Mental Health - Guidelines for Clopine Connect Monitoring - Essay Example

? Guidelines for Clopineconnect Monitoring Guideline for clopineconnect monitoring Due to the adverse effects associated with the use of antipsychotic drugs, it is best practice to monitor patients who are under medication with antipsychotic drugs such as clozapine. The process of monitoring patients receiving antipsychotics has two main benefits one that is to help identify treatable pathology in a population and the other is to link and track antipsychotic induced adverse effects in patients. Antipsychotic drugs have been linked with a variety of adverse effects, which include and not limited to cardiovascular, hepatic, metabolic, endocrine and hematologic complications hence the need for very close monitoring of patients. This paper will explore the use of the antipsychotic drug clozapine with a deep insight into the guideline that should be followed in its use in mental health centres. First, the paper will look into what clozapine is and how it works, its dosage and then look into its initiation procedure, observations and side effects. The paper will also look into haematological tests and why they are so important in the monitoring and lastly look into how smoking effect clozapine in the body. What is Clozapine? Clozapine is a drug that belongs to the group of medicines known as antipsychotics, which are mainly used in the treatment of schizophrenia (Castle & Buckley, 2011). Clozapine is a highly regulated drug under the specialised drugs program and is only intended as third line treatment for chronic schizophrenia refractory to treatment with other drugs or drug resistant schizophrenia (Labbate, Fava, Rosenbaum, & Arana, 2010). It is a second generation neuroleptic drug whose availability is tightly controlled and can only be used when mandatory blood testing and other monitoring can be achieved at the required intervals. Clozapine was first developed in 1958 but was then removed from the market because of its potentially lethal side effects of agranulocytosis also known as neutropenia and was only approved for use in mental health centres 30 years later after a pivotal study demonstrated its efficiency and efficacy in treating resistant schizophrenia (Usher, Foster, & Bullock, 2009). In Australia and elsewhere around the globe, the risk of neutropenia and other side effects necessitated that a standard monitoring system known as the Clozapine Patient Monitoring System be used for all patients under medication with clozapine. Clopineconnect database Clopineconnect is an online database where all consumer blood test results and other essential and relevant information is stored and can be accessed by registered personnel thus making it easier to check compliance with the monitoring requirements. If a patient consuming clozapine does not adhere to the treatment requirements or the organisation in charge does not follow the required monitoring protocol, the database will show absence of critical information and the prescription of the medication must cease in accordance with the set protocol until the required monitoring is completed (Usher, Foster, & Bullock, 2009). How Clozapine waorks Clozapine is a very strong drug and should only be used where other medications have failed but it also requires patience as positive effects of the drug may not be realised until 4-6 weeks and the full positive effects may not be realised until 6-12 months where consistency is very important (Lauriello & Pallanti, 2011). Clozapine is very effective in alleviating the normal symptoms of schizophrenia such as social withdrawal, lack of motivation, lack of interest in doing things and lack of energy. It is also very efficient in treatment of hallucinations, delusions, agitation, unusual thinking, speech and behaviour (Stahl, 2006). Clozapine works through interaction with neurotransmitters, which are used by the cells in the brain for communication. Too much or too little amounts of neurotransmitters in the brain cause abnormalities in behaviour and clozapine works by blocking the action of two of these neurotransmitters, dopamine and serotonin, in certain areas of the brain to bring about normalcy (Dulcan, 2007). Dosage The medication with clozapine may cause very serious side effects in a small proportion of the population and once the treatment has commenced, the doses must be carefully titrated up or down to here necessary. The careful titration of dosses is based on the symptom control and the severity of the side effects experienced by the consumer (Alan Stoudemire, 1995). Once the treatment has commenced, the patient must be carefully monitored with regular blood test every week for the first 18 weeks and every 28 days after that (Usher, Foster, & Bullock, 2009). Clozapine Initiation procedure It is the responsibility of the medical officers to ensure that each patient who commences the use of clozapine is known to the clozapine clinic that will manage their care and that the patient meets the required criteria prior to prescription. The prescription should be in accordance with S 100 and TGA regulations and the required test should be ordered at the right intervals (Llewellyn-Smith, & Verberne , 2011) Nursing staff administering clozapine should ensure that they are conversant with the TGA and S100 regulations, the clopineconnect data entry, treatment options for possible side effects and any other treatment requirement. Clozapine clinic coordinators are responsible for database update and assessment of consumers as per the protocol and notifying the medical staff in case complications due to the medication arise (Simon, 1992). Before commencement of clozapine, the patient must have tried at least two other antipsychotic drugs with documented valuation indicating inadequate reaction to the drugs or unpleasant opposing effects. The ability of the patient to comply