Medication Combination of the Day

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Sushirolls said:
Hospital D/C Summary; Adjustment D/O w/ Aripiprazole.

Please post your cringe worthy med combo you have witnessed today! Let's see these beauties.
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It's not great, but this is not the worst thing ever. Who knows, maybe the adjustment disorder caused agitation that was so severe it required Abilify or they had already failed so many other meds?

Nothing particularly bad in my day, but I did see Bipolar Diagnosis in a 17 year old treated with just Prozac.
 
shahseh22 said:
It's not great, but this is not the worst thing ever. Who knows, maybe the adjustment disorder caused agitation that was so severe it required Abilify or they had already failed so many other meds?

Nothing particularly bad in my day, but I did see Bipolar Diagnosis in a 17 year old treated with just Prozac.
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I think the joke is that adjustment disorder is a diagnosis and aripiprazole is a medication 🙂
 
I just admitted a patient with appears to be a severe, psychotic, anxious unipolar depression with clear features of catatonia who was discharged from an inpatient unit on a regimen of bupropion XL 300 mg daily, OXC 300 mg BID, and quetiapine 25 mg BID. No prior history of psychiatric symptoms until this current episode. Zero history suggestive of a bipolar illness.

Another one of my current patients is an older person with a well-established diagnosis of bipolar disorder type I and recurrent admissions for mania who was admitted for mania after home paroxetine was increased from 30 mg to 40 mg. The patient was given olanzapine PRN for “mania.”

????????
 
NickNaylor said:
I just admitted a patient with appears to be a severe, psychotic, anxious unipolar depression with clear features of catatonia who was discharged from an inpatient unit on a regimen of bupropion XL 300 mg daily, OXC 300 mg BID, and quetiapine 25 mg BID. No prior history of psychiatric symptoms until this current episode. Zero history suggestive of a bipolar illness.

Another one of my current patients is an older person with a well-established diagnosis of bipolar disorder type I and recurrent admissions for mania who was admitted for mania after home paroxetine was increased from 30 mg to 40 mg. The patient was given olanzapine PRN for “mania.”

????????
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??? frankly, the first is dime a dozen in our field. Be thankful they were just on one antipsychotic and not 2 or 3.

I've worked in 5 different states and every single place has featured medication combos where polypharm to an extreme is the norm. Thats our field....like it or not. And child psych is often the worst
 
As part of my “doc o’ the day” duties at one gig, I frequently get asked to refill meds for other providers. One of my favorite requests was for a patient with diagnoses of Unspecified depression, unspecified anxiety, ADHD, and Tourette’s. On a regimen of trazodone, clonidine, Seroquel, Risperdal, and propranolol.
 
From the ED thread, re: the patient I mentioned on mirtazapine, quetiapine, doxepin, melatonin, trazodone, and zolpidem for sleep. She was also on gabapentin, clonidine, prazosin, lamotrigine, low dose lithium, venlafaxine, aripiprazole, clonazepam, Adderall, and had prns of quetiapine and hydroxyzine. After getting collateral it appeared that this was due to years of bouncing between NPs with a smattering of MDs/DOs who never bothered to adjust her meds. She had been seeing her outpatient psychiatrist at the time for 2-3 years when she was admitted and she alluded to her medication regimen being "unwieldy" yet had made no efforts to clean it up and actually added to the mess.

Not necessarily a horrendous combo, but one of my outpatients in residency clinic has followed in our clinic for close to a decade. She was transferred to me on citalopram, lithium, Adderall, gabapentin, and clonazepam. Lots of social stressors and likely character traits but no history of suicide, SIB, hospitalization, severe depression, or multiple medication trials. I was reviewing her meds with her when she was transferred and I inquired about the lithium, assuming it was for depression or SI, but she was adamant it was for insomnia. I eventually get around to reviewing her chart much more closely and come across the notes from when she was started on lithium about 4-5 years....sure as ****, documented that it's being used for insomnia by the resident that was seeing her at the time. No mention of worsening depression, SI, not tolerating citalopram, etc., and she honestly appeared to be doing somewhat better than she is now.
 
