Drug level monitoring frequency

Specialties NP

Published

So I have been working at my first job for a month. One of the biggest factors that take up my time is determining when a patient needs a blood level for a drug. For example, I'm looking at Dynamed right now for the drug Dilantin. Under "monitoring" it says the usual range is 10 - 20 mcg/mL. But it does not say how often to take blood levels when starting the medication for the first time, or when changing the dosages, or when the drug level is within range.

Is there a web resource some where which has the frequency of obtaining blood levels for all medications?

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Specializes in Case Manager/Administrator.

Phenytoin (Dilantin) has a half life of average 22 hours (range 8-60), the time it takes to get to a therapeutic steady level is 1-4 weeks. The higher the dose the longer it takes. You check trough levels if it is PO every 7-21 days or you can compare two levels drawn at 2-4 day intervals (post loading dose and then compare 2-4 days afterward). This should be able to provide a reasonable maintenance dose. Ensure you are holding doses for 1 days for every 20 umol/L over 80 umol/L. Do NOT increase dose by more than 50-100 mg increments. Theraputic levels are 20-40 umol/L

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What about Keppra? I cant even find its reference range anywhere. At the nursing home we use a ran​ge of 5.0 - 46.0. But I can't find this range in any books or websites. And how often should I be getting the blood levels?

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Specializes in Family Nurse Practitioner.

Absolutely no disrespect to the OP because my well known, well respected brick and mortar school didn't teach us much about labs either but here we are with another glaring reason NP school is embarrassingly inferior to medical school. Imagine giving prescribing rights to someone with minimal knowledge of labs...or addictions-don't even get me started on that one.

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I have been begging for a good lab analysis class ever since nursing school. It's been hopeless. I have graduated and still struggling just to find a good book on interpreting these kinds of things. I have bought a couple of recent lab interpretation books, but they don't have this information.

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Specializes in Cardiac, ER.

LMGTFY

Let me google that for you

This information is easily available. My brick and mortar school did teach lab levels as well as pharmacology, but most of all they taught me to use my resources. Good luck to you

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Specializes in ER, PCU, UCC, Observation medicine.

Do you work in an office or hospital? Whenever I don't know something, which is a lot, I use uptodate.com. best thing for medical knowledge

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Specializes in Reproductive & Public Health.
Do you work in an office or hospital? Whenever I don't know something, which is a lot, I use uptodate.com. best thing for medical knowledge

Yes, uptodate is a godsend. The hospital I worked at as a nurse had no professional references besides some random dusty textbooks. There was an old nursing drug book on a shelf at the nurses' station, but hell if I am going to use a print source for any drug information. Nope, not gonna do it.

I honestly don't know how one can keep up without an external "brain" to assist our decision making. It's not physically possible to hold all that information, let alone keep up with the constant flow of new information/updated guidelines. It seems almost ..unethical for employers to not provide a service like uptodate for their employees.

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Specializes in ER, PCU, UCC, Observation medicine.
Yes, uptodate is a godsend. The hospital I worked at as a nurse had no professional references besides some random dusty textbooks. There was an old nursing drug book on a shelf at the nurses' station, but hell if I am going to use a print source for any drug information. Nope, not gonna do it.

I honestly don't know how one can keep up without an external "brain" to assist our decision making. It's not physically possible to hold all that information, let alone keep up with the constant flow of new information/updated guidelines. It seems almost ..unethical for employers to not provide a service like uptodate for their employees.

good point, but then again that is why we are required to get CMEs so we can stay in the loop of new things. Maybe take an in depth pharmacology review as a cme, it's good to know these things.

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