Medication Audit Criteria and Guidelines

Medication Audit Criteria and Guidelines Drug Audit Checklist

Reviewer: Date: Class: Drug: valproic acid (Depakene®), divalproex sodium (Depakote®, Depakote® ER)

Audit# Comments Requires Phys. Review Patient# Yes No Ordering Physician

S 1. Cyclic mood disorders N

O 2. Aggressive behavior secondary to a psychiatric I T

- disorder

A 3. Impulse control disorders C I 4. Acute mania D N I s s n b 1. History of anaphylactic reaction or similarly o A i t t severe significant hypersensitivity to the u a l c o i medication prescribed e d n e i

v 1. Hepatic disease/impairment i a t r a t l n e

o 2. Blood dyscrasias, clotting disorders or R C concomitant drugs that alter clotting function (aspirin, non-steroidal anti-inflammatory drugs, warfarin, heparin, low molecular weight heparins, clopidogrel etc.) 3. Pregnancy/nursing mothers s G r 1. CBC - with differential and platelet count e N t I e - baseline then one (1) to two (2) weeks after R m a O each dosage increase, and as clinically r T a I indicated P N

g 2. Hepatic function panel- baseline and as O n i M r clinically indicated

o t T i 3. Pregnancy Test – baseline and as clinically N n o E indicated I M T

t 4. Valproic acid level – 1-2 weeks after A n P e initiation and dosage change, then as i t

a clinically indicated. P 5. Serum creatinine and BUN at baseline and as clinically indicated g

n Take with food to avoid stomach upset i s o

D See DSHS/DADS Formulary for dosage guidelines.

Exceptions to maximum dosage must be justified as per medication rule.

Drug: valproic acid (Depakene®), divalproex sodium (Depakote®, Depakote® ER) Drug Audit Checklist

Drug Audit Checklist Page 1 of 2 Revised April, 2010 Patient# Comments Requires Phys. Review Yes No Ordering Physician

Date Date Comments Physician's Referred Reviewed Signature

Additional Comments:

Drug Audit Checklist Page 2 of 2 Revised April, 2010