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vistaril said:
Thats our field....like it or not. And child psych is often the worst
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Hard disagree. Reading this thread reminded me of one of the top 10 reasons I greatly prefer CAP. Most of my referrals from PCPs have had 0-2 meds tried. Even inpatient work for all but the most severe complex trauma and SMI have only 1-2 medications and I can actually collect a real history of every medication trial (parents/guardians are much better historians than most adults are of themselves and our state department of family services tracks this for their children). I find parents much more reticent to start medication for their children and I spend about an even % of my time talking people into treatment as I do talking them out of treatment (no ODD is not treated with adult dosages of risperidone...).
 
Two that came to me:

1) Lithium ER 450 BID, Seroquel 800 qHS, gabapentin 900 TID, Ambien 10 mg qHS, Klonopin 1.5/1.5/0.5 mg TID, Adderall IR 40 mg q AM and q2PM, temazepam 30 mg qHS, Depakote 500 mg effectively used as a PRN for anxiety/agitation.

This was a person with pretty clear bipolar I with some pretty severe manic episodes in the past (like, stop sleeping, kidnap your child and flee the state to escape a Satanic conspiracy kind of manic). Thus making big changes quickly seemed like a bad idea, but holy Jesus. In the past it had been worse - someone put them on tramadol for depression and they wound up with a serious opioid problem but had been sober several years when I met them. The klonopin was actually for lithium-related tremor, although it seemed like previous psychiatrist had only really tried propranolol and not much else. They were very dedicated to lithium and felt it had saved their life so stuck with it through some pretty nasty medical complications but even with all that only managed about 5 hours of sleep most nights. Works in mental healthcare so strong opinions about meds. Did I mention they're in their 60s?

They were not happy about benzos but also afraid of coming off. Interestingly at some point they just cold-stopped temazepam instead of gradual taper we agreed to and noticed zero difference. This was very helpful for making them more interested in pursuing klonopin taper/reduction.

2) Adderall 40 mg XR, Adderall 40 mg IR, Klonopin 2 mg TID, Wellbutrin XL 300, Latuda 80, Lexapro 20, synthroid 75 mcg, Ambien 15, trazodone 400. Uses medical weed, natch.

Recorded diagnosis: depression

Strongly disagreed with my insistence that 'brain fog' complained of might be due to benzos. Ultimately parted ways because PDMP showed they were getting oral ketamine from someone else and refused to stop.

Also worked in healthcare, i am noticing a pattern.
 
Merovinge said:
Hard disagree. Reading this thread reminded me of one of the top 10 reasons I greatly prefer CAP. Most of my referrals from PCPs have had 0-2 meds tried. Even inpatient work for all but the most severe complex trauma and SMI have only 1-2 medications and I can actually collect a real history of every medication trial (parents/guardians are much better historians than most adults are of themselves and our state department of family services tracks this for their children). I find parents much more reticent to start medication for their children and I spend about an even % of my time talking people into treatment as I do talking them out of treatment (no ODD is not treated with adult dosages of risperidone...).
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well Child psychiatry is known for some of the 'thought leaders' in that field colluding with drug companies for big payoffs in exchange for pushing certain prescribing strategies(and those strategies werent lets not use the drugs lol), so that right there says a lot.

It's definately very common to see kids with a combination of fair low IQ, lots of impulsivity/disinhibition, unstable parenting situation, and feeling depressed and/or anxious put on a host of drugs....antipsychotics and mood stabilizers included. Depakote and Risperdal in particular seem particularly common amongst child/adol patients. Seroquel too. The diagnosis are always the same- some combination of autism spectrum d/o, ODD, and a mood d/o.
 
vistaril said:
well Child psychiatry is known for some of the 'thought leaders' in that field colluding with drug companies for big payoffs in exchange for pushing certain prescribing strategies(and those strategies werent lets not use the drugs lol), so that right there says a lot.

