College of Psychiatric and Neurologic Pharmacists

# 0284-0000-10-020-H04-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Develop a Medication Use Evaluation (MUE) process from identification of drug to development and implementation of protocols or guidelines.
2. Design a plan to start a new service or evaluate a current service using the performance improvement cycle
3. Design a program to monitor medication misadventures and develop strategies to prevent their occurrence
4. Apply The Joint Commission standards related to pharmacy practice in psychiatric settings (e.g., Medication Management, National Patient Safety Goals).
5. Apply the State Operations Manual F-tags to the pharmacological management of psychiatric disorders in long-term care facilities.
6. Explain the basic ethical principles of the Belmont Report and its relationship to human subject research and clinical practice.
7. Describe the role of the Institutional Review Board (IRB) and the U.S. Department of Health and Human Services; Office for Human Research Protections (OHRP) in research that impacts patients with psychiatric illness.
8. Describe the role of Centers for Medicare and Medicaid Services in the reimbursement process for healthcare, including pharmacy.

Pharmacy Director
Texas Department of State Health Services,
Hospital Section
San Antonio, TX

# 0284-0000-10-020-H04-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Describe the differences between internal and external validity.
2. Explain the different types of study design.
3. Judge the strengths and weaknesses of each type of study design.
4. Assess the appropriateness of the study design for research questions and hypotheses.
5. Distinguish between cross-over and parallel designs.
6. Distinguish between different types of bias.
7. Interpret key epidemiologic concepts: incidence, prevalence, relative risk, odds ratio, relative and absolute risk reduction, and number needed to treat.
8. Differentiate between descriptive and inferential statistics.
9. Describe the different types of data and number of groups being used
10. Describe components of sample size calculations. 
11. Explain the different types of error and how to reduce them.
12. Assess which statistical tests can be used for the different types of data, groups being used, and relationship between groups.
13. Distinguish between the different ways to report and interpret statistical significance of a study using p-values and confidence intervals.
14. Describe and interpret different types of survival analyses.
15. Distinguish between noninferiority and traditional hypothesis testing trials.
16. Compare the differences between clinical and statistical significance.

Administrative Director of Pharmacy Services
University of Utah Hospitals and Clinics
Salt Lake City, UT

# 0284-0000-10-020-H04-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Distinguish between efficacy and effectiveness studies.
2. Distinguish the different types of pharmacoeconomic studies.
3. Distinguish the different outcomes that could be evaluated in a study.
4. Describe the features of decision analysis and sensitivity analysis.
5. Outline key features of meta-analysis and how the data are analyzed.
6. Interpret common statistical analyses included in a meta-analysis such as effect size, funnel plot and tests for heterogenity.
7. Assess examples from the recent literature.

Professor
The University of Texas College of Pharmacy
Austin, TX

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Demonstrate knowledge of the DSM-IV-TR criteria and classification of bipolar disorder.
2. Describe the efficacy of mood stabilizers, benzodiazepines, and antipsychotics in the acute and long-term management of bipolar disorder.
3. Design an appropriate drug therapy regimen (drug, dose and schedule) for stabilizing symptoms and preventing relapse given the clinical presentation of a specific patient with bipolar disorder (manic, mixed manic, hypomanic, depressed, rapid cycling),  
4. Identify drug interactions and prevent adverse outcomes given a medication regimen designed to treat bipolar disorder
5. Develop a plan of laboratory and clinical monitoring parameters to ensure the safety of lithium, valproate, carbamazepine, oxcarbazepine, lamotrigine, topiramate, and atypical antipsychotics in the management of bipolar disorder.
6. Discuss the use of mood stabilizers in special populations with prescribers and patients (i.e., pregnancy/lactation).
7. Evaluate whether patient counseling information is optimal as it applies to patients taking mood stabilizers, benzodiazepines and antipsychotics for the management of bipolar disorder. (DII)

Psychiatric Clinical Pharmacy Specialist
VA San Diego Healthcare System
San Diego, CA

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Identify the signs and symptoms of major depression, adjustment disorder with depressed mood, seasonal affective disorder, and substance-induced mood disorder using DSM-IV-TR criteria.
2. Identify and compare the differences among commonly used rating scales to assess symptoms of depression. (DII)
3. Differentiate the mechanisms of action, side effects and drug interactions between tricyclic antidepressants, selective serotonin reuptake inhibitors, nefazodone, trazodone, serotonin/norepinephrine reuptake inhibitors, mirtazapine, bupropion, phenelzine, tranylcypromine, selegiline, and St. John’s Wort .
4. Design a plan to initiate and monitor antidepressant therapy and nonpharmacologic therapy in a patient with major depressive disorder.
5. Recommend the appropriate length of therapy necessary to adequately treat initial and recurrent depressive episodes (i.e., acute, continuation, and maintenance therapy).
6. Develop a plan to manage patients with treatment resistant depression with therapies including combination antidepressants, ECT, VNS, and augmentation with lithium or T3.
7. Outline strategies for management of depression given a specific patient population (e.g., pregnancy/lactation).
8. Discuss important counseling points as it applies to the disease state of major depression and the medications that are used to treat symptoms.

