Mental Health Clinician Volume 2: Issue 6

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Editorial-the future of psychotropics: Did santa forget about mental illness?

PharmD

Last year, the December issue of the Mental Health Clinician was dedicated to highlighting new psychotropics agents recently granted FDA-approval, including iloperidone (Fanapt®, 2009), asenapine (Saphris®, 2009), lurasidone (Latuda®, 2010), and vilazodone (Viibryd®, 2011). Unfortunately, the 2012 year has brought no new agents to the psychotropic drug market; however, numerous investigational agents are “pipelined-up” and optimistically awaiting their market debut. Please see the “toolbox” for an abbreviated review of psychotropic agents currently undergoing Phase III trials.

All antidepressants currently approved for the treatment of depression in the United States act primarily on the monoamine system. These agents often

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Toolbox: Current phase III clinical trials

PharmD

DOI: 10.9740/mhc.n129046

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Citalopram-induced QTc prolongation: A brief review of the data

PharmD and

Pharm.D., BCPP

DOI: 10.9740/mhc.n129018

Recently, Forest Laboratories warned about QTc prolongation associated with the use of citalopram. After these reports, the FDA warned that citalopram should no longer be used at doses greater than 40 mg/day for patients ≤ 60 years of age or greater than 20 mg/day in patients over 60 years of age. As a result, providers and formulary managers were advised to reevaluate the use of citalopram to conform to current FDA guidelines. Clinicians have the option to: (1) maintain the patient on the current dose (no change), document that the current EKG (with QTc) is within a normal range and inform the patient of the current recommendations or (2) change the therapy, which consists of either a dose reduction or change to an alternate agent. It may be appropriate to keep a patient on current therapy above the FDA recommended maximum if proper documentation is maintained (e.g., past history of severe depression, normal EKG). Citalopram should be discontinued in patients who have persistent QTc measurements greater than 500 ms.

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New drugs of abuse: New threat?

PharmD

DOI: 10.9740/mhc.n129019

There has been an increase in the abuse of synthetic drugs. This article explores the prevalence and legal issues regarding synthetic drugs (e.g., bath salts).

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Was it worth the weight? - Drug review on two new weight loss agents: lorcaserin (Belviq®) and phentermine/topiramate ER (Qsymia^TM)

PharmD Candidate 2013 and

PharmD

DOI: 10.9740/mhc.n129047

The prevalence of obesity in the United States (U.S.) is currently at 34%. This article will review two of the newer weight loss agents: lorcaserin and phentermine/topiramate. Mechanism of action, dosing, adverse events, and drug interactions will be discussed.

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Transcranial magnetic stimulation for major depressive disorder: What a pharmacist should know

PharmD, BCPP, CGP, FASCP

DOI: 10.9740/mhc.n129615

Transcranial magnetic stimulation utilizes strong pulsed magnetic fields from an insulated coil which generate electrical currents resulting in neuronal depolarization in the cortex. Currently, the user manual only cautions against the use of tricyclic antidepressants, antipsychotics, and other medications that lower the seizure threshold during TMS therapy. However, post-marketing reports suggest caution should also be utilized when combining TMS with other antidepressants (e.g. bupropion, serotonin reuptake inhibitors) and stimulants. Data show efficacy of approximately 30%. Adverse effects more commonly reported include application site pain (35.8%), muscle twitching (20.6%), application site discomfort (10.9%), skin pain (8.5%), toothache (7.3%), facial pain (6.7%), and eye pain (6.1%).

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Two case reports of smoking behavior changes after self-initiated e-cigarette use and tobacco smoking cessation

PharmD

DOI: 10.9740/mhc.n129682

Objective: The purpose of this report is to increase the clinician's understanding of electronic nicotine-delivery systems (ENDS) by describing similar observations of two subjects “forgetting” to use self-initiated ENDS.

Observations: A 51 year old Caucasian female with severe persistent mental illness reported continued tobacco abstinence and “forgetting” to use the ENDS at week 24 and continued tobacco abstinence beyond week 52. Also, a 42 year old Caucasian healthy male with continued tobacco abstinence and “forgetting” to use the ENDS after approximately 14 weeks remained abstinent of conventional cigarettes beyond 52 weeks.

Discussion: ENDS do not continually produce smoke like conventional cigarettes; the absence of continuous smoke may not compel the user to continue inhaling. ENDS differ from conventional cigarettes because of the on-off feature of the device, requiring the user to inhale to activate a battery-powered nicotine delivery system (atomizer).

