Basics of Benzodiazepine Use Disorder. DATE: June 12, 2018 PRESENTED BY: Melissa B. Weimer, DO, MCR
|
|
- Brianne Doyle
- 5 years ago
- Views:
Transcription
1 Basics of Benzodiazepine Use Disorder DATE: June 12, 2018 PRESENTED BY: Melissa B. Weimer, DO, MCR
2 Disclosures Speaker: Melissa Weimer, DO, MCR, has nothing to disclose. Planning Committee: The members of the planning committee (Jessica Gregg, Todd Korthuis, Melissa Weimer, John Mahan, Laura Heesacker, O Nesha Cochran, and Chris Colasurdo) have nothing to disclose. Dr. Korthuis serves as principal investigator for NIH-funded research that accepts donated extended-release naltrexone (Alkermes) and buprenorphine/naloxone (Indivior). 2 2
3 Objectives Understand the mechanism of action and pharmacokinetic properties of benzodiazepines Understand that differentiating between benzodiazepine physiologic dependence and benzodiazepine use disorder may be challenging Describe how to safely taper benzodiazepine therapy 3 3
4 Benzos are positive allosteric modulators Increase the GABA A receptor s affinity for GABA
5 Symptom Acute Withdrawal Symptoms: occur after days of continuous use Higher dose, longer use = more symptoms Lower dose, shorter term use = less symptoms Insomnia 71% Anxiety 56% Mood swings 49% Muscle twitching 49% Tremor 38% Headache 38% Nausea, vomiting, anorexia 36% Frequency Hypersensitivity to smells, sounds, lights, noise, touch Up to 38% Seizure* 4% Jahnsen, *Hx of prior seizure = risk of seizure again*
6 Features of a Benzo Use Disorder vs Benzo physiologic dependence Tolerance Withdrawal When severe, these 2 issues can cause problems with their life, ability to cope Benzo dependence alone Benzo use disorder Tolerance Withdrawal Loss of control of use Continued use despite social or interpersonal issues related to use Giving up other activities due to use No longer fulfilling major life obligations Consistent use despite acknowledgement of harms Wanting to cut down, but not being able Taking in larger amounts and longer than intended
7 Case Example 1 Real case Joe is a 72 yo man with HTN and hyperlipidemia. He developed severe anxiety after retirement approximately 10 years ago and was prescribed lorazepam 1mg BID. He found it helped him at first, but now he feels like it is a crutch and he doesn t like the effect his wife says it has on him. He would like to stop the medication but every time he stops, he becomes sweaty, fearful, anorexic and can not sleep. He would like to stop the medication before he goes on a cruise in 10 days. He has been erratically taking his meds over the last 2 weeks in an attempt to stop them, but has not been able to sleep and feels horrible.
8 Features of a Benzo Use Disorder vs Benzo physiologic dependence Tolerance Withdrawal Benzo dependence alone Benzo use disorder Tolerance Withdrawal Loss of control of use Continued use despite social or interpersonal issues related to use Giving up other activities due to use No longer fulfilling major life obligations Consistent use despite acknowledgement of harms Wanting to cut down, but not being able Taking in larger amounts and longer than intended
9 Taper plan outpatient slow taper Enjoy your vacation on a stable dose of lorazepam 1mg BID Start benzodiazepine taper when you return Consider transition to clonazepam or diazepam Taper by 10-25% per week depending on how well patient tolerates each step of the taper and dose availability Start mirtazapine and melatonin for sleep Create sleep routine and cut out naps Refer for cognitive behavioral therapy (CBT) Find hobbies or volunteer work
10
11 Taper Example: Clonazepam 0.5mg BID x 2 weeks Check in Clonazepam 0.5mg in AM and 0.25mg in PM x 2 weeks Check in Clonazepam 0.25mg BID x 2 weeks Check in Clonazepam 0.25mg in AM and 0.125mg In PM x 2 weeks Check in Clonazepam 0.125mg BID x 2 weeks Check in Clonazepam 0.125mg QAM x 2 weeks Check in Clonazepam 0.125mg every other day x 2 weeks Check in STOP
12 Case Example 2 Real case Joanne is a 52 year old female with hx of PTSD and major recurrent depression who seeks care in your primary care clinic for help getting off of benzos. She has been prescribed benzos (diazepam) since age 20 and has tried several times to stop them. She has developed a social phobia about psychiatrists. She can not go longer than 4 hours between doses or she has severe panic, though she does not take them more than prescribed to her. She has completely isolated herself from family and friends, can not work and feels completely disabled. Her friend recently drove to FL to pick her up because she was so distraught over her use and inability to stop benzodiazepines and her current prescriber is threatening to cut her off. She desperately wants to stop and her friend plans to help her and support her.
