1 Use of Psychotropic Medications in Older Adults with Dementia! Deepa Pattani, PharmD, RPh Owner: PrevInteract Health
2 About Me Deepa Pattani, PharmD, RPh with over 13 years of experience as a Pharmacist Practiced in various aspects of pharmaceutical care Licensed to practice in 4 states throughout the country Contact info:
3 Introduction: Dementia Dementia: decline in mental ability severe enough to interfere with daily activities. 2015: million individuals affected worldwide. Alzheimer s dementia accounts for 60-80% of all dementia cases. Vascular dementia: occurs after stroke: 2 nd most common type of dementia. 15 million people provide unpaid care for people with dementia: 18.2 billion hours: $230 billion. Incorrectly labeled senile dementia and not a part of the normal aging process cost to nation: $257 billion
4 Agenda After completion of this activity, the target audience should be able to: Describe different types of dementia and methods of identification. Describe at least 2 classes of psychotropic medications used in the treatment of dementia. Recognize side effects of psychotropic medications vs. symptoms of disease progression. Clinically determine how to screen a patient that may need medications or behavior modifications.
5 Types of Dementia Alzheimer s disease: difficulty remembering. Vascular dementia: impaired ability to make decisions. Dementia with Lewy bodies (DLB): early symptoms: sleep disturbance, visual hallucinations. Mixed dementia: multiple dementia symptoms seen. Parkinson s disease: gait disturbances.
6 Types of Dementia (contd) Frontotemporal dementia: behavior problems & difficulty with language. Creutzfeldt- Jacob disease: rapidly fatal: memory loss, coordination & behavior changes. Huntington s disease: involuntary movements, severe decline in reasoning, depression, mood changes. Normal pressure hydrocephalus: memory loss, loss of bladder control. Wernicke-Korsakoff syndrome: memory loss due to severe thiamine deficiency: alcohol misuse.
7 Treatment No treatment for dementia currently. Medications and non-drug therapy used in combination. Dietary supplements.
13 Anxiolytics: Benzodiazepines Side-effects: FALL risk greatly increased. CONFUSION, CONFUSION, CONFUSION!!! Paradoxical reactions More likely to have withdrawal symptoms (and to have these symptoms misrecognized) Dementia: very hard to differentiate if effects are from BZDs or dementia. (Risk of mis-diagnosis) Depression Misuse
15 Psychotropics: Sedative/Hypnotics Benzodiazepines Non-benzodiazepine hypnotics: Falls, confusion, misuse Zolpidem Zaleplon Eszopiclone Melatonin receptor agonist: Ramelteon: well-tolerated Miscellaneous: Trazodone, mirtazapine, and chloral hydrate (effects similar to alcohol)
16 Psychotropics: Stimulants Used for apathy, amotivation, depression Worsen anxiety Buproprion: Anticholinergic properties Methylphenidate: tachycardia, hypertension, confusion, hallucinations
17 Psychotropics: Mood Stabilizers May be useful for impulsivity and irritability Divalproex, valproic acid, valproate: dizziness, falls, elevated liver enzymes, elevated ammonia, weight gain, hair loss. Carbamazepine: blood dyscrasias, elevated liver enzymes, interactions with other medications
19 Neuroleptics Appropriate Indication Acute psychotic episode, atypical psychosis, brief reactive psychosis Delusional disorders Schizophrenia, schizo-affective disorder Huntington s disease Mood disorder w/ psychotic features Tourette s syndrome Dementia & delirium with agitated behaviors Short term (< 7 days): hiccups, pruritic, nausea & vomiting Inappropriate Use Agitated behaviors that is not a threat to patient or others Depression without psychosis Anxiety, nervousness Fidgeting, restlessness, wandering Impaired memory Indifference to surrounding, poor self care/hygiene Unco-operativeness, unsociability Insomnia
20 Neuroleptics: cont d Weight gain All Ages Diabetes/ metabolic syndrome Akathesia Sedation Dystonic reactions Older Adults Sudden death (Black Box Warning) EPS, Parkinsonism Cardiac dysrhythmias Anticholinergic effects Hyponatremia Seizures
21 Neuroleptics: Black Box Warning Increased risk of death when used in elderly patients treated for dementia-related psychosis
22 Psychotropics: Cognitive Enhancers Acetylcholinesterase inhibitors Donepezil, galantamine, rivastigmine Side effects: GI, vivid dreams (donepezil) Peripheral cholinergic side effects (cardiac) NMDA antagonist: Memantine GI side-effects, paradoxical agitation
23 Cognitive Enhancers (cont d) FDA approval Alzheimer s disease/dementia Beneficial in vascular dementia, dementia related to Parkinson s disease, and perhaps in some FTD Beneficial in neuropsychiatric symptoms of dementia!
