Risperidone Case 1: Drug-Drug Interactions
|
|
|
- Adela Grant
- 6 years ago
- Views:
Transcription
1 Risperidone Case 1: Drug-Drug Interactions de Leon & Bork (a resident) J Clin Psychiatry 1997;58: Jose de Leon, MD
2 Educational Objectives At the conclusion of this presentation, the participant should be able to: 1. Consider pharmacological principles in the context of polypharmacy. 2. Appreciate the potential for risperidone drug-drug interaction. 3. Show familiarity with how to correct for drug-drug interactions.
3 Abbreviations 9-OHR: 9-hydroxyrisperidone Marketed as paliperidone C: concentration (ng/ml) D: dose (mg/day) C/D: concentration/dose ratio. It is an index of drug clearance. For R: Total C = R C + 9-OHR C (both active) C/D ratio = R C + 9-OHR C R D R: risperidone R/9-OHR ratio = R C 9-OHR C RCT: randomized controlled trial TDM: therapeutic drug monitoring (blood levels)
4 CYP2D6 Terminology Everyone has two alleles which determine his/her phenotype. Phenotype = The outward appearance of the individual. It is the product of interactions between genes, and between the GENOTYPE and the environment.
5 CYP2D6 Terminology Preferred by Dr. de Leon Phenotype N active copies Ultrarapid metabolizer (UM) 3 Extensive metabolizer (EM) 1 to <3 Intermediate metabolizer (IM) 0 to <1 Poor metabolizer (PM) 0 Dr. de Leon has only one normal active allele. He considers himself a CYP2D6 EM. See the presentation Pharmacogenetic Testing in Psychiatry for more details.
6 CYP2D6 Terminology: According to Some Pharmacogenetic Companies Phenotype N active copies Ultrarapid metabolizer (UM) 3 Extensive metabolizer (EM) >1 to <3 Intermediate metabolizer (IM) 0 to 1 Poor metabolizer (PM) 0 Dr. de Leon has only one normal active allele. He is a CYP2D6 IM for some pharmacogenetic companies providing CYP2D6 genotyping.
7 1.0 Risperidone Case 1
8 Relevance for Dr. de Leon This case convinced Dr. de Leon that R pharmacokinetics was important for clinical practice. This was his first article on R pharmacokinetics. Currently he has > 10 articles in that area. Two have been quoted > 100 times in literature: de Leon J, Susce MT, Pan RM, Fairchild M, Koch WH, Wedlund PJ. The CYP2D6 poor metabolizer phenotype may be associated with risperidone adverse drug reactions and discontinuation. J Clin Psychiatry Jan;66(1): PubMed PMID: Bork JA, Rogers T, Wedlund PJ, de Leon J. A pilot study on risperidone metabolism: the role of cytochromes P450 2D6 and 3A. J Clin Psychiatry Jul;60(7): PubMed PMID: ISI provides quotations from each article on their Web of Science page. It is not free. ResearchGate provides quotations from each article. It is free but requires signing in.
9 Risperidone Case Case Description 1.2. R TDM in Outcome 1.4. Case Interpretation 1.5. Update on R TDM 1.6. Conclusion of the Case
10 Risperidone Case Case Description 1.2. R TDM in R/9-OHR Ratio C/D Ratio 1.3. Outcome TDM After First Medication Change Second Medication Change 1.4. Case Interpretation 1.5. Update on R TDM Gene Effects: CYP2D Environmental Effects Inducers Inhibitors 1.6. Conclusion of the Case
11 1.1. Case Description
12 1.1. Risperidone Case 1: Description 22-year-old Caucasian Non-smoker Diagnosis of schizophrenia Medication stable for months R D: 4 mg/day Carbamazepine D: 600 mg/day Dr. de Leon had a discussion with a resident on how to verify non-response to R.
13 1.1. Risperidone Case 1: Description So, what is the first step in verifying that the patient is not really responding to R?
14 1.1. Risperidone Case 1: Description So, what is the first step in verifying that the patient is not really responding to R? Being sure that the R D is sufficient.
15 1.1. Risperidone Case 1: Description So, how do you know that the patient is getting enough R?
16 1.1. Risperidone Case 1: Description So, how do you know that the patient is getting enough R? Measure R in blood (TDM).
17 1.2. R TDM in 1996
18 1.2. R TDM in R/9-OHR ratio in C/D ratio in 1996
19 1.2. Risperidone Case 1: TDM in 1996 R 4 mg/day and Carbamazepine R 9-OHR Total Found <5 10 <15 Carbamazepine C: 7.9 mcg/l
20 1.2. Risperidone Case 1: TDM in 1996 So, in 1996 how did Dr. de Leon know how to interpret R TDM?
21 1.2. Risperidone Case 1: TDM in 1996 So, in 1996 how did Dr. de Leon know how to interpret R TDM? He looked at PubMed.
22 1.2. Risperidone Case 1: TDM in 1996 Ereshefsky in 1996 reviewed the pharmacokinetics of available second-generation antipsychotics. He had participated in the R North American RCTs and had access to TDM data.
23 1.2. Risperidone Case 1: TDM in 1996 Ereshefsky described the R/9-OHR ratio: Index of CYP2D6 activity >1:CYP2D6 PM or taking CYP2D6 inhibitors
24 R/9-OHR in 1996
25 Risperidone Case 1: R/9-OHR R 4 mg/d and Carbamazepine R 9-OHR Total C R/9-OHR Found <5 10 <15 <0.5
26 Risperidone Case 1: R/9-OHR What can you say about R/9-OHR<0.5?
27 Risperidone Case 1: R/9-OHR What can you say about R/9-OHR<0.5? The patient was NOT a CYP2D6 PM.
28 Risperidone Case 1: R/9-OHR Ereshefsky provided Dr. de Leon a poster presented as an abstract at the American Psychiatric Association meeting. Anderson CB, True JE, Ereshefsky L, et al: Risperidone dose, plasma levels and response, in New Research Program and Abstracts, presented at Annual Meeting, American Psychiatric Association, San Francisco, CA, May 1993 (NR 217; p 113).