13 Features of a Benzodiazepine Use Disorder vs Benzodiazepine dependence Benzo physiologic dependence Tolerance Withdrawal Benzo use disorder Tolerance Withdrawal Loss of control of use?? Continued use despite social or interpersonal issues related to use Giving up other activities due to use No longer fulfilling major life obligations Consistent use despite acknowledgement of harms Wanting to cut down, but not being able Taking in larger amounts and longer than intended
14 Taper plan: outpatient prolonged taper Stabilize patient over 1-2 weeks on a dose of long acting benzodiazepines (clonazepam) mostly equivalent to her current prescription for diazepam Care coordinate with her friend to help manage medication and inform you if there are any issues Keep a log and lock on the medications Consider inpatient treatment if this doesn t go well Start very slow taper by reducing clonazepam by mg every 2 weeks Add PROPRANOLOL due to patient avoidance of all other meds Taper takes 1 year and is successful Patient engages in NA meetings for support
15 Case 3: REAL case Jimmy is a 22 year old man with hx of tobacco use who has been ordering a research benzodiazepine (etizolam) from CA for the last year. Total dose of 20mg per day. He also drinks a 6 pack of beer per day. He has received a DWI due to driving while intoxicated. He has had 2 seizures in the past due to attempting to taper his use on his own. He feels restless, anxious, sweaty, and continual vomiting. He would like to get back to work for the parks service as soon as possible. His parents have threatened to kick him out of the house if he does not stop his use.
16 Features of a Benzo Use Disorder vs Benzo physiologic dependence Tolerance Withdrawal Benzo dependence alone Benzo use disorder Tolerance Withdrawal Loss of control of use Continued use despite social or interpersonal issues related to use Giving up other activities due to use No longer fulfilling major life obligations Consistent use despite acknowledgement of harms Wanting to cut down, but not being able Taking in larger amounts and longer than intended
17 Taper plan INPATIENT TAPER Inpatient admission for detoxification Start Depakote 250mg TID, continue 3 weeks Schedule Librium mg QID x 1 day and then reduce by 25-50mg per day depending on time in detox Fastest inpatient taper = 5-7 days Longest inpatient taper = days Continue PRN Librium based on CIWA scale as well Work with family on safe discharge plan Advise against working or driving for the next week, minimum Start hydroxyzine, buspirone, trazodone to help with symptom relief Refer for treatment
18 Alternatives to Benzos for anxiety Prazosin or Clonidine Propranolol Quetiapine Mirtazepine SSRIs Hydroxyzine Buspirone Gabapentin* List is not in order of preference and not an exhaustive list Always choose a medication best suited for the specific problem you are attempting to address Consider TRAUMA and PTSD *Beware of possible diversion risk
19 Final Pearls Patients with significant liver disease Use benzos that undergo glucuronide conjugation Lorazepam, oxazepam CAUTION: Chlordiazepoxide, clonazepam, diazepam Don t attempt to taper opioids and benzos at the same time unless there is a significant safety issue Engage patients in other forms of coping CBT DBT Understand that relapse may occur
20 Questions? Soyka, Treatment of Benzodiazepine Dependence. NEJM 376; 12. March 23, /Opioid-and-Benzodiazepine-Tapering-flow-sheets.pdf
21
22 Withdrawal Management Soyka, weeks to taper, maybe longer, but not too long 10-50% in first week Hospitalize if > 100mg diazepam equivalents Don t withdraw opioids at the same time Adjuncts: gabapentin, carbamazepine or depakote, SSRIs, TCAs, antihistamines (i.e. hydroxyzine), melatonin Limited evidence for AEDs, but still consider
23 Benzodiazepine Metabolism Glucuronide Conjugation o Shorter half-life o Inactive metabolites o Safer in liver disease and elderly Lorazepam Oxazepam Temazepam (remember LOT) Oxidation o Longer half-life o More metabolites o Use caution in liver disease Chlordiazepoxide Diazepam Clonazepam
Basics of Benzodiazepine Use Disorder. DATE: March 20, 2018 PRESENTED BY: Melissa B. Weimer, DO, MCR
Basics of Benzodiazepine Use Disorder DATE: March 20, 2018 PRESENTED BY: Melissa B. Weimer, DO, MCR Disclosures Speaker: Melissa Weimer, DO, MCR, has nothing to disclose. Planning Committee: The members
More informationBasics of Benzodiazepine Use Disorder. DATE: October 3, 2017 PRESENTED BY: Melissa B. Weimer, DO, MCR
Basics of Benzodiazepine Use Disorder DATE: October 3, 2017 PRESENTED BY: Melissa B. Weimer, DO, MCR Disclosures Speaker disclosure: One time lecture sponsored by Indivior about overlap of pain and opioid
More informationMANAGING PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER Melissa B. Weimer, DO, MCR Chief of Behavioral Health & Addiction Medicine St.
