

Decreased pain and improved range of motion.

Diclofenac Safety Monitoring Parameters

Monitor CBC, LFTs, SCr, BP, fecal occult blood tests, severe skin rash, black tarry stools, chest pain, yellowing of eyes or skin, and change in urination.

Divalproex Efficacy Monitoring Parameters

Reduction in number of seizures, control of manic symptoms, control of depressive symptoms, or reduction in number and severity of migraine headaches. Therapeutic range for epilepsy, 50-100 mcg/m​L. Therapeutic range for bipolar disease, 50-125 mcg/m​L. Consider drawing free valproate serum levels in patients with suspected issues with plasma protein (eg, drug interactions, low albumin), therapeutic range is considered 5-15 mcg/m​L.

Divalproex Safety Monitoring Parameters

Signs/symptoms of peripheral edema, increased HR, weight changes, pancreatitis (abdominal pain, nausea, vomiting), monitor LFTs, ammonia levels, and CBC; emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior, serum HCG in women of childbearing age.