29 Risperidone Case 1: R 4 mg/day and Carbamazepine D Total C Found 4 <15 Expected* *North American R RCT
30 Risperidone Case 1: R/9-OHR What can you say about total R C <15 for R D=4 mg/day?
31 Risperidone Case 1: R/9-OHR What can you say about total R C <15 for R D=4 mg/day? It is too low. It corresponds to D <2 mg/d.
32 Risperidone Case 1: R/9-OHR Is there a better way to describe this relationship?
33 Risperidone Case 1: R/9-OHR Is there a better way to describe this relationship? Yes. The C/D ratio.
34 R C/D Ratio in 1996
35 Risperidone Case 1: C/D Ratio The C/D ratio provides an estimation of the medication clearance once steady state has been reached. In R this is calculated by dividing the total C (R + 9-OHR) by R D.
36 Risperidone Case 1: C/D Ratio According to the poster from the manufacturers: D=10 mg/day Total C=72.8 ng/ml. Thus, the C/D ratio is 72.8/10=7.28. As a matter of fact, all doses studied (2, 4, 10 and 16 mg/day) provided a C/D ratio very close to 7.
37 Risperidone Case 1: C/D Ratio The R North American RCT TDM was never published beyond that poster. Dr. de Leon published graphs based on the data in one of his review articles.
38 Risperidone Case 1: C/D Ratio C/D Ratio mg/day
39 Risperidone Case 1: C/D Ratio The C/D ratio =7 is used to calculate the expected C in this patient. Later, a C/D ratio =7 was found to be correct in Dr. de Leon s studies. In Dr. de Leon s experience, some labs in Europe appear to provide higher C/D ratios, close to 10.
40 Risperidone Case 1: C/D Ratio The best way of representing the C/D relationship is in a graph.
41 1.2.2 Risperidone Case 1: C/D Ratio
42 Risperidone Case 1: C/D Ratio So, what does this graph showing C and D tell you about R TDM?
43 Risperidone Case 1: C/D Ratio So, what does this graph showing C and D tell you about R TDM? R follows linear kinetics.
44 Risperidone Case 1: C/D Ratio So, what are the consequences of following linear kinetics?
45 Risperidone Case 1: C/D Ratio Consequences: There is a linear relationship between R D and R C. If the R D by 2 x, the C by 2 x.
46 Risperidone Case 1: C/D Ratio So, what is the D that corresponds to total R C <15 ng/ml?
47 Risperidone Case 1: C/D Ratio So, what is the D that corresponds to total R C <15 ng/ml? CD ratio =7, 15/x=7 x<2 mg/day.
48 Risperidone Case 1: C/D Ratio So, how do you interpret this C?
49 Risperidone Case 1: C/D Ratio So, how do you interpret this C? R D=4 mg/day but TDM suggests D=1-2 mg/day.
50 Risperidone Case 1: C/D Ratio Is a R D=1-2 mg/day enough?
51 Risperidone Case 1: C/D Ratio Is a R D=1-2 mg/day enough? Probably not.
52 Risperidone Case 1: C/D Ratio What would you do?
53 Risperidone Case 1: C/D Ratio What would you do? Dr. de Leon doubled the R D.
54 1.3. Outcome
55 1.3. Outcome TDM After First Change Second Medication Change
56 TDM After First Change
57 Risperidone Case 1: Follow-up R 8 mg/d and Carbamazepine R 9-OHR TotalC/D R/9-OHR Expected Found < <3.7 <0.3 Carbamazepine C: 7.8 mcg/l
58 Risperidone Case 1: Change 1 So, what is the D that corresponds to a total R C =24 ng/ml?
59 Risperidone Case 1: Change 1 So, what is the D that corresponds to a total R C =24 ng/ml? CD ratio =7, 24/x=7 x<4 mg/day.
60 Risperidone Case 1: Change 1 So, how do you interpret this C?
61 Risperidone Case 1: Change 1 So, how do you interpret this C? R D=8 mg/day but TDM suggests D=3-4 mg/day.
62 Risperidone Case 1: Change 1 In 1996, according to information provided by the manufacturer, R was metabolized by CYP2D6. In 1996, Ereshefsky found that: Carbamazepine metabolism of some antipsychotics. Carbamazepine is not likely to influence R.
63 Risperidone Case 1: Change 1 The patient had two low R Cs, based on the D. Is there any other explanation besides carbamazepine?
64 Risperidone Case 1: Change 1 The patient had two low R Cs, based on the D. Is there any other explanation besides carbamazepine? The patient was a CYP2D6 UM.
65 Risperidone Case 1: Change 1 But this patient was a CYP2D6 EM. He had two normal alleles (*1/*1).
66 Second Medication Change
67 Risperidone Case 1: Change 2 What would you do next?
68 Risperidone Case 1: Change 2 What would you do next? Dr. de Leon stopped carbamazepine.
69 Risperidone Case 1: Follow-up TDM on 8 mg/day. No carbamazepine R 9-OHR TotalC/D R/9-OHR Expected Found <5 49 <54 <6.8 <0.1 He developed akathisia.
70 Risperidone Case 1: Change 2 So, what is the D that corresponds to a total R C < 54 ng/ml?
71 Risperidone Case 1: Change 2 So, what is the D that corresponds to a total R C < 54 ng/ml? CD ratio =7, 54/x=7 X=7-8 mg/day.
72 Risperidone Case 1: Change 2 So, how do you interpret this C?
73 Risperidone Case 1: Change 2 So, how do you interpret this C? R D=8 mg/day but TDM suggests D=7-8 mg/day.
74 Risperidone Case 1: Change 2 What can you conclude?
75 Risperidone Case 1: Change 2 What can you conclude? After stopping carbamazepine, he metabolized R normally.
76 1.4. Case Interpretation
77 1.4. Case Interpretation Interpretation Relevance
78 Interpretation
79 Risperidone Case 1: Interpretation Drs. de Leon & Bork proposed: Carbamazepine R C 2-fold. CYP3A is involved in R metabolism.
80 Risperidone Case 1: Interpretation In 1999, R was verified to be metabolized by CYP3A4: In vitro study and A larger clinical sample (Bork et al.): CYP3A inducers and inhibitors influence R TDM.
