KD is a 24 year old female that comes to your pharmacy regularly. One day while you are working, KD rushes to your counter to pick up a prescription for Ortho Tri‐Cyclen Lo. KD is crying excessively at the counter, stating that her medications are ruining her life. She complains of increased confusion and has gained thirty pounds in the last two months (current BMI 41). KD has no additional complaints and states that her knee pain is well controlled on her current regimen. DRPs:
1) Safety > Adverse Drug Reaction > Drug-Drug Interaction
NSAIDs used in combination with Lithium increase the serum concentration of lithium resulting in toxicity. Could alternatively alternatively suggest APAP.
Therapeutic levels for Lithium are 0.6-1.2mEq/L and this patient’s levels are well over normal range. Since you haven’t had this in IDD yet, here is a reference:
1.5-2mEq/L – GI complaints/tremor
2-2.5mEq/L – confusion/somnolence
>2.5mEq/L – seizures/death
Monitoring Parameters: Serum lithium every 4-5 days during initial therapy; draw lithium serum concentrations 8-12 hours post-dose; renal, thyroid, and cardiovascular function; fluid status; serum electrolytes; CBC with differential, urinalysis; monitor for signs of toxicity; beta-hCG pregnancy test for all females not known to be sterile.
Reference Range: Levels should be obtained twice weekly until both patient’s clinical status and levels are stable, then levels may be obtained every 1-3 months.
2) Indication > Needs Additional Drug Therapy > Preventative Therapy
Assess immunization needs along with diet and exercise for OA
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