Abstract
Introduction:
The American Society of Health-System Pharmacists' Postgraduate Year 1 and Year 2 Residency Accreditation Standards require that residents demonstrate effective teaching skills. The College of Psychiatric and Neurologic Pharmacists' survey of pharmacy program curricula assessed resident teaching in psychiatry and neurology, however, results were not published. The objective of this article is to describe resident teaching in psychiatry and neurology curricula as reported by responses to the college's survey.
Methods:
An electronic survey was sent to a curricular representative from each of 133 US pharmacy programs accredited as of July 2015. Programs were asked to report on psychiatry and neurology curricular content, faculty credentials, and types of teaching activities, including resident teaching.
Results:
Fifty-six percent (75/133) of programs responded to the survey. Fifty out of 75 (67%) distinct pharmacy programs reported utilizing residents for teaching topics in psychiatry and neurology. Residents were twice as likely to teach didactic topics in psychiatry (n = 44) compared to neurology (n = 22). Three times as many residents were involved in precepting psychiatric Advanced Pharmacy Practice Experiences (n = 37) compared to neurology Advanced Pharmacy Practice Experiences (n = 12).
Discussion:
Residents are involved in both didactic and experiential teaching with more residents teaching psychiatry content compared to neurology content. Authors recommend utilizing the American Society of Health-System Pharmacists' electronic resident assessment tool, PharmAcademic®, to capture the quantity and quality of resident teaching across accredited programs.
Abstract
Introduction:
To address the complex needs of the homeless veteran population, the US Department of Veterans Affairs created the Homeless Patient Aligned Care Team (H-PACT) model. The South Texas Veterans Health Care System has an established H-PACT model, however it does not include a clinical pharmacy specialist in mental health (MH).
Methods:
An H-PACT MH pharmacy resident clinic was created and managed by a postgraduate year-2 psychiatric pharmacy resident. Improvements in access to MH care, Veterans Health Administration performance metrics, and estimated cost savings associated with resident interventions were reviewed to evaluate clinic utility.
Results:
Over the 6-month clinic time frame, there were a total of 40 patient encounters in which 21 veterans had MH medication evaluation on at least 1 occasion. The average wait time for Veterans previously followed by the H-PACT psychiatrist was approximately 8 weeks. The H-PACT MH pharmacy resident clinic enabled veterans to be evaluated every 4 to 6 weeks. Interventions made by the resident included identification of medication administration errors, medication adjustments, adherence education, reduction in polypharmacy, and referral to other services. Estimated cost savings from clinic interventions totaled $33 613.67.
Discussion:
The H-PACT MH pharmacy resident clinic allowed for an improvement in wait time for psychiatric pharmacotherapy follow-up for homeless veterans, with interventions that were associated with significant estimated cost savings.
Abstract
Introduction:
Past trials of buprenorphine (BUP) in the treatment of major depressive disorder (MDD) have displayed favorable results, although its clinical utility was limited by the risk of abuse or physical dependence. By combining BUP with samidorphan (SAM), the euphoric high is negated by an opposing mechanism, which theoretically reduces addictive-like properties while allowing the antidepressant properties to remain. As such, the objective of this article is to analyze the results of BUP/SAM premarketing clinical trials as adjunctive treatment for treatment-resistant MDD.
Methods:
A comprehensive PubMed/MEDLINE search was conducted through November 9, 2017, using the following search terms: depression, samidorphan, buprenorphine, ALKS-5461. Additional data were obtained from Clinicaltrials.gov and resources included in the present study. All English-language clinical trials evaluating the combination of BUP/SAM in the treatment of MDD were included.
Results:
A few premarketing studies have evaluated the efficacy and safety of BUP/SAM combination as adjunctive treatment in patients with treatment-resistant MDD. The FORWARD-1 through FORWARD-5 trials concluded (1) the most effective dosing ratio of BUP/SAM to reduce abuse potential was 1:1; (2) statistically significant changes in scores from baseline on the Montgomery-Asberg Depression Rating Scale were noted for the 2 mg/2 mg dose compared with placebo; and (3) the most commonly reported adverse effects were nausea, dizziness, and fatigue.
Discussion:
Buprenorphine/samidorphan has shown favorable results for efficacy and tolerability in premarketing studies evaluating its use as adjunctive therapy for treatment-resistant MDD. Its novel mechanism targeting the opioid pathway may serve as a promising antidepressant devoid of abuse potential.
Abstract
Background:
Liver fibrosis results from chronic damage to the liver. Advanced liver fibrosis results in cirrhosis, liver failure, and portal hypertension and may even require liver transplantation. A liver biopsy is considered the “gold standard” method for the assessment of liver fibrosis; however, ultrasonography can also detect changes in the hepatic parenchyma due to fibrosis. Although reports in the literature describe phenytoin-induced hepatic injury, often this rare occurrence is usually accompanied by a hypersensitivity reaction.