81 Relevance
82 Risperidone Case 1: Relevance Is the carbamazepine effect on R clinically relevant?
83 Risperidone Case 1: Relevance Is the carbamazepine effect on R clinically relevant? Yes. Ask the R manufacturer.
84 Risperidone Case 1: Relevance R manufacturers developed a RCT to try to prove R is effective as an adjunct treatment for mania. R or placebo was added to: lithium, valproate, or carbamazepine.
85 Risperidone Case 1: Relevance The RCT was published in R added to lithium or valproate was effective. R added to carbamazepine was no different from placebo.
86 Risperidone Case 1: Relevance What was the R manufacturer s mistake?
87 Risperidone Case 1: Relevance What was the R manufacturer s mistake? The R dose in the carbamazepine patients was not corrected to compensate for induction.
88 Risperidone Case 1: Relevance How can you correct for inducer effects on R metabolism?
89 Risperidone Case 1: Relevance How can you correct for inducer effects on R metabolism? You need to double R D.
90 Risperidone Case 1: Relevance To demonstrate R efficacy in carbamazepine patients, this study needed to use a R pill with twice the potency in these patients. In a better-designed RCT, to make carbamazepine effective, each pill should have: 1 mg of R for use in patients with lithium or valproate 2 mg of R for use in patients with carbamazepine 0 mg of R for use in patients with placebo
91 Risperidone Case 1: Relevance Carbamazepine effects appeared to the average total C by two times across all subjects. According to Dr. de Leon s study, it happens in CYP2D6 PMs and in patients taking powerful inhibitors (fluoxetine or paroxetine). See the next section. Remember: normal total C/D ratio=7.
92 1.5. Update on R TDM: Using a Published Figure
93 1.5. Risperidone Case 1: R TDM Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM
94 1.5. Risperidone Case 1: R TDM The figure has 3 panels: Left panel: (bars 1-4) Middle panel: (bars 5-8) Right panel: (bars 9-11).
95 1.5. Risperidone Case 1: R TDM Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Left panel: bars 1-4 Middle panel: bars 5-8 Right panel: bars 9-11
96 1.5. Update on R TDM Gene: CYP2D Environment Inducers Inhibitors
97 R TDM: CYP2D6
98 Risperidone Case 1: R TDM & CYP2D Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Focus on left panel: bars 1-4 Middle panel: bars 5-8 Right panel: bars 9-11
99 Risperidone Case 1: TDM & CYP2D6 Left panel (bars 1-3) UMs: C/D ratio <6.0 (bar 1) EMs: C/D ratio around 7.0 (bar 2) IMs: C/D ratio around 7.0 (bar 3) All of these are normal (around 7) Left panel (bar 4) PMs: C/D ratio =12.0 (bar 4) Too high.
100 Risperidone Case 1: R TDM & CYP2D Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Focus on left panel: bars 1-4 Middle panel: bars 5-8 Right panel: bars 9-11
101 1.5.1 Risperidone Case 1: R TDM & CYP2D6 CYP2D6 PMs do not have active CYP2D6 enzyme and they metabolize R poorly. Figure: C/D ratio =12.0 (bar 4) This is almost twice the normal ratio.
102 R TDM: Environment
103 R TDM: Inducers
104 Risperidone Case 1: TDM & Inducers Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Left panel: bars 1-4 Middle panel: bars 5-8 Focus on right panel: bars 9-11
105 Risperidone Case 1: TDM & CYP2D6 Right panel (bars 9-10) UMs: None taking inducers EMs: C/D ratio around 3.0 (bar 9) IMs: C/D ratio around 3.0 (bar 10) These are half of normal (7). Right panel (bar 11) PMs: C/D ratio <6.0 (bar 11) Lower than normal.
106 Risperidone Case 1: TDM & Inducers Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Left panel: bars 1-4 Middle panel: bars 5-8 Focus on right panel: bars 9-11
107 Risperidone Case 1: TDM & Inducers Adding carbamazepine is approximately equivalent to R dose by two times. Discontinuing carbamazepine is approximately equivalent to R dose by two times.
108 Risperidone Case 1: TDM & Inducers Smoking is NOT an inducer of R metabolism. Polycyclic aromatic hydrocarbon compounds on smoke induce: CYP1A2 (olanzapine, clozapine and probably some phenothiazines). Some glucuronidation enzymes (haloperidol and possibly olanzapine and some phenothiazines).
109 Risperidone Case 1: TDM & Inducers Carbamazepine (and other inducers) appear to have very powerful effects and have greater effects on R metabolism than not having CYP2D6 (PMs).
110 Risperidone Case 1: TDM & Inducers When marketing R, the R manufacturer proposed that R and 9-OHR are equally potent. Later, when marketing paliperidone, R manufacturer data suggests that R may be more potent than paliperidone (9-OHR). The R manufacturer recommends paliperidone Ds that are 2 x higher than R Ds.
111 Risperidone Case 1: TDM & Inducers If Dr. de Leon is correct and R is more potent than 9-OHR (see Risperidone Case 2 Genetics), it will be difficult to predict the outcomes for: carbamazepine + CYP2D6 PM carbamazepine + paroxetine Paroxetine can inhibit CYP2D6 completely.
112 R TDM: Inhibitors
113 Risperidone Case 1: TDM & Inhibitors Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Left panel: bars 1-4 Focus on middle panel: Right panel: bars 9-11 bars 5-8
114 Risperidone Case 1: TDM & Inhibitors R patients taking powerful inhibitors may have complete inhibition of CYP2D6 and in some cases CYP3A4 inhibition. They may metabolize R poorly.
115 Risperidone Case 1: TDM & Inhibitors Inhibitors CYP2D6 CYP3A4 Fluoxetine Potent Weak-moderate Paroxetine Potent Bupropion Moderate Duloxetine Moderate Sertraline Weak-moderate (dose-related) Fluvoxamine Weak Moderate Citalopram Escitalopram Not relevant* Not relevant* *Probably are such weak inhibitors that they are not clinically relevant. See the presentation Antidepressant Pharmacokinetics.
