Southwest
Monitoring Members on Atypical Antipsychotics
As a result of questions from practitioners regarding the monitoring of members taking atypical, or second-generation, antipsychotics (SGA), and of the absence of monitoring in charts we reviewed, Magellan has developed an auditing tool designed to help determine if the appropriate measurements are being monitored during treatment.
Our auditing tool includes questions on whether the following were assessed at baseline and/or follow-up visits, as recommended by a consensus guideline promulgated by the American Diabetes Association, American Psychiatric Association, and the American Association of Clinical Endocrinologists:
- Personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease
- Weight and height (or BMI)
- Blood pressure
- Fasting plasma glucose
- Fasting lipid profile.
Currently available medications in the class of SGA include:
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- Risperidone (Risperdal Consta)
- Paliperidone (Invega).
These are collectively placed in the class of SGAs because they share some advantages over the original, first-generation antipsychotics (FGA), such as chlorpromazine hydrochloride (Thorazine) and haloperidol (Haldol).
These newer SGA agents have a lower tendency to cause extrapyramidal side effects – such as rigidity, tremor, and akathisia – than do the FGAs, but they do have their own set of side effects that must be monitored. These side effects can include weight gain, Type II diabetes, hyperlipidemia, and prolactin elevation.
To assist you in monitoring your patients, Magellan has developed a tip sheet pertaining to SGA. The tip sheet briefly describes benefits, issues and side effects of these medications.
We also have developed an informational sheet for member use, “Medication Safety and Second-Generation Antipsychotics.”
The Southwest and Michigan care management center are establishing baseline data and soon will begin a barrier analysis, in order to determine what type of interventions to make. Stay tuned for updates.