MANAGING PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER Melissa B. Weimer, DO, MCR Chief of Behavioral Health & Addiction Medicine St. Peter s Health Partners, Albany, NY Assistant Professor of Medicine,
More informationMedications For Alcohol Use Disorder
Medications For Alcohol Use Disorder PRESENTED BY: Alann Weissman-Ward, MD, Addiction Medicine fellow June 19, 2018 DISCLOSURES Speaker: Alann Weissman-Ward, MD, has nothing to disclose. Planning Committee:
More informationWHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES?
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences WHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES?
More informationMEDICATION 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
More informationTreatment of Anxiety (without benzos)
Treatment of Anxiety (without benzos) Alison C. Lynch MD MS Clinical Professor Departments of Psychiatry and Family Medicine University of Iowa Health Care None Disclosures Overview/objectives Review common
More informationUsing Benzodiazepines in Primary Care
Using Benzodiazepines in Primary Care Spencer A. Tighe MD, FRCPC Saturday, Feb. 16, 2008 Overview Historical context Drug information Indications Side effects Abuse vs. physical dependence Clinical practice
More informationStrategies in Managing Opioid and Benzodiazepine Co-Prescribing
Strategies in Managing Opioid and Benzodiazepine Co-Prescribing Scott Endsley, MD Associate Medical Director, Quality Partnership HealthPlan of California October 25, 2016 Audio Instructions To avoid echoes
More informationBenzodiazepines: Comparative Effectiveness and Strategies for Discontinuation. Ann M. Hamer, PharmD, BCPP Rural Oregon Academic Detailing Project
Benzodiazepines: Comparative Effectiveness and Strategies for Discontinuation Ann M. Hamer, PharmD, BCPP Rural Oregon Academic Detailing Project This project is funded through a grant from the Pew Charitable
More informationMarijuana. DATE: June 26, 2018 PRESENTED BY: Melissa Weimer, DO, MCR, FASAM
Marijuana DATE: June 26, 2018 PRESENTED BY: Melissa Weimer, DO, MCR, FASAM Disclosures Speaker: Melissa Weimer, DO, MCR, has nothing to disclose. Planning Committee: The members of the planning committee
More informationAnxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM
Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE NURSING PROGRAM NURS 203 GENERAL PHARMACOLOGY DANITA NARCISO PHARM D Learning Objectives Understand the normal processing of fear vs fear processing
More informationWHAT SHOULD WE DO ABOUT BENZODIAZEPINES? Miriam Komaromy, MD Associate Director, Project ECHO August 2014
WHAT SHOULD WE DO ABOUT BENZODIAZEPINES? Miriam Komaromy, MD Associate Director, Project ECHO August 2014 EPIDEMIOLOGY OF BENZO USE 7-18% of US population uses a benzo for medical purposes each year Average
More informationManaging presenting problems with benzodiazepines. By Dr Gideon Felton MRCPsych Consultant Psychiatrist and Clinical Lead
Managing presenting problems with benzodiazepines By Dr Gideon Felton MRCPsych Consultant Psychiatrist and Clinical Lead OUTLINE OF PRESENTATION Why Benzodiazepines (BDZ s) are used Mechanism of Action
More informationPractical Tools to Successfully Taper Prescription Opioids. Melissa Weimer, DO, MCR
Practical Tools to Successfully Taper Prescription Opioids Melissa Weimer, DO, MCR Objectives Understand how to calculate morphine equivalents per day Understand the steps necessary to plan a successful
More informationANXIETY: FAST FACTS AND SKILLS FOR THE PRIMARY CARE PHYSICIAN
UW PACC Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences ANXIETY: FAST FACTS AND SKILLS FOR THE PRIMARY CARE PHYSICIAN RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL
More informationDifficult Conversations
Difficult Conversations D R. L Y D I A A N N E M B A R T H O L O W, D N P, P M H N P, C A R N - AP Skill Building Patient centered Boundaries and self-protection Trauma informed Care 1 Skill Building Trauma
More informationAnxiety Disorders.
