Helping Co-occurring Clients Manage Medications - PowerPoint Presentation

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Helping Co-occurring Clients Manage Medications - PPT Presentation

Presented by Jill S Perry MS NCC LPC CAADC SAP July 19 2017 What does COD Look Like JP Counseling Healing for Adults Youth and Families JP Counseling Healing for Adults Youth and Families ID: 621390

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Slide1

Helping Co-occurring Clients Manage Medications

Presented by

Jill S. Perry, MS, NCC, LPC, CAADC, SAP

July 19, 2017Slide2

What does COD Look Like?

JP Counseling

Healing for Adults, Youth and FamiliesSlide3

JP Counseling

Healing for Adults, Youth and FamiliesSlide4

JP Counseling

Healing for Adults, Youth and FamiliesSlide5

Poison Control

1-800-222-1222

From anywhere in the U.S.Slide6

DefinitionsSlide7

Psychotropic

From the Greek

psycho (the mind)

+ trop (a turning) = (capable of) turning the

mindSlide8

Food & Drug Administration (FDA)

Responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, as well as our food supply, cosmetics, and products that emit radiationSlide9

"Off Label"

Use

A health care provider may choose a medication that has not been officially approved by the U.S. Food and Drug Administration (FDA) for

a particular use. Some insurance companies may

not pay for an “off label” medication use.The health care provider may have to complete a Prior Authorization form and receive approval prior to you being able to pick up the medication from the pharmacy. Slide10

Black Box

Warnings

he sternest warning by the U.S. Food and Drug Administration (FDA) that a medication can carry and still remain on the market in the United StatesAppears

on the label of a prescribed medication to alert you and your healthcare provider about any important safety concerns, such as serious side effects or life-threatening risksAlso known as a “black label warning” or “boxed warning,” is named for the black border surrounding the text of the warning that appears on the package insert, label, and other literature describing the medicationSlide11

Black Box

Warnings

The FDA requires a black box warning for one of the following situations:

The medication can cause serious undesirable effects (such as a fatal, life threatening or permanently disabling adverse reaction) compared to the potential benefit from the drug.

A serious adverse reaction can be prevented, reduced in frequency, or reduced in severity by proper use of the medication. For example, a medication may be safe to use in adults, but not in children.Slide12

Autonomic Nervous System (ANS)

Division of the peripheral nervous system that influences the function of internal organs.

The “Control System” that acts largely unconsciously and regulates bodily functions such as heart rate, digestion, respiratory rate, pupillary response, urination and sexual arousal.Slide13
Slide14

Neurotransmitters

Chemical

messengers

used to communicate between brain cellsSlide15

Serotonin

One of

the chemical messengers (neurotransmitters) that carry signals between brain cellsSlide16

Gamma-Aminobutyric Acid (GABA)

Neurotransmitter that blocks impulses between nerve cells in the brain. Low levels of GABA may be linked to:

Anxiety or mood disorders

Epilepsy

Chronic painSlide17

Most Common Health Conditions Requiring Prescription Medication

Pain

High Cholesterol

High Blood PressureHypothyroidismGERD

InfectionDiabetes (primarily type 2)Slide18

Selective Serotonin Reuptake Inhibitors (SSRI)

Most commonly prescribed antidepressants

Minimal side effects

Eases depression by increasing levels of serotonin in the brainSSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmittersSlide19
Slide20

SSRIs

may take several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. You may need to try several dose adjustments or different antidepressants before you find the right oneMost side effects go away within few

weeksSSRIs differ in chemical makeup so if you can’t tolerate one, you may tolerate anotherSlide21

SSRIs

be used to treat conditions other than depression, such as anxiety disorders.FDA has approved these SSRIs to treat depression:Citalopram (

Celexa)Escitalopram (Lexapro)Fluoxetine (Prozac) == also approved for OCDParoxetine (Paxil, Pexeva)Sertraline (Zoloft)Vilazodone (Viibryd)Slide22

SSRIs

Possible side effects of SSRIs may include, among others:

Drowsiness

NauseaDry mouthInsomniaDiarrhea

Nervousness, agitation or restlessnessDizzinessSexual problems, such as reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction)HeadacheBlurred visionSlide23

SSRIs

Drug interactions.

