Which of the following tests should be performed before beginning a prescription of Accutane?
A. Check the calcium level
B. Perform a pregnancy test
C. Monitor apical pulse
D. Obtain a creatinine level
Correct Answer: B. Perform a pregnancy test
Accutane is contraindicated for use by pregnant clients because it causes teratogenic effects. Isotretinoin was a pregnancy category X drug under the previous FDA system and is contraindicated in women who are pregnant or who may become pregnant. There have been severe, documented congenital disabilities when pregnant women have taken isotretinoin.
Option A: Calcium levels are unnecessary. To prescribe and receive isotretinoin, the Food and Drug Administration requires prescribers and patients to register with the iPLEDGE program. iPLEDGE ensures the fulfillment of appropriate requirements before the distribution of isotretinoin to prevent the use of this medication during pregnancy.
Option C: Apical pulse is not necessary. Two negative pregnancy tests are necessary before the initiation of therapy with isotretinoin. The first pregnancy test occurs up to 30 days prior to medication initiation. The second pregnancy test must occur at least 19 days after the first negative pregnancy test and within the first five days of the patient’s menstrual cycle. Each subsequent month the patient must have a recorded negative pregnancy test to continue therapy. After discontinuation of therapy, a final pregnancy test should take place at 30 days following therapy completion.
Option D: Liver function tests (LFTs), fasting lipid profile (including triglycerides), blood glucose, creatinine phosphokinase (CPK), and complete blood counts (CBC) with differential should be drawn before initiating therapy with isotretinoin. Screening for mood alteration, psychosis, aggression, suicidal ideation, skin changes, and visual changes should also take place prior to starting therapy.