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Recommendations for Reducing Cardiometabolic Risk Cheat Sheet (DRAFT) by [deleted]

Recommendations for Reducing Cardiometabolic Risk

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Introd­uction

Quality Concerns in Psycho­tropic Prescr­ibing: Reducing the Use of Antips­ych­otics with High or Moderate Risk of Metabolic Side Effects in Indivi­duals with Cardio­met­abolic Risk Factors

Recomm­end­ations for Reducing Cardio­met­abolic Risk

1. Consumers with cardio­met­abolic conditions who are currently receiving high or moderate risk antips­ychotic medica­tions should be engaged by their prescr­ibers in a conver­sat­ion­about the cardio­met­abolic risks associated with their regimen, and the benefits of making a change. A switch to a medication posing a lower riskfor cardio­met­abolic compli­cations should be considered if clinically approp­riate.
2. Consumers with preexi­sting cardio­met­abolic risks should be started initially on low risk medica­tions
3. Alternate non-an­tip­syc­hotic treatm­ents should be considered for children and adoles­cents with cardio­met­abolic risk. If an antips­ychotic medication is indicated, a low risk medication is the first-line choice. Emphasize to the clinical staff the importance of asking consumers about both their medical and family historyof cardio­met­abolic diseaseat intake.
4. Psycho­edu­cation in varied formats should be availa­ble to all consumers. Brochures, scientific summaries, inform­ation sessions, and ongoing medication education groups can be helpful in providing inform­ation helpful to consumers and promote dialogue with prescr­ibers.
5. Cross tapers are recomm­ended when switching medica­tions. To decrease the risk of relapse, the new antips­ychotic drug should be started first and titrated to a therap­eutic

Revised 6/29/2011 7dose (if tolerated) before beginning the taper of the first medica­tion. Medication changes are tolerated best by consumers when the changes start low and go slow. A common clinical practice is to change a medication by no more than 1/3 of the current dose, no more frequently than every 2-3 weeks.
6. Consumers and families will benefit from supportive services from the clinic during periods of medication change. These services may include frequent check-in calls with the clinic nurse, increased appoin­tment frequency with the prescriber and therapist, medication groups with other consumers, and psycho­edu­cation about side effects or symptoms likely to be experi­enced. Specific interv­entions for management of common diffic­ulties including sleep problems, anxiety, and other changes in wellbeing may be developed by the clinical staff to provide clients with tools to use during the change.
7. Rating scales filled out by the client can be very helpful during medication changes. Rating scales can educate consumers in unders­tanding and observing symptom conste­lla­tions over time; and provide clinicians with accurate longit­udinal inform­ation about the effect of medication change or discon­tin­uation on symptoms and function.
8. Clinics should develop processes to liaise with primary care provid­ers, including facili­tation of appoin­tment scheduling for clients who have not had regular medical consul­tation.