Note To Attending Physician/Prescriber Personal Consult Physician: Physician, Unassigned This review is based on the information provided. Background Patient with dementia and behaviors and now non-responsive, will not talk, does not interact per family. Recent psych admission d/t behaviors likely related to her dementia. On Exelon Patch, Ativan prn, Seroquel prn, Trazadone, Namenda
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Vaisef conference• Child, Adolescent and Adult Psychiatry • Medical Director – The Child & Family • Voluntary Faculty – Virginia Commonwealth University (Psychiatry in Family Practice) • Voluntary Faculty – George Washington University School of Medicine (4th Year Medical Students) • Voluntary Faculty – Georgetown Medical School • To become familiar with the different classes of medications, their effects and indications for use • To know common side effects, and how these may manifest in a school or classroom setting • To understand the difference between “On label” and “Off label” use of medications • To understand the differences in the use of these medications in children and adults, as well as the research that supports their use (or not) • Talking about medications is NOT instead • This is not an endorsement of “ a happy • The assumption here is that you want to know what is going on with your students’ medical treatments, not that you want them to be on these medications • Dextroamphetamine Sulfate (Dexedrine, Dextrostat, Dexedrine Spansules, Vyvanse) • Oral – Ritalin (LA), Concerta, Metadate • Side effects – loss of appetite, weight loss, trouble falling asleep, tics, rebound hyperactivity, irritability headaches, stomach upset • Medication effects wearing off during class can result in the loss of control over attention and behavior • Communicating this clearly to parents is vitally useful to proper management of the medication • Atamoxetine (Strattera) • Side effects – stomach upset, nausea, • Alpha Agonists -Clonidine (Catapres, • Side effects – sedation, low blood • Bupropion (Wellbutrin) • Side effects – loss of appetite, tremors, • Magnesium Pemoline (Cylert) • Side effects – nausea, liver toxicity • Stimulants and Strattera are approved for • All of the rest are non-approved, but often • Do anti-depressants work in children? • What is our experience in the field? • Selective Serotonin Reuptake Inhibitors (SSRI’s) – fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro) • Side effects of the class – weight gain, • Activation in younger children • Suicidal Ideation • Dual action agents – Effexor, Cymbalta • Side effects – nausea, blurred vision, dizziness, sedation, constipation, withdrawal symptoms with sudden stopping • Tricyclic antidepressants (TCA’s) – Imipramine (Tofanil), desipramine (Norpramine), nortriptyline (Pamelor), amitrptyline (Elavil), protryptyline, maprotiline • Side effects – dry mouth, constipation, blurry vision, heart rhythm effects, urinary retention • Mono Amine Oxidase Inhibitors (MAOI’s) - • Side effects – rarely used because of risk of hypertensive crisis and need for strict dietary control • SSRI’s – for Panic Disorder, Separation Anxiety, • Non-SSRI’s – chlomipramine (Anafranil) – for • Benzodiazepines – Xanax, Ativan, Klonopin, • Side effects – habituation, tolerance, addiction • Buspirone (Buspar) – for generalized anxiety • Side effects – sedation, dry mouth • Antihistamines – Benadryl (Diphenhydramine), Attarax (Hydroxyzine) – as first line agent, especially in younger children • Side effects – sedation, dry mouth, constipation • Having said that, let’s talk about medications for mood regulatory problems • First ever treatment for mood regulatory • Helped make the differentiation of Bipolar • Side effects – tremors, nausea, vomiting, • Frequent urination, tremors, acne and impaired • Water is the antidote, because Lithium is a salt! (Tegretol), Oxycarbamazepine (Trileptal) • Side effects – nausea, weight gain, effects • Lamotigene (Lamictal) • Side effects – rash is only major concern Atypical anti-psychotics, aka Major Tranquilizers • Multiple use agents – tics, schizophrenia, Pimozide (Orap), fluphenizine (Proloxin) (Stellazine), perphenazine (Trilafon), thiothixine (Navane), loxapine (Loxitane) mesoridazine (Serentil), thioridazine (Mellaril), chlorpromazine (Thorazine) • Rare use now • Controversial, given recent research showing equal or better effects to second generation agents • Side effects – muscle stiffness, sedation, • Second generation antipsychotics – (Clozaril), Olanzepine (Zyprexa), Quietapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify) • Common Side effects for the class – • Metabolic Syndrome – weight gain, diabetes, cholesterol and triglyceride elevations • Sedation, impaired cognition, lethargy, • ON LABEL • Risperidone (Risperdal) • Abilify (aripiparazole) • OFF LABEL • All other second and first generation • Side effects – daytime sedation, tolerance • Eneuresis – DDAVP, Imipramine • Side effects – are the desired effects increasing frequency, increasing effectiveness, and increasing sloppiness. • They are neither automatically good or • They are NEVER the only answer, but can • The use of medications in children and adolescents is receiving more scrutiny of late, but not more research! • Working with the doctors of your students creates a collaboration that is to the good of the student.
LNP Magazine - Anno 4 - Numero 295 Domenica, 11 Gennaio 2009 Ideato e realizzato da ITALIAN MADE SERIE A DILETTANTI 2008/09 - Girone A - 14a Giornata I RISULTATI DELLA 14a GIORNATA Incontri / Risultato Top Scorer VemSistemi Forli-Banco Sardegna Cagliari 89-69Intertrasport Treviglio-Tirreno Power Vado 94-57Nobili SBS Castelletto-PentaGruppo Ozzano 87-88Assigeco Casalpu