Clinical Manager
Fulton State Hospital
Fulton, MO

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Describe the environmental, medical, psychiatric, and drug-induced causes or disorders associated with aggression and agitation.
2. Discuss the evidence-based pharmacologic treatment of aggression and agitation.
3. Identify strategies for prevention and management of aggression and agitation.
4. Develop medication education on agitation, aggression, and delirium for patients, families, and caregivers. (DII)
5. Describe the assessment and pharmacologic management of delirium.
6. Discuss the role of nonpharmacologic interventions in managing delirium.
7. Describe methods to prevent the development of delirium.

Clinical Pharmacy Specialist, Psychiatry
Louis Stokes Cleveland VAMC
Brecksville, OH

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Develop a plan for the evaluation and treatment of a patient with a seizure disorder.
2. Identify the optimal drug treatments for the motor and nonmotor complications of Parkinson’s disease.
3. Determine the appropriate options for abortive and prophylactic therapies in an individual with a primary headache disorder.
4. Describe the genetic correlates and the neuropsychiatric manifestations of Huntington’s disease.
5. Analyze the advantages and disadvantages of treatment options for patients with neuropathic pain.
6. Describe the clinical manifestations and treatment options for traumatic brain injury.
7. Given a case description, identify the signs and symptoms of fibromyalgia and select an appropriate drug therapy for its treatment.
8. Identify the signs and symptoms of fibromyalgia and select an appropriate drug therapy for its treatment given a case description.

Assistant Professor
University of Maryland School of Pharmacy
Baltimore, MD

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Evaluate whether the patient meets DSM-IV-TR criteria for an anxiety disorder [generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD)] given a case example.
2. Interpret common rating scales in the evaluation and management of anxiety disorders.
3. Distinguish differences in pharmacology, kinetics, efficacy, dosing, adverse effects, and drug interactions of benzodiazepines in the management of anxiety disorders.
4. Compare the efficacy, dosing, and adverse effects of the serotonergic antidepressants, and the role of antipsychotics in the management of anxiety disorders.
5. Evaluate whether patient and professional education is optimal to facilitate safe and effective drug therapy for anxiety disorders. (DII)
6. Using practice guidelines, develop a pharmacotherapy plan, including dosing and duration of therapy, and nonpharmacologic treatments, for a patient with anxiety disorders.
7. Discuss the role of pharmacotherapy in the management of anxiety disorders in special populations (e.g., children, elderly patients and pregnancy).
8. Resolve potential drug-related problems in patients with anxiety disorders.

Director of ACP Addiction Outreach
Associate Professor of Pharmacy Practice
Appalachian College of Pharmacy
Oakwood, VA

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Evaluate patient cases involving the use of DSM-IV-TR criteria to distinguish between the personality disorders.
2. Develop a plan to treat the target symptoms of the various personality disorders that are most likely to respond to pharmacotherapy and psychotherapy.
3. Evaluate whether patient counseling information is optimal as it applies to patients prescribed psychotropics for personality disorders.
4. Evaluate case examples of eating disorders, distinguishing between the presentations of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).
5. Detect the physical effects of starvation, bingeing and purging in patients with eating disorders.
6. Determine the most appropriate rating scales that should be used to measure the symptoms and improvement in patients with eating disorders.
7. Design a pharmacotherapeutic plan using pharmacologic and nonpharmacologic therapies for all types of eating disorders.

Assistant Professor
Southern Illinois University Edwardsville
School of Pharmacy
Edwardsville, IL

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Differentiate the etiology and clinical presentation of Alzheimer’s disease (AD), vascular dementia, and other dementias.
2. Analyze the differences among commonly used rating scales to assess the psychiatric, cognitive, and functional status of patients with dementia.
3. Compare and contrast the pharmacological treatments for AD and behavioral disturbances associated with dementia with regard to their pharmacology, efficacy, and safety.
4. Develop a treatment plan, including pharmacologic and nonpharmacologic therapies for patients with behavioral disturbances in long-term care facilities.
5. Design an appropriate pharmacotherapeutic regimen accounting for age-related alterations in sensitivity to medications given a case example of an elderly individual with depression, psychosis, or an anxiety disorder,
6. Apply the Center for Medicare and Medicaid Services State Operations Manual standards to the management of the patients in long-term care facilities who are receiving psychotropic drug therapy.