Case report:
Our patient is a 50-year-old female with history of schizoaffective disorder, bipolar type, who had been admitted to a state psychiatric facility. She has a history of seizure disorder, which had been well controlled with phenytoin since 2011. Mild-to-moderate elevations in her liver enzymes were noted during therapy but normalized once phenytoin was discontinued. An ultrasound of the patient's liver in January 2016 showed changes of fatty infiltration and fibrosis.
Conclusion:
This case differs from other cases reported in the literature that describe phenytoin-induced hepatic injury. The majority of these cases are accompanied by immune-allergic features. To our knowledge, there have been no reported cases in the literature of prolonged liver enzyme elevation resulting in phenytoin-induced hepatic fibrosis.
Abstract
Objective:
To report a case of oral candidiasis that developed in a 70-year-old white female both upon initiation and rechallenge of extended-release bupropion therapy.
Case Summary:
A 70-year-old female with a past medical history of osteoarthritis, degenerative joint disease, and polycythemia vera developed oral candidiasis on 2 occasions following initiation of extended-release bupropion for the treatment of recurrent depression. During both instances, the reaction occurred with an increased dose of the medication, suggesting the adverse event may have been dose-related. The patient had no risk factors for oral candidiasis aside from dry mouth at baseline that reportedly worsened on bupropion.
Discussion:
Though there are no other reports to our knowledge describing the development of oral candidiasis with bupropion, the likelihood of this having been an adverse reaction in this patient is probable as indicated by a calculated score of 8 from the Naranjo Algorithm. The adverse event appeared following bupropion administration and improved over time following its discontinuation. The adverse event reappeared following readministration of the agent, and no alternative causes were able to be identified. Additionally, the reaction occurred following an increase in the dose on both occasions, with the lower dose having only resulted in worsening dry mouth.
Conclusion:
This case demonstrates that an additional adverse event to screen for with bupropion treatment is the development of oral candidiasis. This adverse event may be more likely to occur in the older adult population.
Abstract
Divalproex sodium (DVP) is an antiepileptic medication that also has mood stabilizing properties for patients with mental health disorders. Currently, there are a small number of case reports discussing the incidence of hyponatremia that occurs as an adverse effect of DVP. After completion of a thorough literature search, we present the first case report describing acute hyponatremia with accompanying hyperammonemia secondary to DVP use. This case describes a 44-year-old male patient who experienced hyponatremia with accompanying hyperammonemia following initiation of DVP for schizoaffective disorder. This case highlights the need for clinicians to consider monitoring electrolytes, in addition to liver function and platelets, with the initiation of therapy or increase in daily dosage. Given the drug's action at voltage-gated sodium channels, changes in serum sodium could be expected.
Abstract
Objective:
To describe a patient case in which a drug interaction involving quetiapine and phenytoin resulted in an absence of clinical response and serum quetiapine levels below the point of detection.
Case Summary:
This patient was on concurrent phenytoin, valproic acid, and quetiapine therapy for 10 months. Prior to discontinuing phenytoin, a serum quetiapine level was found to be less than 10 ng/mL. It took approximately 1 month after phenytoin's discontinuation for quetiapine levels to attain measurable concentrations. The patient's clinical response to quetiapine improved significantly after this interaction resolved.
Discussion:
Phenytoin is an inducer of cytochrome P450 3A4, and quetiapine is a substrate of this enzyme. Patients on concurrent phenytoin and quetiapine therapy may require monitoring of quetiapine concentrations, which is often not routine practice, as this drug interaction can result in a clinically significant reduction in quetiapine levels contributing to a lack of efficacy.
Dear Editor:
I enjoyed reading the recently published article “Treatment of psychotic symptoms in patients with Parkinson disease.”1 It provided insight into the underappreciated problem of Parkinson disease psychosis while highlighting limited pharmacological options. In the article, a 5-HT2A inverse agonist, pimavanserin, is discussed as a novel therapeutic treatment option. To date, 2 open-label studies and 4 placebo-controlled clinical trials, 1 phase II and 3 phase III trials, were completed; however, the results of the only published phase III clinical trial (ACP-103-020) were reviewed.
Touma and colleagues2 provided a comprehensive overview of the current
Dear Editor:
I appreciate the reader's1 insights and opinions on the topic of pimavanserin and Parkinson disease psychosis (PDP) and welcome this opportunity for added scholarly discussion concerning “Treatment of psychotic symptoms in patients with Parkinson disease.” The reader highlights additional clinical trial data, some of which are unpublished, extracted from the Food and Drug Administration briefing document prepared for the Psychopharmacologic Drugs Advisory Committee (PDAC).2 After review of the cumulative clinical trials data, the Food and Drug Administration PDAC voted 12 to 2 that the benefits of pimavanserin for the treatment of PDP outweigh the