It's definately very common to see kids with a combination of fair low IQ, lots of impulsivity/disinhibition, unstable parenting situation, and feeling depressed and/or anxious put on a host of drugs....antipsychotics and mood stabilizers included. Depakote and Risperdal in particular seem particularly common amongst child/adol patients. Seroquel too. The diagnosis are always the same- some combination of autism spectrum d/o, ODD, and a mood d/o.
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Yes of course, the common patient with low IQ, unstable home life, who is actively voicing depressive or anxious feelings. Certainly these patients exist, and yes they do often get put on (and actually requrie) some degree of multiple medications but to suggest this as the norm or common place is such a disingenuous representation of a field that you are not even a part.
 
Not today but had to look this one up:

Alprazolam 0.5mg PO TID PRN
Fluoxetine 20mg PO Daily
Lamotrigine 200mg PO Daily
Aripiprazole 10mg PO Daily
Cariprazine 3mg PO Daily
Olanzapine 5mg PO QHS
Quetiapine 25mg PO QHS

The patient was a complete zombie. No history of psychosis and very un-convincing for BPAD. Probably some anger issues/NPD. Feeling better as I pull things off.

Touched base with the pt's therapist who described the psychiatrist who prescribed all this as "very creative." As if they understood these reg were unusual. So why do you keep referring?
 
FlowRate said:
Not today but had to look this one up:

Alprazolam 0.5mg PO TID PRN
Fluoxetine 20mg PO Daily
Lamotrigine 200mg PO Daily
Aripiprazole 10mg PO Daily
Cariprazine 3mg PO Daily
Olanzapine 5mg PO QHS
Quetiapine 25mg PO QHS

The patient was a complete zombie. No history of psychosis and very un-convincing for BPAD. Probably some anger issues/NPD. Feeling better as I pull things off.

Touched base with the pt's therapist who described the psychiatrist who prescribed all this as "very creative." As if they understood these reg were unusual. So why do you keep referring?
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The sheer artistry of prescribing minimally effective doses of EVERYTHING is astounding.
 
SmallBird said:
I think the joke is that adjustment disorder is a diagnosis and aripiprazole is a medication 🙂
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Yes that is fine, it's not entirely absurd in my opinion. You never know the backstory of what required it. Some of my kids have such severe trauma and subsequent aggression that I could see give them a low dose of Abilify to help with what transpired. It's really hard to get everything in an inpatient stay.
 
Adderall 30, Valium 10, Cymbalta 60, Lamictal 100, Caplyta 42, Zyprexa 200, Prazosin 5, Seroquel 200.
 
The two repeat offenders seem to be people on 3+ antipsychotics, and others with multiple high dose benzos.

One example of each:

White woman mid 20s dx of MDD and panic disorder w/ agoraphobia, admitted inpatient due to SI: Lexapro 15mg qAM, Xanax 2mg TID, Klonopin 2mg BID.

White woman early 30s dx of bp1, saw her outpatient after she lost insurance: Lithium ER 450mg BID, Seroquel ER 600mg qHS, Zyprexa 15mg qHS, Abilify 15mg qAM.

Extraordinarily slow and hard to get people off of ridiculous benzo regimens, I began a slow taper inpatient after discussing risks of long term benzo use w/ patient, I also added Effexor for the depression and then discharged her to a local psychiatrist who I know does well with benzo tapers, I also heavily recommended therapy as for some reason she was taking an SSRI and two benzos for MDD and panic disorder but had never tried CBT. With the BP1 gal she was sleeping 18+ hours a day and when awake she was so groggy she couldn't function, was very satisfying to see her begin to function normally after I took away the Zyprexa and Abilify.
 
Got this yesterday evening.

Thank you for seeing ____ for an opinion and management of their ADHD, they were diagnosed as an adult by a neurologist who is no longer able to prescribe for them. This patient needs to be seen urgently, and is on a disability pension and requires financial assistance.

Current Medications
Ritalin 50mg TDS
Vyvanse 30mg daily
Vyvanse 50mg daily
Vyvanse 70mg daily

Medical History
Chronic back pain
Hepatitis C
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My first thought was that I knocked back a referral with a similar frightening combination last year, and found out it was a regime favoured by a neurologist who was struck off by the medical board last year for inappropriate prescribing. Combination of back pain and Hep C always makes me wonder about IV drug use, which was not addressed anywhere in the referral.