with medication requirements is documented and assessed where it should be established that compliance with oral medication is possible. The patient must be registered in the clopineconnect database and must consent to the treatment through signing or if the patient is not in a position to consent to the treatment, the doctor involved may sign on behalf of the patient in accordance with the procedures of consent to treatment (Simon, 1992). A thorough search of the patient’s medical history is also very important to confirm that there are no earlier cases of drug induced neutropenia or bone marrow disorder prior to commencement of treatment with clozapine. Baseline white blood cell and neutrophil count is also necessary and should not be below the green level for blood samples taken within 10days of the proposed start date (Reilly & Raju, 2004). In other words, stability in white blood cell and neutrophil count must be achieved before commencement of clozapine treatment. Due to diurnal variation and white cell count being lowest in the morning, it is advisable to perform the test later in the day to avoid false low results that could possibly prevent the consumer from starting or continuing with clozapine treatment. The patient should also have baseline fasting lipids and liver function test before the commencement of treatment to ensure that there are no core complications that could be accelerated by clozapine. The patient also needs to have a proper cardiac assessment that includes electrocardiogram, troponin among others before starting treatment with clozapine After approval for treatment with clozapine, the patient should be booked into a clozapine clinic that is convenient to their place of residence for medical review every week for a period of 18 weeks. The relevant clinic’s Clozapine Information Folder is then updated with the client’s information and arrangements for blood tests for outside patients should be done within 48 hours of the stipulated medical review appointment time. Observations during initiation After the first/ initiation dose, the consumer will require special monitoring for a minimum of 6 hours for any vital and neurological signs like blood pressure where an increase or decrease with more than 20 units indicates that a medical review is required where the medical officer in charge of the initiation is immediately notified. If an admitted patient using clozapine is to transfer to a community or any other facility, a clozapine Transfer of Care form should be duly completed as per the required guidelines. Monitoring up to eighteenth week Every week for a period of eighteen weeks, a patient under the medication of clozapine will attend a clozapine clinic and must be reviewed by a medical officer in special appointments. The appointment for medical review of clozapine patients cannot be cancelled by the clinic and if the patient happens to cancel the review, another review must be done within 48 hours. Why the Haematological tests are so important The review is very crucial and important for noting any discrepancies in signs and symptoms as well as monitoring improvement or any adverse reactions or infections in the body. The medical review is also used to ensure that the blood test counts of white blood cells and neutrophil are within the required limits. The medical officer only prescribes medication for a period of seven days where the rate of titration depends on the blood tests, symptoms, tolerability as well as gender and body mass index (BMI) (Aronson, 2009). It is recommended that the maximum dosage should meet the TGA regulations of not more than 900 mg per day. It should be noted that 855 of the neutropenia cases occur during the first 18 weeks of treatment and this is the reason why weekly medical review of blood tests are very important and should not be ignored. Neutropenia is an abnormal condition that is characterised by very low levels of neutrophil in the body usually below the count of 2 x 109/L (Theml, Diem, & Haferlach, 2004). Interaction of Clozapine with alcohol and smoking It should also be noted that clozapine increases the effect of alcohol in the body and also causes light headedness whereas smoking reduces the amount of clozapine in the body and a consumer should inform their medical officer in case of any changes in their smoking habits. This will help in maintaining an effective dosage for the consumer (Taylor, 2006). In summary, clozapine, which is a second-generation neuroleptic drug that works through inhibition of neurotransmitters dopamine and serotonin, should only be used when all other antipsychotic drugs have failed. The drug is highly regulated and a medical officer should approve its use after a thorough scrutiny of the medical history of the patient. All the consumers should be registered in the clopineconnect database and prescription and use should follow the required standards. The patient should strictly adhere to weekly medical reviews for the first eighteen weeks to avoid neutropenia. ? References Alan Stoudemire, B. S. (1995). Medical-Psychiatric Practice, Volume 3. Washington DC: American Psychiatric Pub. Aronson, J. K. (2009). Meyler's Side Effects of Psychiatric Drugs. San Diego: Elsevier. Castle, D. J., & Buckley, P. F. (2011). Schizophrenia. Oxford: Oxford University Press. Dulcan, M. K. (2007). Helping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional Problems: A Resource Book of Medication Information Handouts. New York: American Psychiatric Pub. Llewellyn-Smith, I.J & Verberne , A. J. (2011). Central Regulation of Autonomic Functions. Oxford: Oxford University Press. Labbate, L. A., Fava, M., Rosenbaum, J. F., & Arana, G. W. (2010). Handbook of Psychiatric Drug Therapy. Philadelphia: Lippincott Williams & Wilkins. Lauriello, J., & Pallanti, S. (2011). Clinical Manual for Treatment of Schizophrenia. 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