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Activity Date: 04/25/2017

Target Audience

This course is designed for pharmacists, nurse practitioners or other healthcare professionals involved in the comprehensive medication management of psychiatric and/or neurological patients.

Session Summary

The following pearls were selected by the CPNP Program Committee after evaluating a number of member and non-member submissions.

3:15-3:17 PM: Session and Speaker Introduction
Rosana Oliveira, PharmD, BCPS, BCPP

3:17-3:31 PM: Association between Pisa Syndrome (Pleurothonus), Psychoactive Medications, and Cholinesterase Inhibitors
Abimbola Farinde, PharmD

With the rise in the prescribing of antipsychotic medications there has also been an increase in the number of individuals whose quality of life have improved; however, there have been adverse reactions related to this increase. One of the identifiable outcomes of increased neuroleptic use is the development of PISA syndrome or (Pleurothotonus). PISA syndrome is a rare type of truncal dystonia that was first described by Ekbom and colleagues in Germany in 1972 as a side effect of neuroleptic treatment in 3 elderly women taking halperoidol. Ekbom and colleagues initially attributed the syndrome to long-term neuroleptic use but other reports came out to suggest that the syndrome was present with other medication classes. The goal of this presentation is to discuss the clinical features of PISA syndrome, evaluate a patient case, and discuss strategies for management.

3:31-3:45 PM: Medication Selection in Correctional Populations
Brittany Finocchio, PharmD, BCPP

Substance use disorders are common in mental health and correctional populations. Literature suggests that medications with sedative, stimulating, anticholinergic, and/or cognitive blunting properties may be abused within correctional settings. Non-psychotropic medications that come in glass bottles may be turned into weapons for jail or prison fights. Additionally, ointments that come in large tubs or jars may provide patients with opportunities to hide contraband. Given the risks associated with certain medications in correctional populations, newly incarcerated patients must often be transitioned off of intake medications on which they were previously stabilized. This may cause patient frustration, and potential relapse of mental health or medical conditions. Alternatively, patients who achieve competency restoration at state hospitals must typically be continued on the psychotropics prescribed at the state hospital upon return to jail. This can contribute to psychotropic abuse and vulnerability of psychiatric patients within the jail setting. Many psychiatric pharmacists work in non-correctional settings; however, they may assist with medication selection for forensic patients who are admitted to psychiatric hospitals for competency restoration. This clinical pearl will prepare pharmacists to evaluate a medication's potential for abuse or misuse, based on the medication's characteristics and available literature. This knowledge may be useful to pharmacists working with forensic and non-forensic patients, as psychotropic medication abuse has been reported in a variety of populations, and patients may fight or hide contraband in any inpatient psychiatric setting.

3:45-3:59 PM: Why Glial Cells Hurt - Talking to Patients About Chronic Pain
Lee Kral, RPh, PharmD, BCPS

Central sensitization is caused by an imbalance in pain and sensory neurotransmitters. There is insufficient activity in the descending inhibitory pain pathway (low levels of serotonin and/or norepinephrine), and overactivity in the ascending pain pathway (excessive substance P and glutamate). This results in an exaggerated painful response to relatively non-noxious stimuli. Activation of glial cells, the bridge between the nervous system and immune system, are the crux of the augmented response. This is seen in many chronic musculoskeletal painful conditions including low back pain and osteoarthritis. It is also seen in functional pain syndromes like fibromyalgia, chronic pelvic and chronic abdominal pain. Finding a way to help patients understand this phenomenon is essential in management and ongoing education has been shown to be beneficial.

Pharmacists are not only in a position to educate patients about the pain physiology in lay terms, but also explain why certain treatments worsen (e.g. opioids) and improve (e.g. antineuralgics, SNRI's) sensitization. We can also encourage non-pharmacologic therapies (cognitive and physical), which are equally important aspects of management. This pearl will present a case and examples of scripted education to show how pharmacists can incorporate physiology with pharmacology to help manage this difficult and chronic source of patient suffering.

3:59-4:13 PM: More than Genotype: Including Concurrent Medications and Environmental Factors in Phenotype Analysis for Pharmacogenomic Recommendations

Lisa Weisser, RPh, PharmD, BCPP

As pharmacogenetic data becomes increasingly available and incorporated into the medication decision making process, the need to analyze and apply this information will also increase. Pharmacists are uniquely qualified to provide guidance to providers incorporating pharmacogenetic data to guide medication selection for improved response to treatment. The American Society of Health System Pharmacists has provided a statement supporting the pharmacist’s role in clinical pharmacogenomics. 

Psychiatry is particularly suited for utilization of pharmacogenetic testing to minimize the trial and error period by increasing the opportunity for treatment success with recommending well metabolized medications and minimizing the potential for adverse effects. The genetic information or genotype is part of a complex puzzle when considering an optimal medication for a patient. Other factors such as concurrent medications, environmental factors, diet, vitamin supplements, tobacco and alcohol are all known to induce or inhibit Cytochrome P450 enzymes.  Phenoconversion is a significant factor when analyzing the overall phenotype of drug metabolizing enzymes. The FDA recommends that Drug-Gene Interactions should be considered as important as Drug-Drug Interactions. We will discuss how to analyze and utilize information for Drug-Drug-Gene interactions in addition to Drug-Drug and Drug-Gene interactions to maximize the clinical pharmacist’s role on the psychiatric team to help patients. 

4:13-4:15 PM: Session Conclusion
Rosana Oliveira, PharmD, BCPS, BCPP

Course Requirements

To receive ACPE credit for the live session at the Annual Meeting, you must:

  • Attend and participate in the entire session and reflect upon its teachings.
  • Complete the evaluation and the self-assessment questions at the end of the activity. (login first)
  • Provide the necessary details in your profile to ensure correct reporting by CPNP to CPE Monitor. (login first)

This course will be provided at the CPNP 2017 Annual Meeting, April 23-26, 2017. Upon successful completion, ACPE credit is reported immediately to CPE Monitor although transcripts can be retrieved by participants online at

Faculty Information and Disclosures

Abimbola Farinde, PharmD
Brittany Finocchio, PharmD, BCPP
Lee Kral, RPh, PharmD, BCPS
Lisa Weisser, RPh, PharmD, BCPP

View biographical information and disclosures

Learning Objectives

Association between Pisa Syndrome (Pleurothonus), Psychoactive Medications, and Cholinesterase Inhibitors

  1. Evaluate the origin and development of Pisa syndrome (Pleurothontonus)
  2. Review the hallmark presentation of Pisa syndrome (Pleurothontonus)
  3. Discuss a case presentation focused on Pisa syndrome

Medication Selection in Correctional Populations

  1. Recall medication properties associated with abuse and misuse in correctional populations
  2. Recognize select medications with a potential for abuse and misuse in correctional settings

Why Glial Cells Hurt - Talking to Patients About Chronic Pain

  1. Describe the role of glial cells in chronic pain in terms that a patient will understand.
  2. Educate a patient about the treatments for central pain syndromes.

More than Genotype: Including Concurrent Medications and Environmental Factors in Phenotype Analysis for Pharmacogenomic Recommendations

  1. Discuss the different types of drug and gene interactions.
  2. Identify resources available for pharmacogenetic drug-gene information.

Continuing Education Credit and Disclosures

Activity Date: 04/25/2017
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-17-018-L01-P (Knowledge)
Nursing Credit Reminder: Note that ACPE credit is accepted for certification renewal.

ACPEThe College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This course provides 1.0 contact hours of knowledge-based continuing education credit from CPNP approved programming. The ACPE universal program number assigned to this course is 0284-0000-17-018-L01-P.