24 Neuroleptics Common side effects: EPS (akathisia, dystonia, pseudoparkinsonism, dyskinesia), sedation, and orthostatic hypotension Long term use of drugs such as Haldol, Risperdal, Zyprexa increase risk of falls by 81%. Recommended to use the smallest possible dose for the shortest duration of action.
25 Drug Selection Appropriate and documented diagnosis associated with medication being prescribed. Document trials of behavioral management. Document assessment of medication s side effects. Document benefit of medication. Documentation of dose reduction trial. Explanation for continued medication.
26 Clinical Decision Making: Side-effect vs. Symptom Management What is the issue/behavior? What might be causing it or contributing to it? Is there a way to quantify or measure the degree of symptomatology (e.g., a screening instrument)? Is it an issue that can be completely or partially addressed without medication?
27 Clinical Decision Making: Side-effect vs. Symptom Management Non-drug symptom management Monitor personal comfort. Avoid being confrontational. Redirect the person's attention (use of art/ music). Create a calm environment. Allow adequate rest Provide a security object. Acknowledge requests, and respond to them. Look for reasons behind each behavior.. Explore various solutions. Don't take the behavior personally.
28 Clinical Decision Making: Sideeffect vs. Symptom Management Supplements used for dementia patients: Ginger Gingko biloba Omega 3 fatty acids Vitamin C Curcumin
29 Clinical Decision Making: Side-effect vs. Symptom Management So, a medication is needed Is there a current medication that can be adjusted to address the behavior? What are the individual s comorbidities and do they prevent the use of any medications? What are the most benign medications that can be used? Are there any side effect profiles that can be useful?
30 Clinical Decision Making: Side-effect vs. Symptom Management Once a medication has been selected: Monitor and document response of symptoms. Monitor and document screening for side effects (e.g., sodium, falls, AIMS). Periodically conduct trials of a decreased dose. Try tapering off the medication to determine if it s still needed.
Psychotropic Medication Use in Dementia Marie A DeWitt, MD Diplomate of the American Board of Psychiatry and Neurology, Specialization in Psychiatry & Subspecialization in Geriatric Psychiatry Staff Physician,
Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for
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
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists
Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral
Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA Goals of Medications Use least number at lowest dose to get
SPEAKER NOTES Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials Summarized by Thomas T. Thomas New psychotropic medications are coming on the
Appendix: Psychotropic Medication Reference Tables How to Use these Tables These reference tables are designed to provide clinic staff with specific medication related criteria for the Polypharmacy, Cardiometabolic
MEDICATION USE IN ASSISTED LIVING FACILITIES FOR MENTAL HEALTH ISSUES Holly Altenberger, PharmD, RPh Director of Pharmacy O Connell Pharmacy firstname.lastname@example.org Objectives At the conclusion of the
Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Pretest 1. Which of the following conditions is LEAST likely to benefit from emergency
Reducing the Use of Antipsychotics in Long Term Care Communities Alan W. Obringer RPh, CPh, CGP Executive Director Senior Care Pharmacy Objectives Recognize the clinical evidence for the need to change
NorthSTAR Pharmacy Manual Revised October, 2008 Table of I. Introduction II. III. IV. Antidepressants New Generation Antipsychotic Medications Mood Stabilizers V. ADHD Medications VI. Anxiolytics and Sedative-Hypnotics
Drugs, Sleep & Wakefulness Brian Koo Reena Mehra MD MS Kingman Strohl MD Things To Keep In Mind Many drugs effect sleep either causing insomnia or sedation Disruption of sleep and wakefulness may not be
A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.
Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic
Annex to Section J Page 1 Study Guidelines for Quiz #1 Theory and Principles of Psychopharmacology, Classifications and Neurotransmitters, Anxiolytics/Antianxiety/Minor Tranquilizers, Stimulants, Nursing
Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Pretest 1. Appropriate target symptoms for emergency room medication treatment
DEMENTIA AND MEDICATION Dr. Siobhan Ni Bhriain, MRCP, MRCPsych. Clinical Director, Tallaght and SJH MHS, Consultant Old Age Psychiatrist, Chair, DSIDC Steering Committee. SUMMARY OF TODAY S TALK Dementia-definition,
MO Medicaid Foster Care Drugs FY10-FY14 Medicaid (MO HealthNet) Cost of Drugs given to Missouri Foster Care Children by combinations of Age, Gender, Drug Class and Fiscal Year [Raw Data Provided by Missouri
DRUGS AND PHARMACOLOGY Effect of Age on the Profile of Psychotropic Users: Results from the 2010 National Ambulatory Medical Care Survey Donovan T. Maust, MD,* David W. Oslin, MD, and Steven C. Marcus,
Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines
PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally
Psychiatric Illness In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis 12,000,000 children infants through 18 y/o nation wide 5,000,000 suffer severely Serious
Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17
Cognitive enhancers PINCH ME Anticholinergic burden BPSD Agitation, Aggression and antipsychotics 2 types Cholinesterase inhibitors licensed for mild to moderate AD Donepezil Galantamine Rivastigmine also
Drugs and Dementia in the Hospice Patient Jim Joyner, Pharm.D., C.G.P. Director of Clinical Operations Outcome Resources 1 Drug Therapy: Targeted at Symptoms Cognitive: Impaired abstract thinking Impaired
Management of Behavioral Problems in Dementia Ghulam M. Surti, MD Clinical Assistant Professor Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Definition of
Child & Adolescent Behavioral Medicine & Medication Therapies Brian J Cowles, PharmD Associate Professor of Pharmacy Practice Albany College of Pharmacy & Health Sciences; Vermont Campus Behavioral Medicine
Retrospective Drug Use Review for the Use of Psychotropic Medications in Children Recommendations Send providers an annual request for additional clinical data for children receiving any of the following
Nsg 85A / Psychiatric Page 1 of 7 Psychobiology Handout STRUCTURE AND FUNCTION OF THE BRAIN Psychiatric illness and the treatment of psychiatric illness alter brain functioning. Some examples of this are
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University 500 Summer Street NE, E35, Salem, Oregon 97301 1079 Phone 503 947 5220 Fax 503
Joint for Psychotropic Medication. This document has been produced in collaboration with the Lancashire Commissioning Support Unit Page 1 Table of Contents Section Page Number Page 2 Definition of categories
Joint for Psychotropic Medication. This document has been produced in collaboration with the Lancashire Commissioning Support Unit Date: December 2014. Reviewed August 2016. Next review Date April 2019
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
DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that
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
IMPORTANT NOTICE Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members These changes apply only to members covered under the DC Healthcare Alliance program Alliance
Mood 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
2015 Update on Psychotropics Jeffrey T. Apter, M.D. August 2015 Princeton Medical Institute 256 Bunn Drive, Suite 6, Princeton NJ (609) 921-6050 Learning Objectives Upon completion of this session, participants
*We are not accepting any New Patients who are currently taking any controlled pain medications *We are *Note: not completion accepting of the any following New Patients paperwork who and Initial are Screening
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:
Tables Interventions where new studies have been published are indicated in bold italics. Changes in conclusions are indicated in italics and are highlighted in yellow. Any interventions, where RCTs in
Insomnia: Updates in Medical Management Michael Newnam M.D. Sleep Neurobiology Delicate balance of excitatory and inhibitory neurotransmitters that control the switch between wakefulness and sleep Circadian
Chapter 161 Antipsychotics Episode Overview Extrapyramidal syndromes are a common complication of antipsychotic medications. First line treatment is benztropine or diphenhydramine. Lorazepam is used in
Depression in Late Life Robert Madan MD FRCPC Geriatric Psychiatrist Key Learnings Robert Madan MD FRCPC Key Learnings By the end of the session, participants will be able to List the symptoms of depression
Speaker Introduction Katee Kindler, PharmD, BCACP Current Practice: Clinical Pharmacy Specialist Ambulatory Care, St. Vincent Indianapolis Assistant Professor of Pharmacy Practice, Manchester University,
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
Polypharmacy, Adverse Effects, and the Importance of Tapering Medications for People with Intellectual and Developmental Disabilities Garrett McCann, RPh How did we get here? 1876 Methylene Blue Insecticide
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.
