Activity Date: 04/09/2019
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
To receive ACPE credit for the live session at the Annual Meeting, you must:
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.
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Chelsea N. Carr, PharmD, BCPP
Michelle D. Colvard, PharmD, BCPP
Erica Davis, PharmD, BCPS, BCPP
Jessica L. Moreno, PharmD, BCPP
Hot Take: PRN Anxiolytics Might Cause More Harm than Good
Double Trouble: Management of Concurrent Opioid and Alcohol or Benzodiazepine Withdrawal
Adjunct Allopurinol for the Treatment of Schizophrenia and Aggression
Clozapine-Associated Renal Failure
The 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.
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information and disclosures). The opinions expressed in the educational activity do not necessarily represent the views of CPNP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: (Chelsea Carr) My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: allopurinol for treatment of aggression and refractory symptoms of schizophrenia. (Michelle Colvard) My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Clonidine (opioid withdrawal treatment), Phenobarbital (benzodiazepine withdrawal treatment) (Jessica Moreno): My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: gabapentinoids, antihistamines, antipsychotics, propranolol
It is the policy of CPNP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by CPNP for any product or manufacturer identified.