When taking an antidepressant, tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you're taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal supplements

.Abnormal bleeding with certain pain relievers (aspirin, ibuprofen [Motrin, Advil], naproxen [

Naprosyn, Aleve], and blood thinners such as warfarin [Coumadin])Slide24

MariaSlide25

Serotonin syndrome

Rarely, an antidepressant can cause high levels of serotonin to accumulate in your body. Serotonin syndrome most often occurs when two medications that raise the level of serotonin are combined. Slide26

Serotonin Syndrome

Prescription & over-the-counter (OTC) drugs that can raise serotonin levels alone or in combination to cause

serotonin syndrome

include:Serotonin & norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine

succinate (Pristiq)Monoamine oxidase inhibitors (MAOIs): phenelzine (Nardil)Buspirone (Buspar) used for anxiety disordersDesyrel (Trazodone) used for depression or insomniaMigraine treatments: almotriptan (Axert), Amerge (naratriptan), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)Slide27

Serotonin Syndrome

Certain pain medications

including fentanyl , fentanyl citrate,

meperidine (Demerol), and tramadol (Ultram)Dextromethorphan , a cough suppressant found in many over-the-counter and prescription cough medicines or cold medicinesCertain medications prescribed for nausea, such as metoclopramide (Reglan), and ondansetron (Zofran)Antidepressants that affect multiple serotonin receptors, such as vortioxetine (Trintellix -formerly Brintellix) and vilazodone (Viibryd)Some illegal drugs, such as LSD and cocaineDietary supplements, including St. John's wort and ginsengSlide28

Serotonin Syndrome

People with serotonin syndrome are typically hospitalized for observation and treatment of symptoms. For example, benzodiazepines are given to treat agitation and/or

seizures

. Intravenous fluids are given to maintain hydration. Removing the drug responsible for the serotonin syndrome is critical.

Hydration by intravenous (IV) fluids) is also common. In severe cases, a medication called cyproheptadine (Periactin) that blocks serotonin production may be used.Slide29

Antidepressants and Pregnancy

Talk

to your doctor about the risks and benefits of using specific antidepressants. Some antidepressants may harm your baby if you take them during pregnancy or while you're breast-feeding. If you're taking an antidepressant and you're considering getting pregnant, talk to your doctor about the possible risks. Don't stop taking your medication without contacting your doctor first, as stopping might pose risks for you.Slide30

Suicide Risk

and

Antidepressants

Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings. In some

cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.Slide31

Discontinuation Syndrome

SSRIs aren't considered addictive. However, stopping antidepressant treatment abruptly or missing several doses can cause withdrawal-like symptoms.

Work

with your doctor to gradually and safely decrease your dose.Withdrawal-like symptoms can include:General feeling of uneasiness

NauseaDizzinessLethargyFlu-like symptomsSlide32
Slide33

Serotonin & Norepinephrine Reuptake Inhibitors (SNRI)

Help relieve

depression symptoms, such as irritability and sadness, but some are also used for anxiety disorders and nerve pain

.Ease

depression by impacting neurotransmittersWork by ultimately effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression.Slide34

SNRIs

orepinephrine and Noradrenaline are different names for the same neurotransmitter. N

orepinephrine has multiple rolesIt relays messages in the autonomic nervous system's fight-or-flight responseNorepinephrine prepares the brain to encounter and respond to stimuli from the environment, thereby facilitating vigilanceIn both roles, norepinephrine mediates arousal.Slide35
Slide36

SNRIs

Desvenlafaxine

(

Pristiq, Khedezla)Duloxetine (Cymbalta) ― also approved to treat anxiety and certain types of chronic painLevomilnacipran

(Fetzima)Venlafaxine (Effexor XR) ― also approved to treat anxiety and panic disorderSlide37

SNRIs

Side effects are usually mild and go away after the first few weeks of treatment. Taking your medication with food may reduce nausea. If you can't tolerate one SNRI, you may be able to tolerate a different one, as each SNRI varies in chemical makeup

