Metabolic monitoring of second-generation antipsychotics: Evaluation of a pharmacist- and nurse-driven protocol.

OBJECTIVE: Second-generation antipsychotic therapy can lead to metabolic abnormalities, increasing the risk of cardiovascular disease and death in patients with serious mental illness. However, the literature suggests there is a lack of appropriate monitoring in individuals receiving these therapies. This study aims to evaluate whether the implementation of a pharmacist- and nurse-driven metabolic monitoring protocol will increase monitoring in patients prescribed second-generation antipsychotic therapy in an outpatient community mental health clinic. METHODS: A retrospective review of adult outpatients in a community mental health clinic who were prescribed second-generation antipsychotics was conducted from October 1, 2017, to March 31, 2019. Pre- and postprotocol implementation groups were compared to assess the impact of the protocol on the primary outcome of appropriateness in monitoring for metabolic parameters. RESULTS: A total of 160 patients who met the inclusion criteria were randomly selected and reviewed, allowing for 80 individuals in each group. Improvement in the appropriateness of monitoring was found for 4 of 5 metabolic parameters after protocol implementation, including blood pressure (17.5% to 43.8%, P < 0.001), weight (17.5% to 43.8%, P < 0.001), hemoglobin A1C (27.5% to 42.5%, P = 0.044), and lipid levels (17.5% to 31.3%, P = 0.04). Primary care physicians ordered most of the laboratory values (44.5% to 46.2%); however, pharmacists and nurses ordered 7% of laboratory tests after the protocol implementation. CONCLUSION: Despite the knowledge that second-generation antipsychotic therapies commonly lead to metabolic syndrome and therefore increased cardiovascular disease risk, monitoring for metabolic effects remains poor, and there is a lack in diversity of strategies to improve this monitoring. Although further research on the effectiveness of a pharmacist- and nurse-driven metabolic monitoring protocol in this setting is warranted, this protocol serves as an example of a novel strategy with the potential to improve metabolic monitoring of second-generation antipsychotic therapy.

The evolving role of the pharmacist for individuals with serious mental illness.

Adults with serious mental illness such as schizophrenia, bipolar disorder, or severe depression encounter many barriers in receiving appropriate health care services and are at a markedly increased risk of premature mortality. A range of clinical pharmacist roles in community mental health may help offset the increasing issues related to access to care and contribute to recovery-oriented systems of care for individuals with serious mental illness. In this commentary, we offer a description of one such model operationalized within a large community mental health center. Clinical pharmacists provide substantial contributions toward optimizing care for individuals with serious mental illness through medication therapy management, cardiovascular risk reduction, and various other interventions to help positively impact the health disparity these individuals face.

Brexpiprazole (Rexulti): A New Monotherapy for Schizophrenia and Adjunctive Therapy for Major Depressive Disorder.

Brexpiprazole (Rexulti): a new monotherapy for schizophrenia and adjunctive therapy for major depressive disorder.

Idarucizumab, a Humanized, Monoclonal Antibody Fragment for Immediate Reversal of Dabigatran.

OBJECTIVE: To evaluate the role of idarucizumab, a humanized monoclonal antibody fragment, as a specific reversal agent for the anticoagulant activity of dabigatran and to review the pharmacology, pharmacokinetic properties, efficacy, and safety of this agent. METHODS: A literature search was conducted consisting of a PubMed database using the MeSH term idarucizumab and the key word dabigatran antidote. Studies evaluating the pharmacology, pharmacokinetics, safety, and efficacy of idarucizumab for the reversal of the anticoagulant activity of dabigatran were included. RESULTS: Idarucizumab represents a novel treatment option as it is the only humanized, monoclonal antibody fragment that specifically binds to dabigatran. Studies evaluating reversal of dabigatran-induced anticoagulation have demonstrated immediate, complete, and sustained effects with idarucizumab. Idarucizumab did not overcorrect thrombin generation. Additionally, evaluations have shown that dabigatran can be safely reinitiated 24 hours after the administration of idarucizumab. The United States Food and Drug Administration granted priority review for the biologic license application and accelerated approval for idarucizumab. CONCLUSION: Idarucizumab represents an encouraging development in the reversal of dabigatran. Its novel mechanism of action, pharmacokinetics, tolerability, and lack of thrombotic events contribute positively to its use in patients who experience bleeding or for those who require emergent surgery or procedures.