Anxiety Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationSedative / Hypnotics
Sedative / Hypnotics David H. Rubin, MD Executive Director, Massachusetts General Hospital Psychiatry Academy Director of Child and Adolescent Psychiatry Residency Training Massachusetts General Hospital
More informationIdentification and Management of Benzodiazepine and Z-drug abuse
CSAM-SCAM Fundamentals Identification and Management of Benzodiazepine and Z-drug abuse Presentation provided by Dr. Mandy Manak MD, ABAM, CSAM, MRO Interior Chemical Dependency Office Disclosures Potential
More informationBenzodiazepines. Benzodiazepines
: History 1950s - Invented by Swiss chemists who identified its sedative effects 1950s 60s - Chlordiazepoxide (Librium) marketed as a safer alternative to barbiturates; along with newer benzodiazepines
More informationALCOHOL USE DISORDER WITHDRAWAL MANAGEMENT AND LONG TERM TREATMENT ANA HOLTEY, MD ADDICTION MEDICINE FELLOW UNIVERSITY OF UTAH HEALTH
ALCOHOL USE DISORDER WITHDRAWAL MANAGEMENT AND LONG TERM TREATMENT ANA HOLTEY, MD ADDICTION MEDICINE FELLOW UNIVERSITY OF UTAH HEALTH Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV
More informationBENZODIAZEPINES: WHAT YOU DON T KNOW CAN HURT YOU
BENZODIAZEPINES: WHAT YOU DON T KNOW CAN HURT YOU TABLE OF CONTENTS 4 Benzodiazepine Addiction 8 Xanax Withdrawal Symptoms 11 Professional Help for Benzo Withdrawal is Essential for Success 15 Relapse
More informationTreating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP
Treating Anxiety Disorders Adil Virani, BSc (Pharm), Pharm D, FCSHP Outline! Michelle s Case! Types of anxiety disorders! Goals of therapy! Treatment options and guidelines! Pharmacological options! Benzodiazepines
More informationten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment
ten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment This booklet was created to help you learn about tapering. You probably have lots
More informationVistaril ( hydroxyzine ) is a non-addictive antihistamine medication. This drug is used to relieve the itching caused by allergies and to control the
Vistaril ( hydroxyzine ) is a non-addictive antihistamine medication. This drug is used to relieve the itching caused by allergies and to control the nausea and. wisdom in this exchange. Alprazolam, available
More informationFor: NEON Primary Healthcare Providers By: Michelle Romero, DO June 2013
For: NEON Primary Healthcare Providers By: Michelle Romero, DO June 2013 This power point is only a guideline for recommendations in the treatment of psychiatric disorders. This is not comprehensive. Please
More informationCOMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications*
COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications* Bupropion (Wellbutrin) Start: IR-100 mg bid X 4d then to 100 mg tid; SR-150
More informationAnxiolytic, Sedative and Hypnotic Drugs. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Anxiolytic, Sedative and Hypnotic Drugs Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Anxiolytics: reduce anxiety Sedatives: decrease activity, calming
More informationCan klonopin help withdrawal opiates
Can klonopin help withdrawal opiates Search During detox, people can lose large amounts of bodily fluids (and with them important nutrients and electrolytes). There is also a possibility of breathing in
More informationSedatives and Hypnotics. Ahmad Al-Tarifi. Zahra Khalil. Pharmacology. 1 P a g e
Sedatives and Hypnotics Ahmad Al-Tarifi Zahra Khalil 1 P a g e Pharmacology 7 OCD can lead to an anxious behavior and anxiety can be treated with drugs called Sedatives and Hypnotics. What are sedatives?
More informationMultiple Choice Questions
Multiple Choice Questions 25yo M presents without psychiatric or medical history, with complaint of tremor to the ER. He denies drinking alcohol but his friend at bedside takes you to the side and reports
More informationPrepared by: Dr. Elizabeth Woodward, University of Toronto Resident in Psychiatry
Prepared by: Dr. Elizabeth Woodward, University of Toronto Resident in Psychiatry In broad terms, substance use disorders occur when a substance is used in a compulsive manner with a lack of control over
More informationDr. Oslin receives grant support from the NIH, VA, and the Pennsylvania Department of Aging.