The most common possible side effects of SNRIs include:Nausea

Dry mouthDizzinessHeadacheExcessive sweatingSlide38

SNRIs

Other possible side effects may include:

Tiredness

ConstipationInsomniaChanges in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction)

Loss of appetiteIncreased blood pressureWorsening of liver problemsSlide39

SNRIs

SNRIs may increase your risk of bleeding, especially when you're taking other medications that also increase the risk of bleeding, such as aspirin or warfarin (Coumadin,

Jantoven

).Serotonin syndrome

Antidepressants and pregnancy: Some antidepressants may harm your baby if you take them during pregnancy or while you're breast-feeding.Slide40

GeorgeSlide41

SNRIs

enerally safe

but the FDA requires that all antidepressants carry black box warnings. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.Slide42
Slide43

Discontinuation Syndrome

Withdrawal-like symptoms can include

DizzinessHeadache

Flu-like symptoms, such as tiredness, chills and muscle achesIrritability or agitationNauseaDiarrheaSlide44

Monoamine oxidase inhibitors (MAOI)

irst

type of antidepressant developedGenerally been replaced by antidepressants that are safer and cause

fewer side effects.Requires diet restrictions because they can cause dangerously high blood pressure when taken with certain foods or medications.ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants, MAOIs work by ultimately effecting changes in the brain chemistry that are operational in depression.

ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants,

MAOIs

work by ultimately effecting changes in the brain chemistry that are operational in depression.

Slide45

MAOIs

Eases depression by impacting neurotransmitters used to communicate between brain cells.

Work most effectively by changing the brain chemistry that are operational in depression.

An enzyme called monoamine oxidase is involved in removing norepinephrine, serotonin and dopamine from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available to effect changes in both cells and circuits that have been impacted by depression.

MAOIs are sometimes used to treat conditions other than depression, such as Parkinson’s Disease.Slide46

MAOIs

The FDA has approved these MAOIs to treat depression:

Isocarboxazid

(

Marplan)Phenelzine (Nardil)Selgiline (Emsam)—transdermal (skin) patch which may cause few side effects Tranylcypromine (Parnate)Slide47

MAOIs

Diet restrictions include foods high in tyramine that can cause serious spike in blood pressure:

Strong or aged cheeses

Cured meats

Smoked or processed meatsPickled or fermented foodsSoy based saucesSoybeansSnow peas, broad beans (fava beans) and their podsDried or overripe fruitsMeat tenderiziersSlide48
Slide49

MAOIs

Side effects:

Dry mouth

Nausea, diarrhea or constipationHeadacheDrowsinessInsomnia

Dizziness or lightheadednessSkin reaction at the patch siteSlide50

MAOIs

Other possible side effects:

Involuntary muscle jerks

Low blood pressureReduced sexual desire or difficulty reaching orgasmWeight gain

Difficulty starting a urine flowMuscle crampsPrickling or tingling sensation in the skin (paresthesia)Slide51

JaneSlide52

MAOIs

Serotonin Syndrome

Antidepressants

and pregnancy: Some antidepressants may harm your baby if you take them during pregnancy or while you're breast-feeding

.Drug Interactions: Other antidepressantsCertain pain drugsCertain cold & allergy medicationsSome herbal supplements Slide53

MAOIs

Generally safe but the FDA requires that all antidepressants carry black box warnings. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed

Discontinuation Syndrome

Stopping treatment with MAOIs can cause flu-like symptoms, including anxiety, agitation, insomnia, sweating, chills, nausea, headache, and generally feeling unwell (malaise)

Rarely, addition withdrawal symptoms may occur including:

Confusion

Detachment from reality (psychosis)ConvulsionsSlide55

Discontinuation Syndrome

You may need to wait two or more weeks between the use of MAOIs and other antidepressants to avoid serotonin syndrome. During those two weeks, continue with food and beverage restrictions and avoid taking drugs that can cause interactions with MAOIs.Slide56

Anxiety Meds

Generalized anxiety disorder

(

GAD)

PhobiasObsessive-compulsive disorder(OCD)Post-traumatic stress disorder(PTSD)Panic disorder (PD)Social anxiety disorder (SAD)Slide57

Anxiety Meds

Antidepressants

and

anxiolytic medications work primarily by affecting the balance of serotonin, norepinephrine and GABA.

