Mental Health Clinician Volume 2: Issue 5

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Editorial: The complexity of epilepsy

Pharm.D., BCPS, BCPP

The treatment of epilepsy is complicated and often fails to achieve the one main goal of treatment – the elimination of seizures. Far too often patients are treated with multiple drugs that lead to serious adverse events or drug-drug interactions and still have seizures that impair their ability to function. There is an ever-present need for newer, more effective agents with fewer side effects and less complicated drug-drug interactions. Clearly, there is a significant place for pharmacists in assuring appropriate treatment and monitoring is provided for epilepsy patients.

Since 2009, five, new antiepileptic (AEDs) have been approved by the US

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Table of new antiepileptic drugs

Pharm.D., BCPS

DOI: 10.9740/mhc.n127376

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Management of phenytoin with enteral tube feeding

PharmD, BCPP

DOI: 10.9740/mhc.n126907

Though the mechanism of the interaction is poorly understood, phenytoin absorption is reduced when given concomitantly with enteral tube feedings. This article reviews strategies that may help maintain phenytoin levels when enteral nutrition is required.

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Q & A with Melody Ryan

DOI: 10.9740/mhc.n126918

In order to gain some insight as to how one might train for and develop a pharmacy practice in neurology, the MHC asked an expert, Dr. Melody Ryan from the University of Kentucky Departments of Pharmacy Practice & Science and Neurology. Her practice site is in neurology ambulatory care at the Veterans Affairs Medical Center in Lexington, Kentucky.

How long have you been practicing? Is your practice inpatient or outpatient?

I have been practicing in neurology ambulatory care for 17 years.

How did you get to where you are today? What training have you had?

I completed a pharmacy practice

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A review of eslicarbazepine acetate (Stedesa®)

Pharm.D. and

Pharm.D, MPH, BCPS

DOI: 10.9740/mhc.n127372

Eslicarbazepine acetate is an anticonvulsant medication approved in Europe for adjunctive therapy in adults with partial-onset seizures. FDA approval is expected shortly for use in the United States. This article reviews the pharmacologic and pharmacokinetic profile of eslicarbazepine acetate, and factors that should be considered when using this medication.

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De-escalation of antipsychotic medications in an elderly patient with Alzheimer's dementia residing in an assisted living facility

PharmD, BCACP, BCPS, CPP,

PharmD, BCPP, CGP, and

MD, MSPH

DOI: 10.9740/mhc.n127370

Clinicians frequently encounter the use of antipsychotic medications in elderly patients with Alzheimer's dementia (AD). The use of these agents may be a concern since they are not approved by the Food and Drug Administration (FDA) for the treatment of AD and have been shown to increase mortality in the elderly population. This case report focuses on the gradual de-escalation of antipsychotic medications in an 80 year-old female with AD residing in an assisted living facility who was prescribed three antipsychotic medications to help manage behavioral and psychotic symptoms consistent with progressing AD. Following a request by the assisted living facility, a local family medicine practice assessed the resident's treatment regimen. A collaborative consultation between the family medicine practice's clinical pharmacist, the family medicine physician, and the health care providers at the assisted living facility resulted in the decision to gradually discontinue each antipsychotic agent at subsequent facility visits by the family medicine team.

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A high-stakes decision: Generic substitution of antiepileptic drugs

Pharm.D., BCPP

DOI: 10.9740/mhc.n127375

In recent years, generic versions of several antiepileptic drugs have been approved and released to the US market. This article reviews some of the concerns associated with generic substitution of antiepileptic drugs.

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Anticonvulsant effects of SSRIs

PharmD candidate and

PharmD, FCCP

DOI: 10.9740/mhc.n127566

Although it has previously been thought that serotonin reuptake inhibitors (SSRIs) increase seizure risk, recent evidence suggests that the risk of seizures comes from an underlying deficiency in serotonin rather than the pharmacologic treatment. This article reviews some of the theories on the mechanisms behind seizures, and how antidepressant therapy, particularly SSRIs, could affect the risk.

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Clinical pearls for chronic use of antiepileptic drugs

PharmD and

PharmD

DOI: 10.9740/mhc.n127567

Patients with various forms of epilepsy rely on antiepileptic medications to control and prevent seizures. This article describes some of the “clinical pearls” that should be considered when initiating, combining, or transitioning patients on epileptic medication therapy.