David W. Oslin, MD University of Pennsylvania Philadelphia VAMC Dr. Oslin receives grant support from the NIH, VA, and the Pennsylvania Department of Aging. Dr. Oslin is a consultant to the Hazelden Betty
More informationMixing 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
More informationROLE OF HEALTH CARE PROVIDERS IN THE MANAGEMENT OF ALCOHOL AND DRUG USE RELATED PROBLEMS
ROLE OF HEALTH CARE PROVIDERS IN THE MANAGEMENT OF ALCOHOL AND DRUG USE RELATED PROBLEMS Dr. Anita Rao? ASK SCREEN Refer HELP T T Ranganathan Clinical Research Foundation TTK Hospital IV Main Road, Indira
More informationSCENARIOS IN SUBSTANCE MISUSE. By Dr Gideon Felton Consultant Psychiatrist and Clinical Lead
SCENARIOS IN SUBSTANCE MISUSE By Dr Gideon Felton Consultant Psychiatrist and Clinical Lead ALCOHOL SCENARIOS DON T PRESCRIBE LIBRIUM AS YOU ARE CONTRIBUTING TO A SECOND ADDICTION WITHOUT TREATING THE
More informationAcute General Medical and Surgical Admission:
Acute General Medical and Surgical Admission: Managing Substance Use Disorders in Patients Who are Severely Ill Scott Grantham, MD Executive Director, Behavioral Health Saint Francis Health System By the
More informationDisclosures. Objectives. Symptoms of fear. The Fifteen Minute Hour: Psychotherapy & Medications for Anxiety Management in Primary Care 4/5/18
Disclosures The Fifteen Minute Hour: Psychotherapy & Medications for Anxiety Management in Primary Care I have nothing to disclose Emma Samelson-Jones, MD Assistant Clinical Professor UCSF Department of
More informationMANAGING PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER
MANAGING PAIN IN PATIENTS WITH SUBSTANCE USE DISORDER Melissa B. Weimer, DO, MCR Chief of Behavioral Health & Addiction Medicine St. Peter s Health Partners Grand Rounds October 11, 2017 Disclosures One
More informationSession 2: Mental Health A: Alcohol Dependency: The Pharmacist s Role in Detox and Treatment 1:45pm - 2:45pm
January 20-22, 2012 Des Moines Marrio, 700 Grand Avenue, Des Moines, IA Session 2: Mental Health A: Alcohol Dependency: The Pharmacist s Role in Detox and Treatment 1:45pm - 2:45pm ACPE UAN 107-000-12-015-L01-P
More informationOLDER ADULTS & DEPRESCRIBING: TREATMENT
OLDER ADULTS & DEPRESCRIBING: CONTEMPLATION, ASSESSMENT & TREATMENT Jonathan Bertram Faculty/Presenter Disclosure Faculty: Jonathan Bertram Relationships with commercial interests: Grants/Research Support:
More information11/1/2010. Psychology 472 Pharmacology of Psychoactive Drugs. Listen to the audio lecture while viewing these slides
Treatment for Anxiety Disorders Benzodiazepines and Other Anxiolytics Psychology 472 Pharmacology of Psychoactive Drugs Listen to the audio lecture while viewing these slides Ethanol Barbiturates and related
More informationBenzodiazepines Information for GPs
Drug and Alcohol Services South Australia Benzodiazepines Information for GPs This information is designed to assist doctors in the management of patients ceasing benzodiazepine use, and is to be read
More information6/27/2017. Disclosures. Overview. Case Overview
Disclosures Jessica Gray, MD Nothing to disclose Daniel Alford, MD, MPH Nothing to disclose John Renner, MD Overview The intersection of active illicit opioid use, acute pain and severe mental illness
More informationDRUGS USED IN THE TREATMENT OF ADDICTION JOSEPH A. TRONCALE, MD FASAM RETREAT PREMIERE ADDICTION TREATMENT CENTERS
DRUGS USED IN THE TREATMENT OF ADDICTION JOSEPH A. TRONCALE, MD FASAM RETREAT PREMIERE ADDICTION TREATMENT CENTERS MAJOR CATEGORIES OF TREATMENTS Detoxification and Post-Acute Withdrawal Maintenance Co-Occurring
More informationManaging Pain in the Patient with Opioid Use Disorder: Inpatient Management. Melissa Weimer, DO, MCR Oregon Health & Science University
Managing Pain in the Patient with Opioid Use Disorder: Inpatient Management Melissa Weimer, DO, MCR Oregon Health & Science University 1 Educational Objectives At the conclusion of this activity participants
More informationCurrent Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS)
1 Current Clinical Patterns in the Management of Alcohol Withdrawal Syndrome (AWS) The goal of the survey is to evaluate current practices for the inpatient management of AWS in adult hospitals located
More informationAntidepressant Medication Therapy in Primary Care July 25, 2013
New York State Collaborative Care Initiative Antidepressant Medication Therapy in Primary Care July 25, 2013 http://uwaims.org Presenter Building on 25 years of Research and Practice in Integrated Mental
More informationTreatment of Alcohol and Opiate Withdrawal
Objectives Treatment of Alcohol and Opiate Withdrawal Renee Striker, Pharm.D., BCPS, BCPP Pharmacy Clinical Specialist Huron Hospital East Cleveland, Ohio Outline the diagnostic criteria for substance
More informationANTICONVULSANTS IN ALCOHOL WITHDRAWAL TREATMENT: A BETTER WAY?