Beta-blockers and other types of drugs are used to address the physical symptoms that may accompany an anxiety attack by blocking the receptors that are associated with some of the physiological symptoms of anxiety -- including rapid heartbeat.First-generation antihistamines are also used to help with anxiety symptoms because they have a sedating effect.Slide58

Anxiety Meds

SSRIs

are the first-line for treating most types of anxiety, including:

Panic disorder

Obsessive-compulsive disorderSocial anxiety disorder, general anxiety disorderPost-traumatic stress disorderSlide59

Anxiety Meds

Tricyclic antidepressants

are used in treating:Panic disorder

Post-traumatic stress disorderGeneral anxiety disorder. Clomipramine (Anafranil), may also be used to treat obsessive-compulsive disorder.Slide60

Anxiety Meds

MAOIs

are used

for:Panic disorderSocial

anxiety disorderPost-traumatic stress disorderSlide61

Anxiety Meds

Buspirone

(BuSpar), an anti-anxiety drug, is used in the treatment of general anxiety disorder. Buspirone

(BuSpar) enhances the activity of serotonin. Large amounts of grapefruit juice may increase blood levels of buspirone. First-generation antihistamines, such as diphenhydramine, can be used to treat general anxiety disorder. The antihistamine hydroxyzine (Atarax, Vistaril), has a sedative effect by blocking certain receptors in the brain.Slide62

Anxiety Meds

enzodiazepines

are used to treat:General anxiety

disorderSocial anxiety disorderPanic disorder. Benzodiazepines act on the neurotransmitter gamma aminobutyric acid (GABA).Benzodiazepines should not be abruptly stopped because of the risk of seizures and other serious side effects. It is dangerous to combine benzodiazepines with other central nervous system depressants, including alcohol. Doing so may cause profound drowsiness and/or impair breathing. Those who have breathing difficulties such as sleep apnea or chronic obstructive pulmonary disease (COPD) should not use benzodiazepines.Benzodiazepines frequently cause drowsiness; therefore, care should be taken when operating machinery or motor vehicles.Slide63

Benzodiazepines

Alprazolam (

Xanax

®)

Clonazepam (Klonopin®) Diazepam (Valium® and Distat®)Slide64

Anxiety Meds

Alprazolam

increases blood levels of the antidepressants imipramine and

desipramine. Alprazolam may also interact with some calcium channel blockers and with grapefruit juice. Carbamazepine decreases blood levels of

alprazolam.Combining benzodiazepines with alcohol or other central nervous system depressants can cause increased sedation and potentially dangerous respiratory depression.Fluoxetine, propoxyphene, and oral contraceptives increase blood levels of alprazolam (Xanax), as do ketoconazole, itraconazole, nefazodone, fluvoxamine, and erythromycin.Slide65

SallySlide66

Anxiety Meds

Beta-blockers, such as propranolol, are used to

treat:

Performance anxiety, a kind of social anxiety

disorderSometimes used for panic disorder. off-label uses for treating panic disorders They may also have some use in PTSDSlide67

Anticonvulsants as Anxiety Meds

Gabapentin (Neurontin)

is an anticonvulsant used to treat anxiety.

It may affect blood levels of hydrocodone and

morphine. Gabapentin levels can decrease when given with the antacid Maalox. Allow 2 hours between the drugs.The following medications significantly decrease blood levels of some anticonvulsants:Oral contraceptivesPhenobarbitalSlide68

Stimulants

rescribed

to treat children, adolescents, or adults diagnosed with ADHDIncrease alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration

Stimulants used to treat ADHD include:Methylphenidate (Ritalin)Amphetamine Dextroamphetamine (Adderall, Dexedrine)Lisdexamfetamine Dimesylate (Vyvanse)Slide69