116 Risperidone Case 1: TDM & Inhibitors Neither inhibitors nor inducers Inhibitors, not inducers Inducers C/D ratio UM EM IM PM UM EM IM PM EM IM PM Left panel: bars 1-4 Focus on middle panel: Right panel: bars 9-11 bars 5-8
117 Risperidone Case 1: TDM & Inhibitors Middle panel (bars 5-8) UMs: C/D ratio around 10.0 (bar 5) EMs: C/D ratio around 9.0 (bar 6) IMs: C/D ratio around 11.0 (bar 7) PMs: C/D ratio around 11.0 (bar 8) PMs (bar 4) and PM+ inhibitors (bar 8) look similar. You cannot inhibit CYP2D6 if you do not have it. You can inhibit CYP3A4.
118 1.6. Conclusion of Case
119 1.6. Risperidone Case 1: Conclusion The patient was able to tolerate R D=8 mg/day + carbamazepine. The patient was unable to tolerate R D=8 mg/day without carbamazepine. He developed akathisia. He was switched to clozapine. He eventually was discharged.
120 Questions Please review the 10 questions in the pdf entitled Questions on the Presentation: Risperidone Case 1. You will find the answers on the last slide after the Thank you slide. No peeking until you have answered all the questions. If you did not answer all the questions correctly, please review the PowerPoint presentation again to reinforce the pharmacological concepts.
121 Thank you
122 Answers 1. B 6. D 2. A 7. D 3. A 8. C 4. D 9. B 5. D 10. A
Quetiapine Case 1 Warfarin Jose de Leon, MD
Quetiapine Case 1 Warfarin 1-23-16 Jose de Leon, MD 1. Quetiapine Case 1 J Clin Psychopharm 1999;19:382-3 http://www.ncbi.nlm.nih.gov/pubmed/10440472 Educational Objectives At the conclusion of this presentation,
Quetiapine Case 2 Therapeutic Drug Monitoring Jose de Leon, MD
Quetiapine Case 2 Therapeutic Drug Monitoring 1-27-16 Jose de Leon, MD 2. Quetiapine Case Therapeutic Drug Monitoring (unpublished) Educational Objectives At the conclusion of this presentation, the participant
Clozapine Case 6: Half-Life Jose de Leon, MD
Clozapine Case 6: Half-Life 1-16-16 Jose de Leon, MD 6. Clozapine Case 6 J Clin Psychopharmacol 1996;16:193-4. http://www.ncbi.nlm.nih.gov/pubmed/8690839 Educational Objectives At the conclusion of this
They deserve personalized treatment
Your patients are unique They deserve personalized treatment New laboratory service offered by STA 2 R is a panel of genetic tests that gives prescribers answers to the clinical questions below. The test
Valproate Case 3: Formulations Jose de Leon, MD
Valproate Case 3: Formulations 2-12-16 Jose de Leon, MD 3.Valproate Case 3 Described in J Clin Psychiatry 2004;65:724-5 http://www.ncbi.nlm.nih.gov/pubmed/15163266 Pharmacological explanation provided
Pharmacogenetic Testing in Psychiatry Jose de Leon, MD ( )
Pharmacogenetic Testing in Psychiatry Jose de Leon, MD (12-01-15) Conflicts of Interest (See more details on conflict of interest in the first presentation Training Psychiatrists to Think like Pharmacologists
Clozapine Case 1 The Relevance of CYP Jose de Leon, MD
Clozapine Case 1 The Relevance of CYP 12-18-15 Jose de Leon, MD 1. Clozapine Case 1 J Clin Psychiatry 1996;57:175-176 http://www.ncbi.nlm.nih.gov/pubmed/8601555 Educational Objectives At the conclusion
Valproate Case 1: Pharmacokinetics Jose de Leon, MD
Valproate Case 1: Pharmacokinetics 2-12-16 Jose de Leon, MD 1. Valproate Case 1 J Clin Psychopharmacology 2009;29:509-11 http://www.ncbi.nlm.nih.gov/pubmed/19745660 Educational Objectives At the conclusion
Guidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Gene(s)/Level of evidence
Drug Gene(s)/Level of evidence Guidelines/Supporting Studies* FDA Label Information Additional Information/Commentsxc` Haloperidol CYP2D6 ( SLC6A5 ( 2D6: DPWG guidelines Reduce dose by 50% in PMs Aripiprazole
Mental Health DNA Insight WHITE PAPER
Mental Health DNA Insight WHITE PAPER JULY 2016 Mental Health DNA Insight / White Paper Mental Health DNA Insight Pathway Genomics Mental Health DNA Insight test is aimed to help psychiatrists, neurologists,
Clinically Relevant Interactions between Newer Antidepressants and Second-Generation Antipsychotics
University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 5-2014 Clinically Relevant Interactions between Newer Antidepressants and Second-Generation Antipsychotics Edoardo Spina University
CYP2D6: mirtazapine 2001/2002/2003
CYP2D6: mirtazapine 2001/2002/200 Cl or = oral clearance,=c ss = steady state concentration, EM = extensive metaboliser, IM = intermediate metaboliser, MR = metabolic ratio, NS = non-significant, PM =
PEER REVIEW HISTORY ARTICLE DETAILS VERSION 1 - REVIEW
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (see an example) and are provided with free text boxes to
TRAINING PSYCHIATRISTS TO THINK LIKE PHARMACOLOGISTS: INTRODUCTION (2015 version) Jose de Leon, MD 04/20/16
TRAINING PSYCHIATRISTS TO THINK LIKE PHARMACOLOGISTS: INTRODUCTION (2015 version) Jose de Leon, MD 04/20/16 Dr. de Leon is affiliated with the University of Kentucky Department of Psychiatry and Eastern
Antipsychotics. Something Old, Something New, Something Used to Treat the Blues
Antipsychotics Something Old, Something New, Something Used to Treat the Blues Objectives To provide an overview of the key differences between first and second generation agents To an overview the newer
POLYPHARMACY : FOR AND AGAINST NZMA GP CONFERENCE 2012 PSYCHOPHARMACOLOGY SERIES. Guna Kanniah Waikato Hospital
POLYPHARMACY : FOR AND AGAINST NZMA GP CONFERENCE 212 PSYCHOPHARMACOLOGY SERIES Guna Kanniah Waikato Hospital POLYPHARMACY FIVE REASONS FOR POLYPHARMACY 1. To treat a concomitant disorder 2. To treat an
Induction by Antiepileptic Drugs: An Update for Clinicians Jose de Leon, MD ( )
Induction by Antiepileptic Drugs: An Update for Clinicians Jose de Leon, MD (11-21-15) Conflicts of Interest: About the Field 1) Dr. de Leon is firmly convinced that the literature is contaminated by false
Therapeutic drug monitoring in neuropsychopharmacology: does it hold its promises?
