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Session Time and Location

Date: Tuesday, 04/09/2019

Time: 2:00 PM (view in the schedule)

Room: Grand Ballroom A

Target Audience

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

Session Summary

2:00-2:02 PM: Session and Speaker Introduction
Michael Kotlyar, PharmD, MS

2:02-2:16 PM: Hot Take: PRN Anxiolytics Might Cause More Harm than Good

Jessica Moreno, PharmD, BCPP

We are in the midst of an overdose crisis and increasing attention is now going towards the need to reduce benzodiazepine prescribing. In doing so, many patients are left feeling helpless when they experience acute anxiety and have not yet learned effective coping mechanisms other than taking "fast-acting" medications. This clinical pearl presents a controversial perspective that, perhaps, no "fast-acting" medications are appropriate for acute symptoms of anxiety and more appropriate management approaches are available.

2:16-2:30 PM: Double Trouble: Management of Concurrent Opioid and Alcohol or Benzodiazepine Withdrawal

Michelle Colvard, PharmD, BCPP

The management of patients at risk for polysubstance withdrawal from opioids and either alcohol or benzodiazepines poses a significant clinical challenge. Prevention of potentially life threatening withdrawal symptoms from alcohol or benzodiazepines must be prioritized while also attempting to facilitate completion of opioid withdrawal and entry into substance use treatment.  Clinician comfort with effective opioid withdrawal management strategies is more important than ever as the number of opioid-related deaths continues to grow each year. Review of treatment guideline recommendations and patient cases will be used to assist the clinician in developing skills to evaluate risk for withdrawal and develop a medication plan for concurrent management of withdrawal from opioids and either alcohol or benzodiazepines.

2:30-2:44 PM: Adjunct Allopurinol for the Treatment of Schizophrenia and Aggression

Chelsea Carr, PharmD, BCPP

Allopurinol is a medication mainly used for the treatment of gout. Due to the indirect effect on dopamine and glutamate, published case reports and small randomized clinical trials have found it may be effective as an adjunct option in treating residual symptoms of schizophrenia, aggression, and bipolar disorder. Given the well-tolerated adverse effect profile compared to other psychotropic medications used adjunctively, allopurinol may be an option to consider when trying to decrease psychotropic burden and unwanted side effects. This clinical pearl will describe a patient with aggression and residual symptoms of schizophrenia who was tried on allopurinol when multiple antipsychotics, mood stabilizers, and benzodiazepines used concurrently were ineffective. Clinical outcomes and a timeline of events before and after the initiation will be discussed. The clinician will learn of the proposed mechanism for effectiveness, as well as an overview of the current literature detailing the use of allopurinol for these indications.

2:44-3:00 PM: Clozapine-Associated Renal Failure

Erica Davis, PharmD, BCPP

While clozapine has many well-known potential side effects, less is known about inflammatory-related consequences of clozapine treatment. While nephritis is listed in the package insert, very few clinicians are aware of this possible inflammatory side effects of clozapine. This clinical pearl will present a patient case of clozapine-associated renal failure and review the existing published literature for other reports of this adverse effect for common clinical features and potential risk factors. The goal of this presentation is to educate clinicians about this rare and potentially serious side effect in order to increase awareness and earlier detection to prevent long-term adverse outcomes.

3:00-3:02 PM: Session Conclusion
Michael Kotlyar, PharmD, MS

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 2019 Annual Meeting, April 7-10, 2019. Upon successful completion, ACPE credit is reported immediately to CPE Monitor although transcripts can be retrieved by participants online at http://cpnp.org/mycpnp/transcript/acpe.

Faculty Information and Disclosures

Chelsea N. Carr, PharmD, BCPP
Michelle D. Colvard, PharmD, BCPP
Erica Davis, PharmD, BCPS, BCPP
Jessica L. Moreno, PharmD, BCPP

View biographical information and disclosures

Learning Objectives

Hot Take: PRN Anxiolytics Might Cause More Harm than Good

  1. Discuss roles of fear conditioning and fear extinction in anxiety.
  2. Explain to patients and prescribers why PRN anxiolytics may be suboptimal.

Double Trouble: Management of Concurrent Opioid and Alcohol or Benzodiazepine Withdrawal

  1. Recognize risk and severity of withdrawal syndrome in the setting of concurrent opioid and alcohol or benzodiazepine use.
  2. Select a pharmacologic treatment plan for the prevention and/or treatment of concurrent opioid and alcohol or benzodiazepine withdrawal.

Adjunct Allopurinol for the Treatment of Schizophrenia and Aggression

  1. Describe the mechanism of action by which allopurinol may be effective in the treatment of schizophrenia and aggression.
  2. Summarize the literature findings regarding the use of allopurinol in treating aggression and residual symptoms of schizophrenia.

Clozapine-Associated Renal Failure

  1. Summarize the available literature regarding the association between clozapine and renal failure.
  2. Identify presenting features associated with clozapine-associated renal failure. 

Continuing Education Credit and Disclosures

Activity Date: 04/09/2019
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-19-027-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 hour of knowledge-based continuing education credit from CPNP approved programming.