BEHAVIORAL PROBLEMS IN DEMENTIA CLINICAL FEATURES Particularly as dementia progresses, psychiatric symptoms may develop that resemble discrete mental disorders such as depression or mania The course and
Medicine Related Falls Risk Assessment Tool (MRFRAT) The Medicine Related Falls Risk Assessment tool (MRFRAT) in Appendix 1 is designed to help identify patients at risk of falls due to their current medicine
Psychiatric Medications Positive and negative effects in the classroom Teaching the Medicated Child Beverly Bryant, M.D. Hattiesburg Clinic 9/17/14 Introduction According to the National Survey of Children
1 BEHAVIORAL and PSYCHOLOGICAL SYMPTOMS in DEMENTIA (BPSD) Dr. Shah MD, MPH Braodlawns Medical Center DISCLOSURE 2 Dr. Shah has no relevant conflicts with commercial interests to disclose. OBJECTIVES 3
Anti-Depressant Medications A Introduction: This topic may be a little bit underestimated here in Jordan, while in western countries it has more significance. The function of anti-depressants is to change
ARABIIC Professor David Castle Ms. Nga Tran St. Vincent s Mental Health Level 2, 46 Nicholson Street, Fitzroy Vic 3065 (03) 9288 4147 (03) 9288 4751 Psychiatric Medication Information / Arabic 1 Psychiatric
Dealing with a Mental Health Crisis Information and Resources for First Responders P... PROFESSIONAL WHAT NAMI DOES NAMI Minnesota is a statewide 501(c)(3) grassroots nonprofit organization dedicated to
ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good? STEPHANIE M. OZALAS, PHARMD, BCPS, BCGP VA MARYLAND HEALTH CARE SYSTEM BALTIMORE, MD DISCLOSURES Off-label use of medications will be
Handout for the Neuroscience Education Institute (NEI) online activity: Mentoring Session: Participant Cases The Case: 55-year-old patient with depression and anxiety The Question: What to do when antidepressants
Updates in Geriatric Psychiatry Feyza Marouf M.D. Assistant Psychiatrist, MGH Program Director, Partners Healthcare Geriatric Psychiatry Fellowship Disclosures I have no significant financial relationships
Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist HMS Training Webinar January 27, 2017 1 Describe nationwide prevalence and types of elderly dementia + define BPSD Define psychotropic
Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018 Mary Ellen Quiceno, MD, FAAN Associate Professor of Neurology UNTHSC Center for Geriatrics 855 Montgomery Street, PCC 4, Ft.
Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, MD Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, M.D. Health Sciences
The Road to Rehabilitation Part 6 Mapping the Way: Drug Therapy & Brain Injury Writ ten by Gregory O Shanick, MD Brain Injury Association of America Brain Injury Association of America Creating a better
DIAGNOSTIC PUZZLES MENTAL ILLNESS MEDICAL COMORBIDITES SUBSTANCE ABUSE SPECIAL POPULATIONS IMPROVING COMPLIANCE CASE STUDIES LEARNING OBJECTIVES Learner will be able to identify substance abuse and state
A Basic Approach to Mood and Anxiety Disorders in the Elderly November 1 2013 Sarah Colman MD FRCPC Clinical Fellow, Geriatric Psychiatry Mount Sinai Hospital, University of Toronto Disclosure No conflict
HEDIS BEHAVIORAL HEALTH RESOURCE GUIDE What is HEDIS? 3 HEDIS Reference Guide for Behavioral Health 4 Behavioral Health HEDIS Measures 13 WHAT IS HEDIS? HEDIS (Healthcare Effectiveness Data and Information
USING ANTIPSYCHOTICS TO TREAT THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)- WHAT IS THE EVIDENCE? Mugdha Thakur, MD Associate Professor of Psychiatry and Behavioral Sciences Duke University
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
Depression in Older Adults Paul Boulware, MD Arizona Neurological Institute April 22, 2012 What is it? Major depressive disorder is a syndrome, a collection of symptoms Presentation is variable among individuals
You have successfully downloaded the list from sharedlist.org You can find here first 1000 rows for free. We do this to prevent fraud and overload of our servers. If your list is more than 1000 rows and
4 Embarcadero Center, Suite 1400, San Francisco, CA 94111 (415) 926-7774 phone; (415) 591-7760 email@example.com New Patient Questionnaire Thank you for trusting San Francisco Psychiatry with
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.
Anxiolytic & Hypnotic Drugs Asst Prof Dr Inam S Arif firstname.lastname@example.org Anxiolytic & Hpnotic Agents Anxiety: unpleasant state of tension, apprehension or uneasiness, characterised by, tachycardia, sweating,