This patient is actually stuffed, as they were probably getting their medications for a pension discount of $6/month per script, but with the new rule changes introduced this year the subsidy for Vyvanse cuts out if doses go beyond 70mg. Then it reverts to the private price of $120 per script. Even someone who wants to continue prescribing this horror regime (not me) is going to come up against the brick wall that is the government phone authority service
 
Liquid8 said:
Got this yesterday evening.



My first thought was that I knocked back a referral with a similar frightening combination last year, and found out it was a regime favoured by a neurologist who was struck off by the medical board last year for inappropriate prescribing. Combination of back pain and Hep C always makes me wonder about IV drug use, which was not addressed anywhere in the referral.

This patient is actually stuffed, as they were probably getting their medications for a pension discount of $6/month per script, but with the new rule changes introduced this year the subsidy for Vyvanse cuts out if doses go beyond 70mg. Then it reverts to the private price of $120 per script. Even someone who wants to continue prescribing this horror regime (not me) is going to come up against the brick wall that is the government phone authority service
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Not saying this is acceptable at all but 70mg Vyvanse is equivalent pharmacologically to around 30ish mg Adderall. So you think those people who put patients on 30mg Adderall TID (which I don’t agree with anyway) probably have no problem justifying to themselves trying to put people on monster doses of Vyvanse.

This looks like a dose titration though, you sure it isn’t med trials automatically generated by the EMR? (Like tried Ritalin, then switched to Vyvanse, then titration up and the EMR is just auto filling all the “active” scripts into the form letter)? You should be able to check the PDMP and see if the persons actually filling all these.
 
calvnandhobbs68 said:
Not saying this is acceptable at all but 70mg Vyvanse is equivalent pharmacologically to around 30ish mg Adderall. So you think those people who put patients on 30mg Adderall TID (which I don’t agree with anyway) probably have no problem justifying to themselves trying to put people on monster doses of Vyvanse.

This looks like a dose titration though, you sure it isn’t med trials automatically generated by the EMR? (Like tried Ritalin, then switched to Vyvanse, then titration up and the EMR is just auto filling all the “active” scripts into the form letter)? You should be able to check the PDMP and see if the persons actually filling all these.
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Can you clarify this for me. I see conflicting information on Vyvanse conversion rates to Adderall. First suggests a 1 Adderall to 1.85 Vyvanse (Thus about 40mg of Adderall XR = Vyvanse 70) and the later follows what you are saying with a 70 Vyvanse = Adderall 30XR. I had learned the conversion as the former but am definitely interested in learning if I'm wrong.

Vyvanse vs Adderall Dosage Conversion And Equivalence Chart

Let's presume that you've been prescribed 20mg Adderall, but want to switch to Vyvanse. What's an equivalent dose of Vyvanse that would be comparable to 20mg of Adderall?
focuswish.com
 
Merovinge said:
Can you clarify this for me. I see conflicting information on Vyvanse conversion rates to Adderall. First suggests a 1 Adderall to 1.85 Vyvanse (Thus about 40mg of Adderall XR = Vyvanse 70) and the later follows what you are saying with a 70 Vyvanse = Adderall 30XR. I had learned the conversion as the former but am definitely interested in learning if I'm wrong.

Vyvanse vs Adderall Dosage Conversion And Equivalence Chart

Let's presume that you've been prescribed 20mg Adderall, but want to switch to Vyvanse. What's an equivalent dose of Vyvanse that would be comparable to 20mg of Adderall?
focuswish.com
Click to expand...

Yeah I see what you're saying with that first reference, from what I've found in the past though more references seem to think that 70mg Vyvanse is equivalent to around 30mg of Adderall XR.


If you put 70mg Vyvanse into adhdmedcalc it'll also spit out 30mg. So that's just what I've always gone off myself.
 
Are we talking worst we've seen today or worst ever? Because if it's the latter I've got some stories...

Most recent cringe was a patient about a month ago I saw for their 2nd F/up after seeing the NP for eval and first follow-up. Patient diagnosed with schizoaffective disorder and started on Olanzapine 10mg for psychosis, Klonopin 1mg BID for anxiety, and Seroquel 50-100mg for sleep. Still "pyschotic" and after the first appointment and was started on Abilify with plan to titrate up that and Olanzapine.

