Question

6. What schedule would you follow for monitoring labs for a patient taking antipsychotic medication?

7. What does the HGA1C represent? List the values for Normal, pre-diabetic, and diabetic values?
8. What is significant about an elevation or decrease in the MCV?
9. What is significant about an elevation or decrease in the MCH?
10. In what clinical condition would you order a serum prolactin?
11. If the serum prolactin was elevated, in your patient, what action would you take?
12. Describe how to interpret a LIPID profile?
13. What are the recommended levels for triglyceride? What disorders cause elevated triglycerides?
14. What are the recommended levels for LDL? What are the recommended goals for treatment?
15. You are reviewing a urinalysis on your patient. There are RBC’s present in the urinalysis. What would you do?
16. When do you order a Clozapine level?
17. When the ALT, AST, and GGTP are elevated? What would your list of differentials include?
18. List the causes of elevated and low albumin level and how would out of normal range albumin influence your prescribing?
19. You suspect that your patient may be drinking alcohol to excess. What lab values would you order and why?
20. How would dehydration influence your interpretation of labs?
21. What lab values are assessed for possible pancreatitis? What psychiatric medications are associated with pancreatitis?
22. What test is ordered to determine if a patient is pregnant? When is it important to order this test?
23. What is an expected range for the serum potassium in a patient newly diagnosed with Anorexia Nervosa, restricting type?
24. Your patient’s labs returns with an elevated creatinine phosphokinase. What action would you take ? What might be the etiology of this elevation?

Answer 1

1. For a patient taking antipsychotics we need to monitor Prolactin as it increases prolactin level. HbA1c, fasting plasma glucose, and fasting lipids.
2. HbA1c( Hemoglobin A1C) is done every 2-6 months to determine the recent average blood glucose level. It reflects how well the diabetes is controlled.

Normal- 4-5.6%

Prediabetic-5.7-6.4%

Diabetic->6.5%

3. MCV-Mean Corpuscular Volume

Low level- Microcytic Anemia

High Level-Macrocytic Anemia

4. MCH-Mean Corpuscular hemoglobin

Low level- Microcytic Anemia

High Level- Macrocytic Anemia

5. Prolactin is measured when the patient is on antipsychotic, any pituitary disorders, pregnant women.
6. Elevated serum prolactin- Dopamine agonist(Bromocriptine), if Hypothyroidism, it is treated with synthetic thyroid hormone. It brings prolactin back to normal.
7. Lipid profile or lipid panel is a panel of blood tests that serves as an initial screening tool for abnormalities in lipids, such as cholesterol and triglycerides. It measures Total cholesterol, LDL, HDL, Triglycerides, Non HDL cholesterol , TG to HDL ratio and Total protein. LDL is the bad cholesterol. If it is high, it shows that the patient is at risk of vascular disorders, hypertension and heart diseases. Low HDL level will have grater risk of developing heart disease.
8. Recommended triglyceride- <150mg/dl. Borderline high-150-199 mg/dl, High- >200mg/dl.

Triglyceride level is increased in obesity, hypothyroidism, kidney diseases, estrogen therapy, poorly controlled diabetes mellitus and certain inherited lipid disorders.

9. LDL- <100 mg/dl. 100-129 mg/dl are acceptable. To bring back the LDL level to normal by lipid lowering agents along with diet and exercise is the goal of management.
10. Advice for a CBC to see the hemoglobin level, take a relevant history. Ultrasonography to diagnose any renal calculi. Advice to drink unsweetened cranberry juice as it is a well known natural remedy for urinary tract infection.
11. Clozapine level is monitored 12 hrs after the last dose and several days after treatment begins.