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Lowering the seizure threshold associated with antidepressants, stimulants, antipsychotics, and others

Pharm.D. and

Pharm.D., FCCP

DOI: 10.9740/mhc.n127568

While seizures are commonly associated with epilepsy, seizures can also be provoked by many other causes, including trauma, stroke, fever, and medications. The seizure threshold refers to the patient's susceptibility to seizures. This article reviews common psychiatric medications which may alter the seizure threshold.

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Book Review: The neuropsychiatry of epilepsy, 2nd edition

Pharm, BCPS

DOI: 10.9740/mhc.n122983

CPNP members maintain a suggested reading list to provide information on peer recommended resources and convenient access to the highest quality neuropsychopharmacology publications. A reminder that if you shop with CPNP, by following the links below to Amazon, a small commission will be paid to CPNP which helps to financially support our mission to improve the minds and lives of individuals with psychiatric and/or neurologic disorders.

You can help grow this list of resources by suggesting a book.

Book: The Neuropsychiatry of Epilepsy, 2nd Edition

From the publisher:

Research into the neuropsychiatry of epilepsy has

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Progress Made on CPNP Priorities

Pharm.D., BCPP

DOI: 10.9740/mhc.n124997

Greetings. Well, Autumn/early Winter is arriving. Amazing that soon it will be the Holiday Season. As always, time passes quickly. Time has also passed quickly since we updated everyone on the progress that has occurred with respect to the overarching CPNP priorities identified during our last strategic planning meeting. I want to use part of this message to do that.

Priority # 1: Advance existing relationships and establish new relationships with other organizations. CPNP will focus on improving relationships with additional consumer associations, professional associations, corporate supporters and legislative partners.

We've made significant progress. Just to point out a few:

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Volunteer Spotlight: Shaping the future direction of CPNP through volunteer service

PharmD, BCPS, BCPP

DOI: 10.9740/mhc.n123759

THIS MONTH'S CPNP VOLUNTEER

Jolene Bostwick is currently the CPNP Student Committee Vice Chair, and she dedicates approximately 5 hours to the organization each month. Below, she explains in her own words why she volunteers for CPNP.

HOW I BENEFIT FROM VOLUNTEERING WITH CPNP

Opportunities for networking and professional growth through collaboration with fellow committee members and the CPNP Board of Directors
Ability to gain leadership experience
Opportunity to share my interest and enthusiasm for psychiatric pharmacy with students across the United States
Professional satisfaction in helping to develop future leaders of our organization and so much more!

HOW CPNP

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CPNP Announcements

DOI: 10.9740/mhc.n123754

CPNP DEBUTS NEW VOLUNTEER VIDEO AND OPPORTUNITIES CENTER

As noted in President Lott's article, member involvement and leadership development are among the core values of CPNP. As result, one of the Board's three overarching priorities this year involves nurturing the culture of volunteerism to help grow future leaders and mold our specialty over the coming decades.

In the hustle and bustle of our work and personal lives, it is often challenging to even think about volunteering for your association. CPNP's newest video features several members talking about the tremendous value of volunteering for CPNP—benefits and rewards that can

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Editorial: The complexity of epilepsy

Table of new antiepileptic drugs

Management of phenytoin with enteral tube feeding

Q & A with Melody Ryan

How long have you been practicing? Is your practice inpatient or outpatient?

How did you get to where you are today? What training have you had?

A review of eslicarbazepine acetate (Stedesa®)

De-escalation of antipsychotic medications in an elderly patient with Alzheimer's dementia residing in an assisted living facility

A high-stakes decision: Generic substitution of antiepileptic drugs

Anticonvulsant effects of SSRIs

Clinical pearls for chronic use of antiepileptic drugs

Lowering the seizure threshold associated with antidepressants, stimulants, antipsychotics, and others

Book Review: The neuropsychiatry of epilepsy, 2nd edition

From the publisher:

Progress Made on CPNP Priorities

Volunteer Spotlight: Shaping the future direction of CPNP through volunteer service

THIS MONTH'S CPNP VOLUNTEER

HOW I BENEFIT FROM VOLUNTEERING WITH CPNP

HOW CPNP

CPNP Announcements

CPNP DEBUTS NEW VOLUNTEER VIDEO AND OPPORTUNITIES CENTER

Pharmacist administration of long-acting injectable medications for substance use disorders: A scoping review

Transitions of care: Assessment of adherence to long-acting injectable antipsychotic treatment following discharge from inpatient psychiatry

Use of atypical antipsychotics in individuals with anorexia nervosa

Potential changes impacting psychiatric pharmacy by 2030

A model for timely dissemination of critical information: Clozapine toxicity during the COVID pandemic