10 minutes into our appointment and it was painfully obvious that the patient had PTSD with a recent exacerbation that was previously untreated. Started Fluoxetine and Prazosin and they were doing much better during our next follow-up earlier this week.
 
Prozac, Ativan, Seroquel, Restoril, Prednisone, Estrogen, Levothyroxine, and Hydroxychloroquine for good measure.
 
calvnandhobbs68 said:
Not saying this is acceptable at all but 70mg Vyvanse is equivalent pharmacologically to around 30ish mg Adderall. So you think those people who put patients on 30mg Adderall TID (which I don’t agree with anyway) probably have no problem justifying to themselves trying to put people on monster doses of Vyvanse.

This looks like a dose titration though, you sure it isn’t med trials automatically generated by the EMR? (Like tried Ritalin, then switched to Vyvanse, then titration up and the EMR is just auto filling all the “active” scripts into the form letter)? You should be able to check the PDMP and see if the persons actually filling all these.
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I wish it was titration, but based on the experience of the last patient on a similar regime from said prescriber it was the total dose given at the first appointment which goes hand in hand with the monster 15 x 10mg/day Ritalin script. My guess it is a physician thing, as I've seen neurologist accelerate lithium doses very quickly for migraines, and pain physicians initiate megadoses of cymbalta with seemingly little regard. My gut feel is that as psychiatrists we're more conservative,although another psychiatrist notorious for similar dubious prescribing habits would tell their patients to take apart and dissolve 70mg Vyvanse in water and increase the dose each day by 10mg until they “noticed something” - with many of those patients ending up on 140mg+/day dosages.
 
I could write a book with all the nonsense I see on a daily basis.

Looking at my schedule today, I have an assessment for a young female who is a recent hospital discharge. She was hospitalized for depression and passive SI. Discharge diagnosis was MDD single episode. Discharge medications include Invega Sustenna 234mg monthly and Abilify 20mg daily (both supposedly for depression).

There is one local doctor who starts almost every single patient on Vraylar mono therapy. MDD, GAD, whatever....Vraylar is the treatment.
 
shahseh22 said:
It's not great, but this is not the worst thing ever. Who knows, maybe the adjustment disorder caused agitation that was so severe it required Abilify or they had already failed so many other meds?

Nothing particularly bad in my day, but I did see Bipolar Diagnosis in a 17 year old treated with just Prozac.
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If you’re so severely agitated you’re requiring antipsychotics you don’t have an adjustment disorder. cycling through various ssris until you land on an antipsychotic to treat an adjustment disorder is also very poor care. We need to stop rationalizing bad care.
 
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About a year ago had an overnight call shift and got paged in the early morning by an IM resident for "med recs" on a 50-something yo woman who had been admitted for AMS (no psych consult from the ER). Friend said they were out and she was just really tired and not minimally responsive to questions. Was initially pissed because why not wait 4 hours until the consult team arrived? Logged into the patients chart and saw her med list:

Abilify, Invega LAI, Seroquel, Xanax, Klonopin, Valium, Ambien, Buspar, Duloxetine, Prozac, Mirtazapine, Adderall IR, Vyvanse, Methadone, and Flexeril. All active prescriptions.

Stared at it for about 5 minutes, then checked the PDMP to confirm that yes, she was filling all of the controlled substances regularly. Called the IM resident to let him know I'd get back to him after talking to an attending, and called the attending. I've seen some bad treatment plans, but this one took the cake and it still blows my mind that a patient could be on all of this. The craziest part was that other than the Methadone almost all the other meds were being prescribed by one person.
 
Another one that sticks out for me was on my inpatient substance rotation. Patient was there for alcohol treatment. Was having panic attacks multiple times per but hadn't had alcohol for several weeks PTA. Patient was seeing a pharmacist through the VA for meds and was initially started on Paxil and trazodone. Patient was still anxious so buspar was added. Then patient was more depressed so Bupropion was added and titrated to 450mg. Then patient was having panic attacks and problems sleeping so PRN seroquel was added. Was still anxious/depressed so for some reason Venlafaxine was added...all of which occurred while the patient was drinking something like a fifth per day.

