Activity Dates: 04/22/2009 - 04/22/2012
This course is closed. Please look for other available products in CPNP University.
If you are a pharmacist, nurse practitioner or other healthcare professional involved in the comprehensive medication management of psychiatric and/or neurological patients, we invite you to participate in this online course.
Dosage formulation technologies are undergoing a renaissance, spanning nanotechnology, polymer chemistry, aerosolization, and smart skin patches. The development of new dosage formulations of antipsychotic medications, focuses upon modified oral release, ultra-fast acting inhalation, and long-acting injectable therapies.
Long-acting injectable therapies are described spanning the gamut from oil based esterified drug (fluphenazine, haloperidol, zuclopenthixol) formulations through microcrystalline and nanotechnology suspensions for injection (olanzapine, paliperidone, aripiprazole) and to polymeric encapsulation, i.e., microspheres used for risperidone. This array of formulation technologies provide PK driven modifications in pharmacodynamic effects that are intended to provide greater efficacy and reduced adverse effects. Long-acting products can undergo spurts of release that are probably not clinically significant, since the variation is less than usual oral fluctuations. However, occasionally dose-dumping results in dystonia (fluphenazine decanaote) or rarely in excessive sedation/impaired consciousness (olanzapine pamoate), illustrating the need for these formulations to be rigorously evaluated and stored/handled properly. Haloperidol decanoate demonstrates PK/PD improvements such as equivalent efficacy with lower extrapyramidal rates than oral therapy. Oral extended release formulations appear to offer some advantages including higher starting doses with less need for titration to therapeutic targets (quetiapine ER), and/or potentially greater potency than anticipated due to reduced intra-subject within dose variation (paliperidone OROS). Aerosolized small particle technology might allow inhalation of antipsychotics (e.g. loxapine) or sedatives, providing another alternative in treating acutely ill patients. Modified dosage formulations of antipsychotics appear to have the potential to result in drug concentrations remaining, for more time per day, within the therapeutic target range for D2 receptor occupancy. The pharmacokinetic-pharmacodynamic interface is explored via use of simulations and a mechanism of action driven hypotheses. Less extrapyramidal symptoms with equivalent clinical efficacy in the short term, and possibly greater effect (or lower exposures for maintenance of effect) are consistent with these models and the data. However, there is a paucity of outcomes studies to validate these intuitive assumptions. It is also assumed that long-acting antipsychotics or once daily dosing (from multiple daily dosing), should improve adherence and, hence, outcomes.
Existing drugs have also had new formulations developed: oral dissolving tablets (e.g., arpipiprazole, clozapine, olanzapine, risperidone). Many demonstrate no significant differences from conventional oral therapy. The pharmacokinetics of controlled/extended release oral dosage forms employ a variety of mechanisms (e.g., enteric coatings, layered release systems, osmotic release mechanisms) but all attempt to reduce acute adverse effects, complexity of the dosage regimen, or improve the bioavailability. Additionally, non-parenteral novel dosage forms could include transdermal delivery systems that allow smoother concentrations and extended duration of action compared to oral therapies, can bypass problematic metabolic interactions, or be part of nano-medical devices that diagnose, measure a laboratory parameter, and dose the patient.
You will proceed through the following steps to satisfactorily complete this course:
This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.
Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.
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Larry Ereshefsky, PharmD, FCCP, BCPPView biographical information and disclosures
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This self-study course provides 1.0 contact hours (0.1 CEUs) of knowledge-based continuing education credit from CPNP approved programming. The ACPE universal program number assigned to this course is 0284-0000-09-014-H01-P (1.0 contact hours).
ACPE approved contact hours are accepted for ANCC Certification Renewal (see pages 5 and 6): At least 50% (37.5 hours) of your 75 continuing education hours must be formally approved continuing education hours. Formally approved continuing education hours meet one or more of the criteria listed below:
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.
This programming was supported in part by grants from Bristol-Myers Squibb, Forest Laboratories, Inc., Lilly, Schering-Plough, Cyberonics, and Shire.