Clinical Pharmacy Specialist in Psychiatry
Chillicothe Department of
Veterans Affairs Medical Center
Chillicothe, OH

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Evaluate whether a child’s clinical presentation meets diagnostic criteria for:
   1. Attention-deficit/ hyperactivity disorder
   2. Tourette’s disorder/ tic disorders
   3. Conduct disorder / oppositional-defiant disorder
   4. Separation anxiety disorder.
2. Given a case example of a child with any of the above conditions, discriminate among drug treatments to select the most effective and safe option with an appropriate dose and schedule.
3. Develop an optimal plan to monitor for adverse effects of psychostimulants, antipsychotics, antidepressants, mood stabilizers, and anxiolytics in children and adolescents.
4. Resolve psychotropic drug therapy problems in children and adolescents by modifying the pharmacotherapeutic treatment plan and providing appropriate patient and family counseling.
5. Distinguish between the behavioral phenotypes and the major medical complications of the following syndromes:
   1. Autistic Disorder
   2. Asperger's Disorder
   3. Down Syndrome
   4. Prader-Willi Syndrome
   5. Fragile X Syndrome
   6. Klinefelter’s Syndrome
   7. Rett’s Disorder.
6. Discuss risk factors, pathogenesis, clinical course, and appropriate drug treatment options of the above syndromes.
7. Identify special considerations for treating the following problems in an individual with mental retardation and/or developmental disorder:
   1. Self-injurious behavior
   2. Mood disorders
   3. Anxiety disorders
   4. Psychotic disorders.
8. Describe the limitations of the published literature on psychiatric drug treatment in people with developmental disorders.

Clinical Assistant Professor
Rutgers State University of New Jersey
Piscataway, NJ

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Evaluate within a case example whether the patient meets DSM-IV-TR criteria for schizophrenia, schizoaffective disorder, schizophreniform, brief reactive psychosis, or substance-induced psychotic disorder.
2. Analyze the appropriateness and results of commonly used rating scales for the evaluation and management of schizophrenia.
3. Differentiate among all antipsychotics with regards to efficacy, adverse reactions, dosing, and monitoring.
4. Design a monitoring plan for patients on antipsychotic medications for movement disorders using appropriate rating scales.
5. Compare and contrast the various treatment guidelines for the management of schizophrenia.
6. Assess the use of antipsychotics in special populations (e.g., treatment refractory, pregnancy/lactation).
7. Solve drug therapy problems in patients with schizophrenia and/or movement disorders through the provision of appropriate patient education.

Assistant Professor, Division of Schizophrenia and Related Disorders, Department of Psychiatry
The University of Texas Health Science
Center at San Antonio
San Antonio, TX

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Outline a comprehensive clinical assessment of patient sleep complaints.
2. Design an individualized treatment plan for patients of different ages and psychiatric diagnoses with sleep complaints.
3. Assess an individual’s clinical presentation and the appropriateness of drug therapy to treat periodic limb movements during sleep (PLMS), restless legs syndrome, obstructive sleep apnea, or narcolepsy.
4. Given an individual patient’s type of insomnia, justify the decision to prescribe one hypnotic over another for the management of chronic insomnia.
5. Given an individual patient’s sleep disorder diagnoses and drug therapy regimen, judge the safety of that regimen after screening for drug interactions, appropriate dose and timing of medication administration, and duration of treatment.
6. Identify the use of accurate information and optimal language for counseling a patient on the safe and effective use of hypnotic medication to manage sleep complaints.

Associate Professor of Clinical Pharmacy,
Psychiatry and the Behavioral Sciences
University of Southern California
School of Pharmacy and Medicine
Los Angeles, CA

# 0284-0000-10-021-H01-P (Knowledge)

Learning Objectives
At the end of this program, the participant should be able to:

1. Identify signs and symptoms of acute intoxication, acute withdrawal, and chronic dependency associated with the use of the following drugs of abuse:
   1. Alcohol
   2. Opiates (pain medications, heroin)
   3. Nicotine
   4. Cocaine
   5. Stimulants (Methamphetamines)
   6. Inhalants
   7. Marijuana
2. Describe the pharmacologic properties and pharmacokinetic parameters for drug therapies used in the treatment of substance use disorders.
3. Select appropriate pharmacotherapy (agent, dose, duration of therapy) for substance use disorders based on current practice guidelines.
4. Develop a monitoring plan that includes assessment of efficacy, and evaluation for adverse effects, drug interactions, and toxicity given a patient undergoing treatment for a substance use disorder,
5. Compose a management strategy given a specific drug-related problem in a patient with a substance use disorder.
6. Develop a plan to provide appropriate patient education for substance use disorders

Associate Professor
University of Toledo
Cleveland, OH

Clinical Pharmacist
VA Salt Lake City, HCS
Salt Lake City, UT