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences ANTICONVULSANTS IN ALCOHOL WITHDRAWAL TREATMENT: A BETTER WAY? RICHARD RIES MD PROFESSOR OF PSYCHIATRY AND DIRECTOR
More informationSoma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.07 Subject: Page: 1 of 7 Last Review Date: September 15, 2016 Description (carisoprodol), Compound
More informationOpioid Use Disorder Treatment: Buprenorphine Treatment Basics
Opioid Use Disorder Treatment: Buprenorphine Treatment Basics Daniel Warren, MD Eastern Oregon Coordinated Care Organization Provider Forum on Chronic Noncancer Pain Management Pendleton, OR February 24,
More informationDr Chris Ford Clinical Director IDHDP (International Doctors for Healthy Drug Policies) Thursday 16 th May 2013
Dr Chris Ford Clinical Director IDHDP (International Doctors for Healthy Drug Policies) Thursday 16 th May 2013 The Beginning Benzodiazepines always a problem Most loved Addiction 2004 Jaffe et al Not
More informationAnxiolytic & Hypnotic Drugs. Asst Prof Dr Inam S Arif
Anxiolytic & Hypnotic Drugs Asst Prof Dr Inam S Arif isamalhaj@yahoo.com Anxiolytic & Hpnotic Agents Anxiety: unpleasant state of tension, apprehension or uneasiness, characterised by, tachycardia, sweating,
More informationsome things you should know about opioids before starting a prescription an informational booklet for opioid pain treatment
some things you should know about opioids before starting a prescription an informational booklet for opioid pain treatment This booklet was created to help you learn about opioids. You probably have lots
More informationReducing 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,
More informationSoma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.07 Subject: Soma Page: 1 of 7 Last Review Date: September 15, 2017 Soma Description Soma (carisoprodol),
More informationBuprenorphine 2.0: I have my waiver, now what? Dr. Ritu Bhatnagar, M.D., M.P.H. Dr. John Ewing, M.D., FASAM. Disclosures
Buprenorphine 2.0: I have my waiver, now what? Dr. Ritu Bhatnagar, M.D., M.P.H. Dr. John Ewing, M.D., FASAM Disclosures Dr. Bhatnagar: no disclosures to report Dr. Ewing: no disclosures to report 1 Our
More informationAn algorithm for medication in the treatment of Complex PTSD
An algorithm for medication in the treatment of Complex PTSD Andreas Laddis, M.D. aladdis@gmail.com ESTD Conference Bern November 10, 2017 The purpose for the presentation Algorithm for medication: My
More informationMedications Guide: Public Speaking And Social Anxiety
AnxietyHub.org Dr. Cheryl Mathews Medications Guide: Public Speaking And Social Anxiety Copyright 2016 AnxietyHub Medications Specifically for Public Speaking and Social Anxiety This is not intended to
More informationBenzodiazepines. CRIT program May Alex Walley, MD, MSc Assistant Professor of Medicine Boston University School of Medicine
Benzodiazepines CRIT program May 2010 Alex Walley, MD, MSc Assistant Professor of Medicine Boston University School of Medicine Medical Director, Opioid Treatment Program Boston Public Health Commission
More informationPharmacological Treatment of Anxiety & Depressive Disorders
Pharmacological Treatment of Anxiety & Depressive Disorders Dr Gary Jackson (MB BCh FRCPsych) Consultant Psychiatrist The Priory Hospital Chelmsford Wellesley Hospital Southend-on-Sea Medical Secretary:
More informationTreating Pain and Depression
Treating Pain and Depression Without Getting Depressed Joseph P, Arpaia, MD www.jparpaiamd.com More than 50% of patients with chronic pain also have clinically significant depression. Interestingly that
More informationBOOTS ON THE GROUND CRUCIAL CONVERSATIONS RELATED TO MEDICATION TAPERING
BOOTS ON THE GROUND CRUCIAL CONVERSATIONS RELATED TO MEDICATION TAPERING YOUR SPEAKER Eva Quirion, BSN, MSN, FNP-C, PhD Pain and Recovery Care St. Joseph Internal Medicine 900 Broadway, Building #5 Bangor,
More informationGUIDELINES FOR THE USE OF PSYCHOACTIVE MEDICATIONS IN INDIVIDUALS WITH CO-OCCURRING SUBSTANCE USE DISORDERS
City and County of San Francisco Mayor Gavin Newsom Department of Public Health Community Behavioral Health Services 1380 Howard Street 5 th Floor San Francisco, CA 94103 GUIDELINES FOR THE USE OF PSYCHOACTIVE
More informationDepression & Anxiety in Adolescents
Depression & Anxiety in Adolescents Objectives 1) Review diagnosis of anxiety and depression in adolescents 2) Provide overview of evidence-based treatment options 3) Increase provider comfort level with
More informationTapering off ativan.5
Tapering off ativan.5 Search 10-3-2012 Home Q & A Questions Anxiety - Properly tapering. Anxiety - Properly tapering off Ativan?. I have been on.5 mg ativan for about 3 weeks. Ativan Withdrawal and Detox..
