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Second-Generation Antipsychotic Utilization and Metabolic Parameter Monitoring in an Inpatient Pediatric Population: A Retrospective Analysis

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Abstract

Background

Second-generation antipsychotics (SGAs) are prescribed for a variety of indications and are strongly associated with adverse metabolic effects. Studies of pediatric outpatients have revealed several deficiencies in monitoring practices for adverse effects associated with SGAs.

Objective

Our objective was to characterize SGA prescribing and metabolic parameter monitoring (MPM) in an inpatient pediatric population.

Methods

Patients aged <18 years and discharged on SGA treatment between 1 November 2013 and 30 April 2014 from an inpatient psychiatric institution in Pittsburgh, PA, USA were included. Electronic medical records (EMRs) were reviewed for patient age and weight and for parameters used by the International Diabetes Federation (IDF) to define metabolic syndrome: waist circumference, fasting blood glucose, triglycerides, high-density lipoprotein, and blood pressure. The primary outcome was the percent of patients with completed MPM, defined as all parameters being available within the patient’s EMR in any form, except estimates. Secondary outcomes included percent of patients with existing metabolic syndrome or obesity according to IDF criteria, average total daily dose of individual SGAs, and frequency of individual SGA utilization. Data were analyzed utilizing univariate descriptive statistics.

Results

A total of 243 patients met inclusion criteria and were included in the analysis. For the primary outcome, 13.2% (n = 32) of patients had completed MPM for all parameters. Blood pressure was the most frequently documented parameter (n = 241; 99.2%), whereas waist circumference was the least (n = 67; 28%). Risperidone was the most commonly prescribed SGA (n = 99; 41%; average daily dose 1.92 mg).

Conclusions

Compared with outpatient studies, rates of documented MPM for certain parameters (i.e., fasting blood glucose, lipids) is higher for pediatric inpatients treated with SGAs. However, several monitoring deficiencies are still noted.

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Acknowledgements and disclosures

Preliminary results of this work were presented at the 24th Annual Pediatric Pharmacy Advocacy Group Meeting (April 2015) and American Society of Health-System Pharmacists Midyear Meeting (December 2014.) The corresponding author was completing a PGY-2 Psychiatric Pharmacy residency at the time this project was conducted. Special thanks to Mr. Richard Crabtree for his assistance with the EMR.

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Authors and Affiliations

  1. University of Kentucky HealthCare, Lexington, KY, USA

    Valerie D. Nolt

  2. Penn State Milton S Hershey Medical Center, Pittsburgh, PA, USA

    Alexandra Victoria Kibler

  3. University of the Incarnate Word Feik School of Pharmacy, 4301 Broadway, Box 99, San Antonio, TX, 78209, USA

    G. Lucy Wilkening

  4. University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

    Tanya J. Fabian

  5. Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Tanya J. Fabian

Authors
  1. Valerie D. Nolt
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  2. Alexandra Victoria Kibler
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  3. G. Lucy Wilkening
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  4. Tanya J. Fabian
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Corresponding author

Correspondence to G. Lucy Wilkening.

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There are no grants, funding sources, or commercial interests to report in relation to this publication.

Conflict of interest

Valerie D. Nolt, Alexandra Victoria Kibler, G. Lucy Wilkening, and Tanya J. Fabian have no conflicts of interest to disclose.

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Nolt, V.D., Kibler, A.V., Wilkening, G.L. et al. Second-Generation Antipsychotic Utilization and Metabolic Parameter Monitoring in an Inpatient Pediatric Population: A Retrospective Analysis. Pediatr Drugs 19, 139–146 (2017). https://doi.org/10.1007/s40272-016-0209-x

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  • DOI: https://doi.org/10.1007/s40272-016-0209-x

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