Therapeutic drug monitoring in neuropsychopharmacology: does it hold its promises? Prof. Dr. Christoph Hiemke Psychiatrische Klinik und Poliklinik Universität Mainz Psychopharmacotherapy Psychiatric Patient
Pregnancy. General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition)
Pregnancy General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition) In all women of child bearing potential Always discuss the possibility of pregnancy; half of all pregnancies are unplanned
Interactions between Antiepileptics and Second- Generation Antipsychotics
University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 3-2012 Interactions between Antiepileptics and Second- Generation Antipsychotics Jose de Leon University of Kentucky, jdeleon@uky.edu
SAMPLE REPORT MENTAL HEALTH DNA INSIGHT LABORATORY INFO. Protected Health Information. SSRIs. TCAs. Other Antidepressants
Test Results Reviewed & Approved by: Laboratory Director, Nilesh Dharajiya,.D. ENTAL HEALTH DNA INSIGHT PERSONAL DETAILS DOB Jan 1, 19XX ETHNICITY Caucasian ORDERING HEALTHCARE PROFESSIONAL Glenn Braunstein.D.
The clinical response to the same dose
Making sense of CYP2D6 and CYP1A2 genotype vs phenotype O. Greg Deardorff, PharmD, BCPP, Victoria Jenne, PharmD, MPH, BCPS, and Lauren Leonard, PharmD The clinical response to the same dose of a drug may
Two decades of clinical pharmacogenetic testing - Where do we stand?
Two decades of clinical pharmacogenetic testing - Where do we stand? Marja-Liisa Dahl, MD PhD, Professor Dept of Clinical Pharmacology Karolinska University Hospital/Karolinska Institutet Stockholm, Sweden
Safety and Pharmacokinetics of Atypical Antipsychotics in Children and Adolescents
Pediatr Drugs (2013) 15:217 233 DOI 10.1007/s40272-013-0024-6 REVIEW ARTICLE Safety and Pharmacokinetics of Atypical Antipsychotics in Children and Adolescents Silvio Caccia Published online: 16 April
Pharmacogenetics of antidepressants and antipsychotics: the contribution of allelic variations to the phenotype of drug response
(2004) 9, 442 473 & 2004 Nature Publishing Group All rights reserved 1359-4184/04 $25.00 www.nature.com/mp FEATURE REVIEW Pharmacogenetics of antidepressants and antipsychotics: the contribution of allelic
Aggression (Severe) in Children under Age 6
Aggression (Severe) in Children under Age 6 Level 0 Comprehensive diagnostic assessments. Refer to Principles of Practice on page 6. Evaluate and treat comorbid conditions (i.e. medical, other psychiatric
Effect of Co-medication on the Serum Concentrations of Aripiprazole and the Main Metabolite Dehydroaripiprazole
Effect of Co-medication on the Serum Concentrations of Aripiprazole and the Main Metabolite Dehydroaripiprazole Thesis submitted for the degree Candidate Pharmaciae at Department of Pharmaceutical Biosciences,
Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450
James A. Bourgeois, O.D., M.D. Vice Chair Clinical Affairs and Director, CL Service University of California San Francisco Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450 Localize! Sequence! 1
MEDICATION ALGORITHM FOR ANXIETY DISORDERS
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences MEDICATION ALGORITHM FOR ANXIETY DISORDERS RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL PSYCHIATRY UNIVERSITY OF WASHINGTON
Florida Best Practice Medication Guidelines Principles of Practice for Adults
http://flmedicaidbh.fmhi.usf.edu Florida Best Practice Medication Guidelines Principles of Practice for Adults 1. Goal of the Guidelines Persistent gaps exist in the quality of mental health care delivered
General Discussion 4
General Discussion 4 General Discussion 115 Introduction Psychiatry is considered to be one of the first medical disciplines that will implement pharmacogenetic testing in daily clinical practice. The
Slide 1. Slide 2. Slide 3. About this module. About this module. Antipsychotics: The Essentials Module 5 A Primer on Selected Antipsychotics
Slide 1 Antipsychotics: The Essentials Module 5 A Primer on Selected Antipsychotics Flavio Guzmán, MD Slide 2 About this module 13 antipsychotics will be studied 3 first generation antipsychotics 10 second
WHAT S NEW. Vilazodone (Viibryd ) Vilazodone - Dosing ANTIDEPRESSANT UPDATE: What s New? The Cardiac Debate The Efficacy Debate?Pharmacogenomics?
