Handler et al reported several signals that can help to detect an adverse drug reaction in a nursing home resident. One signal involves review of serum drug levels. The authors are from Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh.
Patient selection: nursing home resident
Drug
Drug Level
aminoglycoside antibiotic
supratherapeutic, peak or trough
phenytoin
supratherapeutic
lithium
supratherapeutic
theophylline
supratherapeutic, trough
digoxin
supratherapeutic
procainamide
supratherapeutic (include N-acetylprocainamide)
primidone
supratherapeutic
quinidine
supratherapeutic
valproic acid
supratherapeutic
phenobarbital
supratherapeutic
carbamazepine
supratherapeutic
disopyramide
supratherapeutic
Trough is just prior to the next dose.
Peak is after a dose, based on maximum level after absorption.
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