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activity is co-sponsored
by USF Health and by
CME Outfitters, LLC.
This CE activity is supported by
educational grants from Janssen,
a Division of Ortho-McNeil-
Janssen Pharmaceuticals, Inc.,
administered by Ortho-McNeil
Janssen Scientific Affairs, LLC,
and from Lilly USA, LLC.
For further information
concerning Lilly grant funding,
visit www.lillygrantoffice.com.
The course guide for this
activity includes slides,
disclosures of faculty
financial relationships,
and biographical profiles.
WHO = World Health Organization; NCEP ATP III = US National Cholesterol Education
Program Adult Treatment Panel III; IDF = International Diabetes Foundation
See supplemental bibliography for full references.
NCEP ATP III and IDF
Definitions for CMS
NCEP ATP III1 IDF2
Criterion (When ≥ 3 criteria (Abdominal obesity plus
are present) ≥ 2 other criteria)
Men > 40 ≥ 37 ≥ 35
Women > 35 ≥ 31 ≥ 31
Fasting triglycerides ≥ 150 ≥ 150
(mg/dL) or treatment for this lipid abnormally
HDL (mg/dL)
Men < 40 < 40
Women < 50 < 50
or treatment for this lipid abnormally
* Augmentation only
See supplemental bibliography for full references.
...But Have Metabolic Side Effects
FDA alerts and label warning
2004 - FDA has asked manufacturers
of all atypical antipsychotic drugs to
add a new warning to the drugs'
labels about the increased risk of
hyperglycemia and diabetes
FDA has labeled this as a class effect,
although there are major differences
in risk associated with the various
medications
Food and Drug Administration. FDA Patient Safety News: Show #28,
June 2004. http://www.accessdata.fda.gov/psn/printer-full.cfm?id=32.
Differential Metabolic Side
Effects Among SGAs1-4
Antipsychotic Weight Gain Diabetes Risk Dyslipidemia
Clozapine +++ + +
Olanzapine +++ + +
Risperidone ++ 0 0
Quetiapine ++ 0 0
Aripiprazole ± - -
Ziprasidone ± - -
+ = increased effect
- = minimal effect
0 = discrepant results
See supplemental bibliography for full references.
Learning
Objective 1
Identify strategies to
overcome barriers that
hinder lipid measurement
Consensus Guidelines
on Metabolic Monitoring
All patients receiving an SGA should
have fasting blood glucose and lipid
levels determined at baseline and after
12 weeks of treatment
ADA/APA Consensus on Antipsychotic Drugs and Metabolic Monitoring
4 8 12 12 5
Start Qtrly
wks wks wks mos yrs
Personal/family hx X X
Weight (BMI) X X X X X
Waist circumference X X
Blood pressure X X X
Fasting glucose X X X
Fasting lipid profile X X X X
Oct ’08 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct ’09
B Q1 Q2 Q3 Q4
Δ Baseline
Baseline Q4 p-value
to Q4
Ordered glucose 16.7% 45.6% 28.9 < .0001
Ordered lipid panel 13.3% 44.4% 31.1 < .0001
Documented BMI 6.7% 48.9% 42.2 < .0001
Documented glucose 16.7% 58.9% 42.2 < .0001
Documented BP 4.4% 43.4% 39.0 < .0001
Documented lipid panel 17.8% 62.2% 44.4 < .0001
Documented full bundle 1.1% 31.1% 30.0 < .0001
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for clinical information and
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on bipolar disorder
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