ANTIDEPRESSANT UPDATE: What s New? The Cardiac Debate The Efficacy Debate?Pharmacogenomics? Rex S. Lott, Pharm.D., BCPP Professor, ISU College of Pharmacy Mental Health Clinical Pharmacist, Boise VAMC
APPLYING ANTIPSYCHOTIC PHARMACOKINETICS TO BEST DOSING PRACTICES: DEPOT MEDICATIONS
APPLYING ANTIPSYCHOTIC PHARMACOKINETICS TO BEST DOSING PRACTICES: DEPOT MEDICATIONS Objectives Review the kinetic parameters of depot antipsychotics Review loading strategies for those depot medications
Clinical Guideline for the Management of Bipolar Disorder in Adults
Clinical Guideline for the Management of Bipolar Disorder in Adults Goal: To improve the quality of life of adults with bipolar disorder Identification and Treatment of Bipolar Disorder Criteria for Diagnosis:
Objectives. Objectives. A practice review. 02-Nov-16 MAJOR DEPRESSIVE DISORDER: NEW DEVELOPMENTS AND PRACTICAL IMPLICATIONS
MAJOR DEPRESSIVE DISORDER: NEW DEVELOPMENTS AND PRACTICAL IMPLICATIONS Jon-Paul Khoo What is treatment resistance really? Database review 328 consecutive non-remitted MDD patients referred for private
MEDICATIONS IN MANAGING DIFFICULT BEHAVIORS
MEDICATIONS IN MANAGING DIFFICULT BEHAVIORS A REALITY CHECK reality check Noun informal an occasion on which one is reminded of the state of things in the real world. ROBERT LACOSTE, MD MEDICAL DIRECTOR,
Clobazam Therapeutic Drug Monitoring: A Comprehensive Review of the Literature With Proposals to Improve Future Studies
University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 2-2013 Clobazam Therapeutic Drug Monitoring: A Comprehensive Review of the Literature With Proposals to Improve Future Studies
Psychiatry in Primary Care: What is the Role of Pharmacist?
Psychiatry in Primary Care: What is the Role of Pharmacist? Benjamin Chavez, PharmD, BCPP, BCACP Clinical Associate Professor Director of Behavioral Health Pharmacy Services January 12, 2019 Disclosure
Intuitive pharmacogenetics: spontaneous risperidone dosage is related to CYP2D6, CYP3A5 and ABCB1 genotypes
(2010), 1 5 & 2010 Macmillan Publishers Limited. All rights reserved 1470-269X/10 www.nature.com/tpj ORIGINAL ARTICLE Intuitive pharmacogenetics: spontaneous risperidone dosage is related to CYP2D6, CYP3A5
Are Two Antipsychotics Better Than One?
Are Two Antipsychotics Better Than One? Lauren Hanna, M.D and Delbert Robinson, M.D. Northwell Health National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office
5 COMMON QUESTIONS WHEN TREATING DEPRESSION
5 COMMON QUESTIONS WHEN TREATING DEPRESSION Do Antidepressants Increase the Possibility of Suicide? Will I Accidentally Induce Mania if I Prescribe an SSRI? Are Depression Medications Safe and Effective
ETHNICITY AND PSYCHOTROPIC RESPONSE
Ethnic Differences in Drug Metabolism ETHNICITY AND PSYCHOTROPIC RESPONSE Bridging Cultures: Improving Evaluation & Treatment of Cognitive 8 March 28 Keh-Ming Lin, M.D., M.P.H. Professor Emeritus of Psychiatry,
Answer ALL questions. For each question, there is ONE correct answer. Use the answer grid provided for ALL your answers.
CLINICAL THERAPEUTICS 7: PSYCHIATRY PHA-MHBY Time allowed: 2 hours UNIVERSITY OF EAST ANGLIA School of Pharmacy Main Series UG Examination 2013-2014 Part ONE Answer ALL questions. For each question, there
A unified in vivomodelingapproach for quantitative prediction of the impact of gene polymorphism and drug interactions on drug exposure
A unified in vivomodelingapproach for quantitative prediction of the impact of gene polymorphism and drug interactions on drug exposure Sylvain Goutelle, Michel Tod, Laurent Bourguignon, Nathalie Bleyzac,
Pharmacogenetics of Codeine. Lily Mulugeta, Pharm.D Office of Clinical Pharmacology Pediatric Group FDA
Pharmacogenetics of Codeine Lily Mulugeta, Pharm.D Office of Clinical Pharmacology Pediatric Group FDA 1 Codeine Overview Naturally occurring opium alkaloid Demethylated to morphine for analgesic effect
Introduction to Drug Treatment
Introduction to Drug Treatment LPT Gondar Mental Health Group www.le.ac.uk Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical
Pharmacokinetic and Pharmacodynamic Interactions between Antiepileptics and Antidepressants
University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 11-2014 Pharmacokinetic and Pharmacodynamic Interactions between Antiepileptics and Antidepressants Domenico Italiano University
Pharmacogenomics of Medications for Pain and Major Depression: Promise and Peril
Pharmacogenomics of Medications for Pain and Major Depression: Promise and Peril Geoffrey C. Wall, PharmD, FCCP, BCPS, CGP Professor of Clinical Sciences Drake University College of Pharmacy and Health
Pharmacogenetics: DNA analysis. to explain / predict. response to drug therapy. Maurizio Ferrari & Ron van Schaik
Maurizio Ferrari & Ron van Schaik Workshop IFCC Kuala Lumpur November 19, 2012 Predictive, Preventive and Personalized Medicine Part II: Pharmacogenetics l r.vanschaik@erasmusmc.nl Pharmacogenetics: DNA
SAMPLE REPORT MENTAL HEALTH DNA INSIGHT
PERSONAL DETAILS DOB Jan 1, 19XX ETHNICITY Caucasian ORDERING HEALTHCARE PROFESSIONAL Glenn Braunstein.D. 6777 Nancy Ridge Drive San Diego, CA 92121 US LABORATORY INFO ACCESSION NUBER ACTIVATION CODE SPECIEN
Medical Treatment of Problem Gambling. Donald W. Black, M.D. Roy J. and Lucille A. Carver College of Medicine Department of Psychiatry
Medical Treatment of Problem Gambling Donald W. Black, M.D. Roy J. and Lucille A. Carver College of Medicine Department of Psychiatry Disclosures Research Support: Forest Labs Nellie Ball Trust Fund National
New Patient Questionnaire
4 Embarcadero Center, Suite 1400, San Francisco, CA 94111 (415) 926-7774 phone; (415) 591-7760 office@sanfranciscopsych.com New Patient Questionnaire Thank you for trusting San Francisco Psychiatry with
Psychiatry Faculty Publications
University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 6-2014 False Negative Studies May Systematically Contaminate the Literature on the Effects of Inducers in Neuropsychopharmacology.