The med list (Paxil, Effexor, Buspar, Trazodone, bupropion, Seroquel) wasn't the worst on it's own, but the progression of that treatment plan just made me cringe, especially since it was coming from a pharmacist. Stopped the Paxil, Trazodone, and buropion and left the rest. Within a week he said his "panic attacks" were completely gone, no depression, mild anxiety. When he left was only on the Venla + Buspar with a prn for sleep (can't remember what, but I think Hydroxyzine?).
 
Stagg737 said:
About a year ago had an overnight call shift and got paged in the early morning by an IM resident for "med recs" on a 50-something yo woman who had been admitted for AMS (no psych consult from the ER). Friend said they were out and she was just really tired and not minimally responsive to questions. Was initially pissed because why not wait 4 hours until the consult team arrived? Logged into the patients chart and saw her med list:

Abilify, Invega LAI, Seroquel, Xanax, Klonopin, Valium, Ambien, Buspar, Duloxetine, Prozac, Mirtazapine, Adderall IR, Vyvanse, Methadone, and Flexeril. All active prescriptions.

Stared at it for about 5 minutes, then checked the PDMP to confirm that yes, she was filling all of the controlled substances regularly. Called the IM resident to let him know I'd get back to him after talking to an attending, and called the attending. I've seen some bad treatment plans, but this one took the cake and it still blows my mind that a patient could be on all of this. The craziest part was that other than the Methadone almost all the other meds were being prescribed by one person.
Click to expand...
What’s you do for the patient? I think it would be good if we say the regimen then what we did as well
 
Stagg737 said:
About a year ago had an overnight call shift and got paged in the early morning by an IM resident for "med recs" on a 50-something yo woman who had been admitted for AMS (no psych consult from the ER). Friend said they were out and she was just really tired and not minimally responsive to questions. Was initially pissed because why not wait 4 hours until the consult team arrived? Logged into the patients chart and saw her med list:

Abilify, Invega LAI, Seroquel, Xanax, Klonopin, Valium, Ambien, Buspar, Duloxetine, Prozac, Mirtazapine, Adderall IR, Vyvanse, Methadone, and Flexeril. All active prescriptions.

Stared at it for about 5 minutes, then checked the PDMP to confirm that yes, she was filling all of the controlled substances regularly. Called the IM resident to let him know I'd get back to him after talking to an attending, and called the attending. I've seen some bad treatment plans, but this one took the cake and it still blows my mind that a patient could be on all of this. The craziest part was that other than the Methadone almost all the other meds were being prescribed by one person.
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Sounds like she just needed a higher dose of stimulants.
 
Old&InTheWay said:
Sounds like she just needed a higher dose of stimulants.
Click to expand...

Obviously. Nuvigil fixed her right up!

robellis said:
What’s you do for the patient? I think it would be good if we say the regimen then what we did as well
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In all seriousness though, we acutely recommended leaving the scheduled Klonopin and putting her on withdrawal protocol*, continuing the Duloxetine (had dual indication for pain), and seroquel PRN for anxiety and sleep and just to ease the withdrawal. Didn't address the Flexeril and said to f/up with consult team regarding the methadone treatment.
 
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Sushirolls said:
Recently learned form patient they get their migraine botox from their dentist, and apparently also does cosmetic botox, too. But I suppose this isn't a bad regiment just an oddity of specialist...

...must have been a biting headache...
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I am *this* close to opening a psychiatric Medispa - get what ever you want - Teeth Whitening, SkinTyte, Juvederm, CoolSculpting...my Master Aestheticians will do CBT with you (you can even wear a robe) and after 60 minutes, you will be convinced you don't need it.
 