Stimulants

lso

prescribed to treat other health conditions, including:NarcolepsyOccasionally depression (especially in older or chronically medically ill people and in those who have not responded to other treatments

)Research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications.Slide70

Stimulants

Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include:

Difficulty falling asleep or staying asleep

Loss of appetiteStomach painHeadache

Less common side effects include:Motor tics or verbal tics (sudden, repetitive movements or sounds)Personality changes, such as appearing “flat” or without emotionSlide71

Mood Stabilizers

sed

primarily to treat:Bipolar disorderM

ood swings associated with other mental disordersTo augment the effect of other medications used to treat depression.Work by decreasing abnormal activity in the brain and are also sometimes used to treat:Depression (usually along with an antidepressant)Schizoaffective DisorderDisorders of impulse controlSlide72

Mood Stabilizers

everal

side effects, and some of them may become serious, especially at excessively high blood levels. These side effects include:Itching, rashExcessive thirstFrequent urination

Tremor (shakiness) of the handsNausea and vomitingSlurred speechFast, slow, irregular, or pounding heartbeatBlackoutsChanges in visionSeizuresHallucinations (seeing things or hearing voices that do not exist)Loss of coordinationSwelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.Slide73

Mood Stabilizers

Cause damage to the liver or pancreas, so people taking it should see their doctors

regularly

Increase testosterone (a male hormone) levels in teenage girls and lead to a condition called polycystic ovarian syndrome (a disease that can affect fertility and make the menstrual cycle become irregular)

Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression may interact badly with anticonvulsantsSlide74

Anticonvulsants as Mood Stabilizers

Originally developed

to treat seizures, but they were found to help control unstable moods as

wellMost commonly used as a mood stabilizer is

valproic acidFor some people, especially those with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than lithiumSlide75

Anticonvulsants as Mood Stabilizers

Some possible side effects linked anticonvulsants (such as

valproic

acid) include:Drowsiness

DizzinessHeadacheDiarrheaConstipationChanges in appetiteWeight changesBack painAgitationMood swingsAbnormal thinkingUncontrollable shaking of a part of the bodyLoss of coordinationUncontrollable movements of the eyesBlurred or double visionRinging in the earsHair lossSlide76
Slide77

Pain Medications

Work by blocking pain signals going to the brain of by interfering with the brain’s interpretation of the signals

Most painkiller use isn’t

misuse

Effective to treat residual pain after surgery, as well as chronic painHighly habit-forming Deadly at high doses or in conjunction with other drugsSlide78

Pain Medications

Celebrex (celecoxib): Arthritis, short term pain, painful menstruation

Ultram (tramadol): schedule IV controlled substance (low potential for abuse; limited physical or psychological dependence—as compared to other substances in other classifications)

Demerol (meperidine

HCl)Lorcet (hydrocodone bitartrate & acetaminophen)Vicodin (hydrocodone & acetaminophen)Slide79

Pain Medications

Norco (hydrocodone

bitartrate

& acetaminophen)Percocet (oxycodone & acetaminophen)Percodan (aspirin & oxycodone hydrochloride)

Oxycontin (oxycodone HCl)Opana (oxymorphone)/Opana ERSlide80

Pain Medications

Contin

(morphine sulfate)Fentanyl (Actiq)Dilaudid

(hydromorphone)Slide81

Pain Medications

More than 1 in 3 American adults – 35%-- were given painkiller prescriptions by medical providers last year.

More American adults used prescription painkillers than cigarettes, smokeless tobacco or cigars

combined

Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men. Women may become dependent on prescription pain relievers more quickly than menSlide82

Pain Medications

Opioid painkillers killed nearly 19,000 Americans in 2014

That number is greater than the number of Americans murdered in 2015 (15,809)

2008: Americans consume about 80% of global opioid supply and 99% of supply of hydrocodoneSlide83

Reason for Using Prescription Pain

Relievers

Easy to get from parents' medicine cabinets--62%

Available everywhere--52%

They are not illegal drugs--51%Easy to get through other people's prescriptions--50%Teens can claim to have a prescription if caught--49%They are cheap--43%Safer to use than illegal drugs--35%Less shame attached to using--33%Easy to purchase over the Internet--32%Fewer side effects than street drugs--32%Can be used as study aids--25%Parents don't care as much if you get caught--21%Slide84

