Clinical Tidbits + General Question

[Requiem]

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Tidbit #1: Atropine eyedrops can be used sublingually to decrease sialorrhea (excessive, excessive salivation) in clozapine patients _or_ (and priaprism might have some use of this) in patients with death rattle with excessive fluids in the oral cavity/oropharnyx. The american academy of palliative medicine had a small (n=5 or so) review on it, and found it effective. Family members may certainly be thankful.

Recommended i gtt s/l qhs, if ineffective i gtt bid, then up to ii drops bid have been used. Swish and swallow. No Systemic side effects noted.

General Question: Behavioral and Psychological Symptoms of Dementia: who's on top of this situation?

Extremely difficult area with increased all cause mortality and CV event risk with the atypical antipsychotics in patients with dementia. Rampant prescribing of antipsychotics to control aggression, etc., which is disturbing.

Anyone have any clinical experience with agents to tx? I've UptoDated this **** to death, looking for any real life insight.

 

[Vitamin K]

General Question: Behavioral and Psychological Symptoms of Dementia: who's on top of this situation?

Extremely difficult area with increased all cause mortality and CV event risk with the atypical antipsychotics in patients with dementia. Rampant prescribing of antipsychotics to control aggression, etc., which is disturbing.

Anyone have any clinical experience with agents to tx? I've UptoDated this **** to death, looking for any real life insight.

Yes, it's definitely difficult. Since atypicals have a black box on them, you'd think you wouldn't see much use...but "in real life", you do. It's unfortunate because it's a huge risk to the patient, but if they're debilitated by dementia, you don't have a lot of options. I also see Namenda used a lot.

 

[Requiem]

Yes, it's definitely difficult. Since atypicals have a black box on them, you'd think you wouldn't see much use...but "in real life", you do. It's unfortunate because it's a huge risk to the patient, but if they're debilitated by dementia, you don't have a lot of options. I also see Namenda used a lot.

Namenda (Memantine), know as Ebixa up here, is unfortunately not covered under the province's drug plan. So moderate-severe Dementia is managed only with cholinesterase inhibitors. Only Aricept even has an indication in mod-severe. So Day 1 I was thinking wow everyone needs memantine, to no avail. Sad situation.

We're pushing SSRI's a lot. Depression can manifest itself as aggression and agitation, so hopefully when Mr. Smith throws his mashed potatoes away (no joke) he won't get risperidone anymore and then stroke out.

Trying Trazodone a bit for sundowning as well. Better than "ohhh give him dat dere lor aaze uh pam".

 

[RxWildcat]

This is why I don't like psych stuff, it all seems like a guessing game to me.

 

[Requiem]

This is why I don't like psych stuff, it all seems like a guessing game to me.

Well you've essentially hit the nail on the head there; the problem though is that we don't understand the comorbidities themselves.... let alone the treatments.

What we do understand is the adverse effects of these treatments, so that's what we can work with.

Other people: Clinical Discussion and/or Tidbits, let's go!

 

[aFarmD]

At one of my interviews for pharmacy school. The interviewer mentioned that it's a common misconception is that clinial/hospital pharmacy does not involve much with clinical aspect of the pharmacy. I disagree but did not tell her that b/c I was not sure and had no evidence/research to back it up.
What do you think?
What is really the clinical pharmacist's job?

thanks

 

[njac]

At one of my interviews for pharmacy school. The interviewer mentioned that it's a common misconception is that clinial/hospital pharmacy does not involve much with clinical aspect of the pharmacy. I disagree but did not tell her that b/c I was not sure and had no evidence/research to back it up.
What do you think?
What is really the clinical pharmacist's job?

thanks

I don't understand your question. Are you missing a couple words?

 

[NormalSaline]

At one of my interviews for pharmacy school. The interviewer mentioned that it's a common misconception is that clinial/hospital pharmacy does not involve much with clinical aspect of the pharmacy. I disagree but did not tell her that b/c I was not sure and had no evidence/research to back it up.
What do you think?
What is really the clinical pharmacist's job?

thanks

engrish?

 

[MarchIoda]

This is why I don't like psych stuff, it all seems like a guessing game to me.

What are some clinical biomarkers for psychiatric disorders? Are outcomes all behavioral based?

 

[meister]

The less the better, that way it's that much harder to second guess MDs. That's why psych is the realm of the incompetent physicians!

 

[MarchIoda]

Does anyone know of non-behavior based clinical biomarkers to study the effectiveness of treatments for neurological disorders?

 

[npage148]

Does anyone know of non-behavior based clinical biomarkers to study the effectiveness of treatments for neurological disorders?

I hear plasma dopamine levels correlate pretty well....

Nm

 

[Praziquantel86]

Changing gears altogether...

How is the current acyclovir shortage affecting treatment of HSV meningitis in pediatric patients? What is everyone using?

I saw that the AAP recommended ganciclovir 2nd line with foscarnet as 3rd, but is this institution specific?

 

[spacecowgirl]

It's the usual risk vs benefit. If it makes the patient manageable and able to stay in the home longer, then use it. We have pts in our psych ward because their SNFs can't handle them. They do not belong on a ward with teenage overdosers and schizophrenics.

My grandma had distressing hallucinations when she went into a SNF and she's on quetiapine even though she's had several strokes. Now she is not stressed or having upsetting thoughts. It's worth it to her and to us for her to be happier. at 91, it's better she have some QOL now than live longer and think that Al Quaeda is going to kidnap my sister. She was genuinely scared of that, sad 🙁

Always try nonpharm methods first: are they constipated, do they have an asymptomatic UTI, are they bored, do they need a stricter schedule, do they have social interaction or are they isolated, are they depressed and a candidate for SSRI? Find a place with a dedicated dementia unit and enough staff.