More information7/7/2016 Journal of the American Medical Association,
1 2 Journal of the American Medical Association, 2008 3 The Clinical Trial 152 Adolescents and Young Adults (Age 15 to 21) randomly assigned to either; 1. 2 weeks of Buprenorphine detox 2. 12 weeks of
More informationPSYCHIATRIC MANAGEMENT IN PRIMARY CARE. Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust
PSYCHIATRIC MANAGEMENT IN PRIMARY CARE Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust Areas to cover Mood Disorders Anxiety Disorders Miscellaneous Conditions
More informationAn overview of Medication Assisted Treatment (MAT) and acute pain management on MAT
An overview of Medication Assisted Treatment (MAT) and acute pain management on MAT Goals of Discussion Recognize opioid use disorder (OUD) Discuss the pharmacology of medication assisted treatments (MAT)
More informationAlcohol 2: Case Examples
Alcohol 2: Case Examples Laura G. Kehoe, MD, MPH Medical Director, MGH Substance Use Disorder Bridge Clinic Assistant Professor of Medicine Harvard Medical School Disclosures Neither I nor my spouse/partner
More informationPharmacotherapy of Anxiety Disorders (GAD, Panic, & SAD) Declaration of Interests
Pharmacotherapy of Anxiety Disorders (GAD, Panic, & SAD) University of Texas Health Science Center San Antonio Pharmacotherapy Education and Research Center (PERC) 7703 Floyd Curl Drive - MSC 6220 San
More informationUSUAL DOSE OF XANAX. Usual Dose Of Xanax
USUAL DOSE OF XANAX Usual Dose Of Xanax Withdrawal what symptoms xanax from Compared valium to xanax.5 Valium vs vs xanax ativan Gocce mg 0 xanax 25 quante Melatonin between and xanax interactions Lb xanax
More informationDisclosures. Overview of Workshop. Objectives. Medical Care of Vulnerable and Underserved Populations: Advanced Cases in Anxiety and Depression
Medical Care of Vulnerable and Underserved Populations: Advanced Cases in Anxiety and Depression Disclosures The speakers have no disclosures. Lisa Ochoa-Frongia, MD Christina Mangurian, MD, MAS L. Elizabeth
More informationAnxiety Disorders.
Anxiety Disorders Shamim Nejad, MD Medical Director, Division of Psychosocial Oncology Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Epidemiology Lifetime
More informationStart Low, Go Slow but Treat to Target
Start Low, Go Slow but Treat to Target Pharmacotherapy for Depression, Anxiety and At-Risk Alcohol Use in Late Life September 29, 2014 Audio and Control Panel instruction On the phone? Raise your hand
More informationFriend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines
Friend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines Program Learning Objectives At the conclusion of the activity, participants should be able to: Have a basic understanding
More informationTapering Opioids Best Practices*
Tapering Opioids Best Practices* Chuck Hofmann, MD, MACP 5 th Annual EOCCO Office Staff and Provider Summit September 28, 2017 Disclosure No Conflicts of Interest to report Learning Objectives Understand
More informationTHEXANAX THREAT 1 THE XANAX THREAT. iaddiction.com
THEXANAX THREAT 1 THE XANAX THREAT 3 6 9 11 SOCIETAL IMPACT OF XANAX RECREATIONAL VALUE OF XANAX THE PHYSICAL, MENTAL, AND EMOTIONAL EFFECTS OF XANAX ADDICTION AND DEPENDENCE Societal Impact of Xanax Since
More informationVA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress. Core Module
VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress Core Module Module A Acute Stress Continue Treatment for ASD Treatment for ACUTE Stress Disorder Module B PTSD Continue Treatment
More informationWithdrawal.
