PARAMETERS COMMONLY USED TO EVALUATE EFFECTIVENESS AND/OR SAFETY OF DRUG THERAPY

PARAMETER GOALS OF THERAPY (NORMAL VALUES) CLINICAL USE

Goals of therapy include: Used to evaluate effectiveness and safety of antihypertensive
Blood systolic blood pressure of 110-140 mmHg drug therapies such as diuretics, beta blockers, ACE inhibitors,
pressure diastolic blood pressure of 75-85 mmHg angiotensin II receptors blockers, aldosterone antagonists,
<130/80 with diabetes or kidney disease calcium blockers.
Goal of therapy Represents all of the different kinds of cholesterol in the blood
Total
< 200 mg/dl and includes high-density lipids (HDL), low-density lipids
Cholesterol (SI < 5.17 mmol/L) (LDL), and triglycerides (TG).
Goal of therapy varies depending on other risk Used to evaluate the effectiveness of lipid lowering drug
factors including cigarette smoking, therapies including
hypertension, HDL<40mg/dl, family history of atorvastatin (Lipitor®), fluvastatin (Lescol®),
CHD and male>45 or female>55. lovastatin (Mevacor®), pravastatin (Pravachol®),
LDL • without other risk factors <160 mg/dl rosuvastatin (Crestor®), simvastatin (Zocor®)
Low-density (SI <4.1 mmol/L) ezetimibe/simvastatin (Vytorin®)
lipoprotein • with 2 risk factors <130 mg/dl nicotinic acid (Niacin®)
(SI <3.4 mmol/L) gemfibrozil (Lopid®), clofibrate (Atromid-S®)
• with CHD and >2 risk factors <100 mg/dl colestipol (Colestid®), cholestyramine (Questran®)
(SI <2.6 mmol/L) Optional high risk <70 mg/dl
HDL Goals of therapy HDL removes excess cholesterol from peripheral tissues and is
High-density > 40 mg/dl considered “good” cholesterol. Elevated HDL levels are
lipoprotein (SI >1.04 mmol/L) associated with decreased risk for coronary heart disease.
<160 mg/dl Elevated triglycerides considered an independent risk factor
Triglycerides <1.8 mmol/L for coronary heart disease.
Goal of therapy includes: Used to evaluate drug therapy to manage hyperglycemia
preprandial blood glucose of 80-120 mg/dL associated with diabetes mellitus including insulin (Humulin®)
bedtime blood glucose of 100-140 mg/dL (Novolin®),
Glucose Fasting plasma glucose of > 126 mg/dL on two glipizide (Glutcotrol®), glyburide (Diabeta®) (Mircronase®),
occasions is consistent with the diagnosis of pioglitazone (Actos®), rosiglitazone (Avandia®)
diabetes mellitus
Goal of therapy Used to evaluate the effectiveness of glucose control in
HbA1c < 7% patients with diabetes. Reflects the blood glucose control over
Hemoglobin A1c Normal range 4-6% the past 2 to 3 months.
TSH Goals of therapy include the reduction of TSH Used to evaluate the effectiveness of thyroid replacement
Thyroid levels to the normal range of therapy to manage hypothyroidism.
Stimulating 0.3-5 µU/ml (SI 0.3-5 mU/L) levothyroxine (Synthroid®). Elevated TSH levels are indicative
Hormone of hypothyroidism.
INR Goal of therapy varies with the indication. Used to evaluate the effectives and safety of anticoagulant
International INR 2.0-3.0 for atrial fibrillation, deep vein therapy. Used to determine dosage adjustments for warfarin
Normalized Ratio thrombosis, pulmonary emboli (Coumadin®) therapy.
INR 2.5-3.5 for mechanical prosthetic values
Goal of therapy is to maintain serum potassium Used to evaluate and prevent cardiac toxicity associated with
within the normal range of hypokalemia caused by diuretics, diarrhea/vomiting. Can
K+ 3.5 – 5.0 mEq/L aggravate digoxin (Lanoxin®) toxicity. Hyperkalemia
Serum Potassium (SI 3.5 – 5.0 mmol/L) associated with renal dysfunction, ACE inhibitors including
captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®)
(Zestril®), ramipril (Altace®)
Creatinine Creatinine normal range Used as a guideline to determine appropriate dosage of
serum creatinine 0.6-1.3 mg/dL (SI 53-115 µmol/L) medications which are dependent on renal function for
(SCr) Creatinine Clearance normal range elimination.
creatinine 80-100 ml/min Used to determine if drug therapy is causing nephrotoxicity or
clearance (CrCl) Drug dosage adjustments often required when if drugs are accumulating to unsafe levels due to decreasing
CrCl is <30 ml/min renal function.
ALT Normal values Used to evaluate liver damage caused by medications such as
Alanine Males 10-40 Units/ml simvastatin (Zocor®), pravastatin, lovastatin (Mevacor®),
aminotransferase Females 8-35 Units/ml atorvastatin (Lipitor®) (Pravachol®), fluvastatin (Lescol®),
rosuvastatin (Crestor®), simvastatin (Zocor®), carbamazepine,
AST Males 20-40 Units/ml phenytoin, acetaminophen
Aspartate Females15-30 Units/ml
aminotrasnferase If elevated 2-3 times drug-induced hepatic damage suspected
Copyright© 2003-2005 Peters Institute of Pharmaceutical Care, Cipolle RJ, Strand LM, Morley PC
Pharmaceutical Care Practice: The Clinician’s Guide, McGraw Hill, 2004