Mixing and Matching: Layering Medications as Family Physicians
Mixing and Matching: Layering Medications as Family Physicians Family Medicine Forum Vancouver, B.C. November 9-12, 2016. Jon Davine, CCFP, FRCP(C) McMaster University Objectives Discuss different examples
Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A
Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A Faculty/Presenter Disclosures Faculty: Mike Allan Salary: College
Augmentation and Combination Strategies in Antidepressants treatment of Depression
Augmentation and Combination Strategies in Antidepressants treatment of Depression Byung-Joo Ham, M.D. Department of Psychiatry Korea University College of Medicine Background The response rates reported
Resubmission. Scottish Medicines Consortium
Scottish Medicines Consortium Resubmission aripiprazole 5mg, 10mg, 15mg, 0mg tablets; 10mg, 15mg orodispersible tablets; 1mg/mL oral solution (Abilify ) No. (498/08) Bristol-Myers Squibb Pharmaceuticals
Mr. E, age 37, has a 20-year history
Antipsychotics for obsessive-compulsive disorder: Weighing risks vs benefits Taylor Modesitt, PharmD, Traci Turner, PharmD, BCPP, Lindsay Honaker, DO, Todd Jamrose, DO, Elizabeth Cunningham, DO, and Christopher
Adverse events of common psychiatric medications: an umbrella review
Adverse events of common psychiatric medications: an umbrella review Katrina Bartellas, 1 Thomas Bajorek 1 Sarah Stockton, 1 Stefan Leucht, 2 Andrea Cipriani, 1 Seena Fazel 1 1 Department of Psychiatry,
Things You Might Not Know About Psychotropic Medications But Wish You Did
Things You Might Not Know About Psychotropic Medications But Wish You Did John E. Dunne, MD December 3, 2016 PAL Conference Conflicts of Interest None to report I am employed by Seattle Children s and
In February 2013, the FDA approved a
Long-acting injectable aripiprazole for adult schizophrenia Jana Lincoln, MD Depot formulation and once-monthly dosing might improve adherence in patients with schizophrenia 46 May 2013 In February 2013,
Tobacco Dependence Treatment Pathway
Tobacco Dependence Treatment Pathway GUIDELINE VERSION 1 RATIFYING GROUP Drugs and Therapeutics Group (DTG) DATE PUBLISHED January 2017 NEXT REVIEW DATE January 2019 FORMULARY SPONSOR Executive Medical
APPENDIX 33: HEALTH ECONOMICS ECONOMIC EVIDENCE PROFILES
APPENDIX 33: HEALTH ECONOMICS ECONOMIC EVIDENCE PROFILES 1.1 Case identification assessment of adults with bipolar disorder... 2 1.1.1 Clinical/economic question: Mood Disorder Questionnaire (MDQ) versus
Variation in drug responses & Drug-Drug Interactions
Variation in drug responses & Drug-Drug Interactions 1 Properties of an Ideal Drug Effective Safety Selective Reversible Action Predictable Freedom from drug interactions Low cost Chemically stable Sources
PSYCHIATRY INTAKE FORM
Please complete all information on this form. PSYCHIATRY INTAKE FORM Name Date Date of Birth Primary Care Physician Current Therapist/Counselor What are the problem(s) for which you are seeking help? 1.
The Pharmacological Management of Bipolar Disorder: An Update
Psychobiology Research Group The Pharmacological Management of Bipolar Disorder: An Update R. Hamish McAllister-Williams, MD, PhD, FRCPsych Reader in Clinical Psychopharmacology Newcastle University Hon.
Psychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI
Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT
SMOKING AND DRUG INTERACTIONS
Medicines Information Centre Pharmacy Department UK Medicines Information SMOKING AND DRUG INTERACTIONS Introduction Smoking rates are significantly higher among people with mental health problems. It
Medically Accepted Indications for Pediatric Use of Psychotropic Medications by
Key: White Background: Medically Accepted Indication Yellow Backgroun: Medically Accepted Indication Status Not Ascertained Orange Background: Pediatric Indication cited, but not supported Red Background:
LAI Antipsychotics Frequently Asked Questions
LAI Antipsychotics Frequently Asked Questions Click each question to see the answer. Click the link to return to this list. Who should receive LAIs (long acting injectable antipsychotics)? Which antipsychotics
Optima Health. Schizophrenia. Next Review Date 9/19
Optima Health Schizophrenia Guideline History Original Approve Date 04/01 Review/Revise 3/05, 12/06, 09/08, 11/08, Dates 11/10, 7/11, 7/13, 7/15, 9/17 Next Review Date 9/19 These Guidelines are promulgated
The Dark Side of Psychopharmacology Managing Common Side Effects of Psychiatric Medications
The Dark Side of Psychopharmacology Managing Common Side Effects of Psychiatric Medications 2018 SCPMG Psychiatry Symposium The interventions discussed in this talk not FDAapproved for these uses unless
PRIMARY CARE MANAGEMENT OF OBESITY
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences PRIMARY CARE MANAGEMENT OF OBESITY LYDIA CHWASTIAK MD, MPH ASSOCIATE PROFESSOR UNIVERSITY OF WASHINGTON DEPARTMENT
SGEC Webinar Handouts 3/8/2013 FAMILIES. Please visit our website for more information
2013 WEBINAR SERIES STATE OF THE SCIENCE: DEMENTIA EVALUATION ANDMANAGEMENT AMONG DIVERSE OLDER ADULTS AND THEIR FAMILIES Please mute your Headset!! Please visit our website for more information http://sgec.stanford.edu/
CULTURAL ASPECTS OF THE PHARMACOLOGICAL MANAGEMENT OF DEMENTIA. SGEC Webinar Handouts 3/8/2013
Please visit our website for more information http://sgec.stanford.edu/ SGEC Webinar Handouts 3/8/2013 2013 WEBINAR SERIES STATE OF THE SCIENCE: EVALUATION AND MANAGEMENT AMONG DIVERSE OLDER ADULTS AND
Stop smoking products guidance
Stop smoking products guidance Ref: Status: Approved Stop smoking products guidance Page 1 of 15 Approval date: 22 November 2018 Contents 1. Purpose... 3 2. Related documents... 3 3. Guidance... 3 3.1
Impact of CYP2C19 genetics on pharmacokinetic variability of escitalopram and sertraline - a study based on therapeutic drug monitoring data
