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Hey guys I've got a bit of a conundrum here.
I'm on rotation at a large (like 75 pharmacists) teaching institution - on a rotation I set up for myself that is extremely unstructured. Last week I was on an emergency surgery team, most of the patients we saw on rounds were post GI surgery (mostly ex laps). I pre-rounded in the mornings with the CNP and we talked with the patients quite a bit. One complained of not sleeping well - she then told us she was bipolar and had been off her meds her entire hospital stay (5 days at this point- Lithium 300mg bid, Lamictal 50mg qam, 25 mg qpm, Seroquel 50mg qam, 200mg qpm). A couple patients later we deal with a very high strung lady who has been in another hospital since early May but just transferred to ours the night before. She tells us she's been taking Paxil 40mg for anxiety for about 10 years but they didn't have her on it while she was npo.
Those are just two of about 7 patients I saw on this service who I found psych meds (primarily SSRIs) in their h&p's or told us they were agitated or not sleeping well because they weren't getting said meds. So I've taken it upon myself to research this further. Antipsychotics come in injectable and quick-dissolving forms. We have injectable benzos. But what about SSRIs? Say a patient is npo for 2 weeks due to whatever GI thing is going on how do we treat this patient? I've also been looking up after what point do we need to titrate the dose back up or when can we restart at the previous dose. I know some of these are available as solutions and suspensions - but are these viable options if the patient is truly npo?
I'm just looking for some input on this concept in general. I don't think I want to specialize in psych but it seems often overlooked.
I'm on rotation at a large (like 75 pharmacists) teaching institution - on a rotation I set up for myself that is extremely unstructured. Last week I was on an emergency surgery team, most of the patients we saw on rounds were post GI surgery (mostly ex laps). I pre-rounded in the mornings with the CNP and we talked with the patients quite a bit. One complained of not sleeping well - she then told us she was bipolar and had been off her meds her entire hospital stay (5 days at this point- Lithium 300mg bid, Lamictal 50mg qam, 25 mg qpm, Seroquel 50mg qam, 200mg qpm). A couple patients later we deal with a very high strung lady who has been in another hospital since early May but just transferred to ours the night before. She tells us she's been taking Paxil 40mg for anxiety for about 10 years but they didn't have her on it while she was npo.
Those are just two of about 7 patients I saw on this service who I found psych meds (primarily SSRIs) in their h&p's or told us they were agitated or not sleeping well because they weren't getting said meds. So I've taken it upon myself to research this further. Antipsychotics come in injectable and quick-dissolving forms. We have injectable benzos. But what about SSRIs? Say a patient is npo for 2 weeks due to whatever GI thing is going on how do we treat this patient? I've also been looking up after what point do we need to titrate the dose back up or when can we restart at the previous dose. I know some of these are available as solutions and suspensions - but are these viable options if the patient is truly npo?
I'm just looking for some input on this concept in general. I don't think I want to specialize in psych but it seems often overlooked.