BradySlide85

Herbal Products

Ginkgo Biloba: improve cognitive functioning and blood flow

St. John’s Wort: anxiety and depression

Ephedra: weight-loss “herbal fen-phen”; decongestants, bronchodilators and stimulants, “herbal ecstacy

”—euphoric state and heightening of awareness & sexual sensationsGinseng: strengthen normal body functions, increase resistance to stress & improve sexual functionKava: antianxiety & calming effectsSlide86

Herbal Products

HERBAL PRODUCT

SIDE EFFECTS

Ginkgo biloba

BleedingSt. John's wortGastrointestinal disturbances, allergic reactions, fatigue, dizziness, confusion, dry mouth, photosensitivityEphedra (ma huang)Hypertension, insomnia, arrhythmia, nervousness, tremor, headache, seizure, cerebrovascular event, myocardial infarction, kidney stones

Kava

Sedation, oral and lingual dyskinesia, torticollis, oculogyric crisis, exacerbation of Parkinson's disease, painful twisting movements of the trunk, rash

Side Effects of Select Herbal ProductsSlide87

Herbal Products

HERBAL PRODUCT

INTERACTING DRUGS

Ginkgo biloba

Aspirin, warfarin (Coumadin), ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine)St. John' s wortAntidepressantsEphedraCaffeine, decongestants, stimulants

Ginseng

Warfarin

Kava

Sedatives, sleeping pills, antipsychotics, alcohol

Drug Interactions with Herbal ProductsSlide88

OscarSlide89

Herbal Products

Are you taking an herbal product, herbal supplement or other “natural remedy?”

If so, are you taking any prescription or nonprescription medications for the same purpose as the herbal product?

Have you used this herbal product before?

Are you allergic to any plant products?Are you pregnant or breast-feeding?Questions to Ask Patients Who May Be Taking Herbal ProductsSlide90

Medication-assisted treatment

Medication

Counseling

Support

Often the best option for today’s opioid addictionSlide91

Medication-Assisted Treatment (MAT)

Opioids

Methadone/

BuphrenorphineActs on the same targets in the brain as heroin and morphine; suppresses withdrawal symptoms and relieves cravings

NaltrexoneBlocks the effects of opioids at their receptor sites in the brainShould only be used in patients who have already been detoxedSlide92

MAT

Methadone

Daily methadone dose determined by the program physician based upon a physical exam and the individual’s history

Administered only in oral form and dosing is initially observed by medical staff

Each individual must receive a minimum of 2.5 hours of counseling/month12-month minimum treatment recommended for maintenanceSlide93

MAT

Buprenorphine

Physicians must request a special certification to prescribe

Subutex

: primarily for pregnant womanSuboxone (Buprenorphine & Naloxone)Buprenex (injectable available)Butrans (7 day transdermal patch)Slide94

Buprenorphine O

verdose

The risk of overdose and death is increased when

suboxone is combined with other drugs, such as

alcohol and benzodiazepines, to give a more intense high. Seek immediate medical treatment if you experience the following symptoms:Profound drowsiness.Intermittent loss of consciousness.Lack of coordination.Slurred speech.Vision problems.Slowed breathing.Sluggish reflexes.Slide95

MAT

Naloxone

Revia

(daily pill)

Vivitrol (monthly injection)Slide96

ValerieSlide97

MAT

Alcohol

Naltrexone: Blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol

Acamprosate

(Campral): May reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness and dysphoriaDisulfiram (Antabuse): Interferes with the breakdown of alcohol. Leads to unpleasant reactions that include flushing, nausea, and irregular heartbeat if the patient drinks alcoholSlide98

Slide99

Naloxone (Narcan

)

Opioid overdose reversal

Opioid antagonist: binds to opioid receptors and can reverse and block the effects of other opioids

Can restore normal respiration to someone whose breathing has slowed or stopped as a result of overdosingInjectable or Nasal SprayStanding Order in PASlide100