Conclusion: Additional research is needed to verify the impact of ENDS on smoking behavior in smoking cessation. Clinicians should monitor but not yet recommend the initial use of ENDS for smoking cessation until the FDA imposes regulations on ENDS companies to ensure consistency of labeling of ingredient amounts and the overall safety of the products.

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Latuda®- New dose, new do's and don'ts?

PharmD and

PharmD, BCPP

DOI: 10.9740/mhc.n129685

Similar to other second-generation antipsychotics, lurasidone is an antagonist at dopamine D2 and serotonin 5HT2A receptors, and also has a high binding affinity (antagonist) for the serotonin 5HT7 receptor. Over the past several years, the dosing of this agent has changed. This article will discuss such changes and compare the efficacy, side effect rates, and cost of lurasidone dosing regimens.

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Establishing and promoting the CPNP Collegiate Chapter at Purdue University

PharmD Candidate,

PharmD Candidate, and

PharmD Candidate

DOI: 10.9740/mhc.n129714

The Purdue collegiate chapter of CPNP, established in the fall of 2010, was one of four pilot chapters launched across the nation. This article will discuss the development, implementation, of the chapter. Chapter involvement in the community and fundraising events will also be discussed.

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Book Review: Clinical manual of electroconvulsive therapy

DOI: 10.9740/mhc.n129267

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: Clinical Manual of Electroconvulsive Therapy

Book by: Mehul V. Mankad, John L. Beyer, Richard D. Weiner,

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Survey results demonstrate lack of awareness regarding psychiatric pharmacists

PharmD, BCPP and

PharmD, BCPP

DOI: 10.9740/mhc.n129057

The Consumer Relations Committee represented CPNP at the 2012 National Alliance on Mental Illness (NAMI) Annual Convention, which was held in Seattle, Washington June 27–30. CPNP members manned a booth during the convention and presented a poster titled “Advancing Recovery through Medication Adherence.”

Each year NAMI Annual Convention attendees are asked to complete a survey to help CPNP better understand the awareness attendees have about psychiatric pharmacists. At the same time, this survey is intended to educate them about the availability of psychiatric pharmacists. The survey asks a variety of questions, however only three questions and answers will be addressed

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Moving forward

DOI: 10.9740/mhc.n129742

I certainly hope everyone had a wonderful Thanksgiving with family, friends, and/or other loved ones. This becomes a busy time of the year. Holidays. For many of our students and residents, ASHP's MidYear Meeting will be the start of moving forward to the next stage of their training/careers. For those who will be attending the MidYear Meeting, remember that CPNP is sponsoring an educational session entitled, “Expecting the Unexpected: Treatment of Opioid Dependence in Pregnancy.” Several other CPNP members are presenting educational programs on Tuesday of MidYear as well. You might also want to stop by Residency Showcase and visit

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CPNP Announcements

DOI: 10.9740/mhc.n129599

CPNP 2013–2015 OFFICERS ELECTED

The College of Psychiatric and Neurologic Pharmacists (CPNP) membership has elected three officers to serve on the 2013–2015 Board of Directors. Assuming their offices effective July 1, 2013 will be President-Elect Dr. Steven Burghart, Treasurer Dr. Christopher Thomas, and Member-at-Large Dr. Raymond Love.

Steven Burghart, DPh, MBA, BCPP, currently serving his second term as Treasurer on the Board of Directors, has been a CPNP member since 2000 and served in a number of volunteer roles. Steve has practiced psychiatric pharmacy for more than 18 years and has been board certified in psychiatric pharmacy since 1999.

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Editorial-the future of psychotropics: Did santa forget about mental illness?

Toolbox: Current phase III clinical trials

Citalopram-induced QTc prolongation: A brief review of the data

New drugs of abuse: New threat?

Was it worth the weight? - Drug review on two new weight loss agents: lorcaserin (Belviq®) and phentermine/topiramate ER (Qsymia^TM)

Transcranial magnetic stimulation for major depressive disorder: What a pharmacist should know

Two case reports of smoking behavior changes after self-initiated e-cigarette use and tobacco smoking cessation

Latuda®- New dose, new do's and don'ts?

Establishing and promoting the CPNP Collegiate Chapter at Purdue University

Book Review: Clinical manual of electroconvulsive therapy

Survey results demonstrate lack of awareness regarding psychiatric pharmacists

Moving forward

CPNP Announcements

CPNP 2013–2015 OFFICERS ELECTED

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