Withdrawal Shamim Nejad, MD Director, Adult Burns & Trauma Psychiatry Division of Psychiatry and Medicine Medical Director, Addiction Consultation Team MGH Center for Addiction Medicine Massachusetts General
More informationManaging presenting alcohol users an Introduction to SPECTRUM (CRI) By Dr Gideon Felton MRCPsych Consultant Psychiatrist and Clinical Lead
Managing presenting alcohol users an Introduction to SPECTRUM (CRI) By Dr Gideon Felton MRCPsych Consultant Psychiatrist and Clinical Lead PLAN OF PRESENTATION Assessment of alcohol dependence Psychiatric
More informationPsychiatric Medication Guide
Psychiatric Medication Guide F O R : N E O N P R I M A R Y H E A L T H C A R E P R O V I D E R S B Y : M I C H E L L E R O M E R O, D O M A Y, 2 0 1 3 Anti-depressants TCA s & MAOI s (Tricyclic Antidepressants
More informationCo-Occurring Mental Health and Substance Use Disorders. DATE: 4/17/18 PRESENTED BY: John Mahan, MD
Co-Occurring Mental Health and Substance Use Disorders DATE: 4/17/18 PRESENTED BY: John Mahan, MD Disclosure Information Speaker: John Mahan, MD has nothing to disclose Planning Committee: The members
More informationTranquilizers & Sedative-Hypnotics
Tranquilizers & Sedative-Hypnotics 1 Tranquilizer or anxiolytic: Drugs used therapeutically to treat agitation or anxiety Sedative-Hypnotic: drugs used to sedate and aid in sleep Original sedatives (before
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2009 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationClient Session:3004, John, Aug 03, 2017, jh. CARS Diagnostic Report Prepared for: jh TABLE OF CONTENTS
Client Session:3004, John, Aug 03, 2017, jh CARS Diagnostic Report Prepared for: jh TABLE OF CONTENTS CARS Diagnostic Case Summary Detailed Diagnostic Reports Alcohol Abuse Alcohol Dependence GAD Risk
More informationMedications for Borderline Personality Disorder
Medications for Borderline Personality Disorder Sarah Roff MD, PhD Attending Psychiatrist, DBT Unit, Oregon State Hospital Assistant Professor, Public Psychiatry, OHSU sarah.roff@dhsoha.state.or.us Skills
More informationSubstance Misuse and Abuse
CHAPTER 18 Substance Misuse and Abuse Lesson Objectives 1. Explain actions that can be taken to help prevent youth from abusing drugs and other substances. 2. Describe specific steps for preventing someone
More informationTreatment 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
More informationTreatment of Substance Use Disorders in the Real World. Jessica M. Peirce, Ph.D. Johns Hopkins University School of Medicine
Treatment of Substance Use Disorders in the Real World Jessica M. Peirce, Ph.D. Johns Hopkins University School of Medicine Objectives identify the core components of the most common substance use disorder
More informationAN OVERVIEW OF ANXIETY
AN OVERVIEW OF ANXIETY Fear and anxiety are a normal part of life. Normal anxiety keeps us alert. Intervention is required when fear and anxiety becomes overwhelming intruding on a persons quality of life.
More informationSafe Alprazolam Prescribing and Benzodiazepine Monitoring Program
Clinical Track Safe Alprazolam Prescribing and Benzodiazepine Monitoring Program Brian S. Taylor, MD, Medical Director, Adult Services and ADP, Ventura County (California) Behavioral Health Celia Woods,
More informationPOLYSUBSTANCE USE IN THE TREATMENT OF OPIOID USE DISORDER WITH BUPRENORPHINE
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences POLYSUBSTANCE USE IN THE TREATMENT OF OPIOID USE DISORDER WITH BUPRENORPHINE MARK DUNCAN, MD November 8, 2018 SPEAKER
More informationManagement of high risk MMT patients. Meldon Kahan MD Methadone Prescribers Conference Toronto, Nov 15, 2013
Management of high risk MMT patients Meldon Kahan MD Methadone Prescribers Conference Toronto, Nov 15, 2013 CFPC CoI Templates: Slide 1 Faculty Disclosure Faculty: Meldon Kahan Relationships with commercial
More informationAnxiety: Cure For Anxiety, Fear, Panic & Techniques For Stress By Zac Dixon READ ONLINE
Anxiety: Cure For Anxiety, Fear, Panic & Techniques For Stress By Zac Dixon READ ONLINE Learn more about anxiety disorders, including types, causes, symptoms, diagnosis, treatment, and prevention. Panic,
More informationMental Health Nursing: Anxiety Disorders. By Mary B. Knutson, RN, MS, FCP
Mental Health Nursing: Anxiety Disorders By Mary B. Knutson, RN, MS, FCP A Definition of Anxiety Diffuse apprehension that is vague in nature and associated with feelings of uncertainty and helplessness
More informationFROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD OF ANXIETY
13 th Pearl Leibovitch Clinical Day November 18th, 2014 Mounir H. Samy, MD, FRCP(C) Associate Professor of Psychiatry McGill University (ret.) FROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD
More information