StanleySlide101

Special PopulationsSlide102

Children & Adolescents

Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents

Still, a doctor can give a young person an FDA-approved medication on an "off-label" basis. Slide103

Children & Adolescents

Children may have different reactions and side effects than adults

Some medications have current FDA warnings about potentially dangerous side effects for younger patients. Slide104

SkylerSlide105

Older Adults

People over 65 have

higher risk for experiencing bad drug interactions, missing doses, or overdosing.Older adults also tend to be more sensitive to medications. Even healthy older people react to medications differently than younger people because older people's bodies process and eliminate medications more slowly. Slide106

Older Adults

Older adults p

urchase more than 30 percent of all prescription medication and more than 40 percent of over the counter (OTC) medicines. Estimates are that as many as 90 percent of seniors use either herbal remedies or vitamins.

Seniors take an average of four to five medications on a daily basis.Slide107

Women Who Are Pregnant or Who May Become Pregnant

The research on the use of psychiatric medications during pregnancy is

limited

There are different

risks depending on which medication is taken and at what point during the pregnancy the medication is takenSlide108

Women Who Are Pregnant or Who May Become Pregnant

Most women should avoid certain medications during pregnancy. For example

Mood stabilizers are known to cause birth defects.

Benzodiazepines and lithium have been shown to cause "floppy baby syndrome," in which a baby is drowsy and limp, and cannot breathe or feed well. Benzodiazepines may cause birth defects or other infant problems, especially if taken during the first trimester.Slide109

Women Who Are Pregnant or Who May Become Pregnant

According

to research, taking antipsychotic medications during pregnancy can lead to birth defects, especially if they are taken during the first trimester and in combination with other drugs, but the risks vary widely and depend on the type of antipsychotic taken. The conventional antipsychotic haloperidol has been studied more than others, and has been found not to cause birth defects. Research on the newer atypical antipsychotics is ongoing.Slide110

Women Who Are Pregnant or Who May Become Pregnant

Antidepressants, especially SSRIs, are considered to be safe during pregnancy. However, antidepressant medications do cross the placental barrier and may reach the fetus. Birth defects or other problems are possible, but they are very rare. The effects of antidepressants on childhood development remain under study

.Slide111

Women Who Are Pregnant or Who May Become Pregnant

Studies have also found that fetuses exposed to SSRIs during the third trimester may be born with "withdrawal" symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (low blood sugar). Most studies have found that these symptoms in babies are generally mild and short-lived, and no deaths have been reported. Risks from the use of antidepressants need to be balanced with the risks of stopping medication; if a mother is too depressed to care for herself and her child, both may be at risk for problems.Slide112

Women Who Are Pregnant or Who May Become Pregnant

omen

who nurse while taking psychiatric medications should know that a small amount of the medication passes into the breast milk. However, the medication may or may not affect the baby depending on the medication and when it is taken

. Slide113

TammySlide114

Members Of Specific Cultural Groups

Certain

ethnic groups respond differently to medication, though more research is needed.

African

Americans and some Asian Americans, for instance, metabolize some medications more slowly than Caucasians. They are thus at increased risk of certain side effects and may benefit from lower dosages. For many ethnic groups treatment is also complicated by language barriers, socio-economic stresses, lack of minority health care professionals and stigma.Slide115

Managing Meds

edication

must be actively managed, particularly in respect to coping with side effects. Difficulty coping with unpleasant side-effects is a common reason for people coming off their

medication.To guard against an interaction, make a list of all medications, vitamins and herbal remedies.Beside each medication, write the contact information of the physician who prescribed the medicine.Slide116

Who Should Prescribe Mental Health and/or Pain Medications

Primary Care Physician (PCP)

Psychiatrist

Pain SpecialistAddictionologistSlide117

DominicSlide118

Managing Meds

Avoid Pharmacy

Shopping

Poly-pharmacy, the “technical” name for pharmacy shopping, is often a source of confusion and drug interactions. Throw Away Outdated

MedicinesBorrowing or Lending MedicinePrescription medication should never be taken by anyone else than for whom it was intended. Other individuals have special medical histories and may also be taking other medicines that can cause serious drug interactions.Slide119

Managing Meds

Don’t Skip

Doses to Save Medication

Check, Check, and RecheckBefore taking a medication, double-check the label to be sure that you are taking it according to your doctor’s

instructionsTry to take your pills at the same time each day and pick a time when you are almost always home (for example, when you wake up in the morning or when you go to sleep at night).Slide120

Managing Meds

Set automated reminders. You can set a daily alarm on your cell phone or computer. Many free online calendars allow you to set daily email or text message alerts (e.g., Google Calendar).