A local pediatrician who sells himself as a mental health expert gives lamictal to any kid (and adult) he sees that essentially has ODD. He has 3 nurse practitioners and his daughter (pediatrician) all are now trained to do the same. No therapy, no parenting advice, just Lamictal. Fail that and it's on to Risperdal with no labs. Then I get them as a child psyc who has to undo all of the BS they have been fed and expect the family to do some actual work.
 
milesed said:
A local pediatrician who sells himself as a mental health expert gives lamictal to any kid (and adult) he sees that essentially has ODD. He has 3 nurse practitioners and his daughter (pediatrician) all are now trained to do the same. No therapy, no parenting advice, just Lamictal. Fail that and it's on to Risperdal with no labs. Then I get them as a child psyc who has to undo all of the BS they have been fed and expect the family to do some actual work.
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Did u report him
 
Recently had an ARNP tell patient they had bipolar and started trileptal. Oh, and the patient is Asian, and they didn't discuss, nor order the HLA-B lab before starting.

Thankfully this patient knew better to discuss with me before starting - not bipolar and definitely doesn't need it.
 
NP maintaining a young patient with anorexia on Wellbutrin and stimulant for ADHD. Also Latuda for some reason (no mood or psychotic disorder), and of course Latuda is not well known for stimulating appetite. It read like the med list a patient with anorexia would ask their doctor for and the NP just gave it.

I occasionally see odd Seroquel dosing as well. For example, 100 mg QAM, 50 mg qNoon, 300 mg QHS, with 50 mg BID PRN. Almost always cluster B, and who is remembering to follow a regimen like this? And they're usually on 3-4 plus other meds from various categories. I think if we as a specialty could draw a hard line at once a day or BID dosing at max, it would be better for patients. What patient is consistently taking meds TID, QID, plus some PRNs?
 
nexus73 said:
NP maintaining a young patient with anorexia on Wellbutrin and stimulant for ADHD. Also Latuda for some reason (no mood or psychotic disorder), and of course Latuda is not well known for stimulating appetite. It read like the med list a patient with anorexia would ask their doctor for and the NP just gave it.

I occasionally see odd Seroquel dosing as well. For example, 100 mg QAM, 50 mg qNoon, 300 mg QHS, with 50 mg BID PRN. Almost always cluster B, and who is remembering to follow a regimen like this? And they're usually on 3-4 plus other meds from various categories. I think if we as a specialty could draw a hard line at once a day or BID dosing at max, it would be better for patients. What patient is consistently taking meds TID, QID, plus some PRNs?
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Some people do manage to do okay with propranolol TID for somatic symptoms of anxiety and obviously with acamprosate you're meant to do TID but outside of rare instances frequent dosing like this is attempting to harness, um, non-specific effects of treatment, let's say.
 
nexus73 said:
NP maintaining a young patient with anorexia on Wellbutrin and stimulant for ADHD. Also Latuda for some reason (no mood or psychotic disorder), and of course Latuda is not well known for stimulating appetite. It read like the med list a patient with anorexia would ask their doctor for and the NP just gave it.

I occasionally see odd Seroquel dosing as well. For example, 100 mg QAM, 50 mg qNoon, 300 mg QHS, with 50 mg BID PRN. Almost always cluster B, and who is remembering to follow a regimen like this? And they're usually on 3-4 plus other meds from various categories. I think if we as a specialty could draw a hard line at once a day or BID dosing at max, it would be better for patients. What patient is consistently taking meds TID, QID, plus some PRNs?
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A long time ago when Paxil CR came out my psychiatrist told me I had to switch to it. I didn't want to for some reason. I honestly can't remember why now. It could have been the cost. Anyhow, I was on 30 mg once a day, and basically as what I saw as a punishment he switched it to 10 mg 3x a day since I wouldn't take Paxil CR. The thing is, I actually did take it that way, even though looking back on it I could have just taken the three 10 mg pills in the morning. As stubborn as I am to make change, I am also scared to not do things in a way that is not officially sanctioned.
 
Sushirolls said:
Recently had an ARNP tell patient they had bipolar and started trileptal. Oh, and the patient is Asian, and they didn't discuss, nor order the HLA-B lab before starting.

Thankfully this patient knew better to discuss with me before starting - not bipolar and definitely doesn't need it.
Click to expand...


Is trileptal for "bipolar" something they teach in all NP schools? Where do they all get this idea...
 
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