Impact of CYP2C19 genetics on pharmacokinetic variability of escitalopram and sertraline - a study based on therapeutic drug monitoring data Ida Rudberg 2009 Department of Psychopharmacology Diakonhjemmet
Common Antidepressant Medications for Adults
(and Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluoxetine Weekly (Prozac Weekly) 20 in AM w/ food (10 mg in elderly or those w/ panic disorder) 20 40 40 (If age >60yo, max 20) 10 10
Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment
Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment Lisa Lloyd Giles, MD Medical Director, Behavioral Consultation, Crisis, and Community Services Primary Children s Hospital Associate Professor,
PORT, 2009 Spain, 2009 Malaysia, 2009 Singapore, 2009 BAP, 2011 WFSBP, 2012 SIGN, 2013 Harvard NICE RANZCP, 2016
Appendix 3. Comparison of recommendations from clinical practice guidelines. Data extracted in relation to key health questions that are relevant to a clinician adopting an algorithmic approach to the
Medication for Anxiety and Depression. PJ Cowen Department of Psychiatry, University of Oxford
Medication for Anxiety and Depression PJ Cowen Department of Psychiatry, University of Oxford Topics Medication for anxiety disorders Medication for first line depression treatment Medication for resistant
ANTIPSYCHOTIC POLYPHARMACY
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences ANTIPSYCHOTIC POLYPHARMACY RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL PSYCHIATRY UWMC GENERAL DISCLOSURES The University
Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting
Improving Mental Health Outcomes in Veterans Through Dashboard Technology Learning Objectives 1. Describe VA Academic Detailing 2. Show how an increase in metabolic monitoring and a decrease in off-label
Treatment Options for Bipolar Disorder Contents
Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8
Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A
Is Depression management getting you down? G. Michael Allan Director Programs and Practice Support, CFPC Professor, Family Med, U of A Faculty/Presenter Disclosures Faculty: Mike Allan Salary: College
3. P450 Drug Metabolism DDIs: Induction
35 3. P450 Drug Metabolism DDIs: Induction General Introductiona and Definition of a DDI: A drug-drug interaction (DDI) occurs when two drugs, each of which is safe and efficacious alone at their respective
Eligible Beneficiaries
Therapeutic Class: Behavioral Health Medications for Adults Clinical Edit Number Long Description 4110 (May change) Quantity limit edit that is applied to atypical antipsychotics for claims identified
Disclosure. Objectives: Technician. Objectives: Pharmacist. Diagnostic and Statistical Manual (DSM-V) The Face of Mental Illness 7/25/2015
49th Annual Meeting Psychiatry for the Non-Psychiatry Specialist Jacintha Cauffield, PharmD, BCPS, CDE Associate Professor of Pharmacy Practice Lloyd L. Gregory School of Pharmacy Palm Beach Atlantic University
New Medications in Early Psychosis
New Medications in Early Psychosis Jean Starling Department of Psychological Medicine, the Children s Hospital at Westmead Department of Psychological Medicine and Department of Paediatrics and Child Health,
CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XV, 2013 INDEX
A acceptance and commitment therapy Posttraumatic Stress, 69 ADHD Adjunctive Fatty Acids, 5 Adjunctive Guanfacine Pharmacokinetics, 27 Amantadine, 21 Atomoxetine, 23 Cancer Risk, 31 CBT for Comorbid Anxiety,
PRESCRIBING GUIDELINES
The Maudsley The South London and Maudsley NHS Foundation Trust & Oxleas NHS Foundation Trust PRESCRIBING GUIDELINES 10th Edition David Taylor Carol Paton Shitij Kapur informa healthcare Contents Authors
Major Depression and Anxiety in Adolescents and Adults
Major Depression and Anxiety in Adolescents and Adults Miggie Greenberg, M.D. Associate Professor of Psychiatry St. Louis University School of Medicine greenbml@slu.edu *NO DISCLOSURES* OBJECTIVES * Recognize
Jolene R. Bostwick, PharmD, BCPS, BCPP Clinical Associate Professor Associate Chair, Department of Clinical Pharmacy University of Michigan College
Jolene R. Bostwick, PharmD, BCPS, BCPP Clinical Associate Professor Associate Chair, Department of Clinical Pharmacy University of Michigan College of Pharmacy Clinical Pharmacist in Psychiatry University
Pharmacogenomics and Cultural Issues! Y. W. Francis Lam, Pharm.D., FCCP!
Pharmacogenomics and Cultural Issues in Psychopharmacology Y. W. Francis Lam, Pharm.D., FCCP 1 Pharmacogenomics and Cultural Issues in Psychopharmacology Y. W. Francis Lam, Pharm.D., FCCP Professor of
FL Medicaid Drug Therapy Management Program for Behavioral Health Monitoring for Safety and Quality
FL Medicaid Drug Therapy Management Program for Behavioral Health Monitoring for Safety and Quality April 23, 2014 Pensacola, FL Presentation Objectives To briefly describe the program and how its components
Your footnote
MANIA Your footnote Your footnote Cipriani A, Barbui C, Salanti G et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. The Lancet 2011;
Final Outcomes Data and Analysis: Bipolar Depression: Diagnosis Confirmed, Next Steps?
Final Outcomes Data and Analysis: Bipolar Depression: Diagnosis Confirmed, Next Steps? neurosciencecme Snack Launch: February 19, 2015 Supported by Sunovion Pharmaceuticals, Inc. Designed, Analyzed and
ANTIPSYCHOTICS 2006 COST-CONSCIOUS USAGE
ANTIPSYCHOTICS 2006 COST-CONSCIOUS USAGE ASCP Model Curriculum David N. Osser, M.D. Harvard Medical School Pre-Lecture Exam Question 1 1. Which of the following is an antipsychotic dose that is in excess
Kelly E. Williams, Pharm.D. PGY2 Psychiatric Pharmacy Resident April 16,2009
Kelly E. Williams, Pharm.D. PGY2 Psychiatric Pharmacy Resident April 16,2009 List the antipsychotics most often prescribed Compare and contrast the use and adverse effects experienced in the pediatric