Carry

a record of your medications with you by using our Medication Wallet Reminder Card.Slide121

Talking to Your Doctor

you are prescribed a medication, be sure that you:

Tell the doctor about all medications and vitamin supplements you are already taking.Remind your doctor about any allergies and any problems you have had with medicines.

Understand how to take the medicine before you start using it and take your medicine as instructed.Don't take medicines prescribed for another person or give yours to someone else.Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.Slide122

Compliance

In the past when doctors treating mental health conditions were seen

the authority figures, they used to use the term “compliance” to describe how good a patient was at taking their medication. It is now recognized

that compliance tends to be a problem for all people with long-term medical conditions whether their conditions are mental or physical.Studies have shown that compliance with medication is no worse in mental health conditions like schizophrenia than it is in long term physical ailments such as asthma or high blood pressure.Demographic factors such as whether you are single or in a relationship are more likely to play a role in your compliance.Slide123

1. Get on to the right medication for you.

Doctors have a range of medications available to them and different drugs will work in different ways. If the side effects you are experiencing with the drug are so serious that they are making life unpleasant then discuss with your doctor the possibility of changing to a different medicine.Slide124

2. Change the dose of the medication

aim with medication is to always be taking the optimum dose: that is the dose that gives you the maximum beneficial effect with the fewest side effects. If the side effects are making life unpleasant and you think that you have got as good as you are going to get with the symptoms then think about asking your doctor to try reducing the dose for a trial period to find out if the side effects can be reduced without the symptoms

returning.Slide125

3. Keep on taking the medication

may sound paradoxical but coming off your medication without first planning it with your doctor can actually lead to an increase in side effects.

It is important that you continue to take this low dose even when you are feeling fine and are symptom free. If you stop taking the maintenance dose you will risk a relapse and would then need to be treated with a much higher dose which in turn would have much worse side effects than the maintenance dose.Slide126

4. Treat the side effects of the medication

Many

side effects can be successfully overcome by treating them with other drugs.

Anxiety can be treated with anti-anxiety drugs called

anxioliticsNausea can be treated with over-the-counter anti-sea sickness preparationsSleep disruption can be eased with one of the sedating antihistaminesMen with sexual side effects may be treated with medications such as Viagra.Some people also find traditional herbal remedies Slide127

4. Treat the side effects of the medication

If your medicine upsets your

stomach

, ask your doctor if you should take it with a meal or if the risk may be less with a brand rather than a generic form of a drug.If your

medicine makes you sleepy during the day or keeps you awake at night, ask your doctor what time of day you should take it. By taking your medicine first thing in the morning or right before bed, you might diminish some of the unwanted effects.Don't take psychotropic medicines with alcohol. Alcohol can affect how well the medicine works, cause sedation, and possibly worsen depression, anxiety and other mental health issues.Slide128

Priapism: A Painfully Hard Topic

ondition

in which a penis remains erect for hours in the absence of stimulation or after stimulation has endedSlide129

5. Find out as much as you can about your diagnosis

more you know about a problem the better you will be able to cope with it. Slide130

6. Join a support group

This

is one area where support groups can prove very useful. Joining a support group for people with similar problems will give you the chance to talk about side effects with other people who have also experienced them and have found their own way of coping.Slide131

Cognitive Behavioral Therapy (CBT) for Improved Med Compliance

Inquire as to patients’ previous experience with medication.

Ask about prior history

Why was it prescribed?Was it helpful?Under what conditions was it terminated?

Did they take med as prescribed?Slide132