Microsoft word - psychotropic_template_jan09.doc

P.I.E.C.E.S. Psychotropic Template
Three-Question Framework for Selection and the Detection, Monitoring the Use, Risk, and Benefits of Psychotropics
1. When should a psychotropic be used or considered? 2. How do I select the right medication? Important Note:
3. How do I monitor the response and side effects (with person, family, providers)? Withdrawal symptoms are associated with many Are the benefits outweighing the risks and side effects (to this treatment vs. other treatments)?? psychoactives, including SSRIs (flu-like symptoms). ; How long is the medication to be used, and when is it to be reviewed? The dose must be reduced slowly and the status ; What are the indicators for increasing or decreasing the medication? If no response, consider non-adherence, wrong diagnosis, wrong dose, or not enough time. Preferred choices, starting doses
Side Effects
Notes & max. recomm. doses
Headache, Agitation, Nausea, Diarrhea
Sweating, Somnolence
Paroxetine, fluoxetine, fluvoxamine: Anticholinergic effects: paroxetine more common or severe drug interactions; prolonged side effects with fluoxetine Headache, nausea, elevated BP in higher doses. Watch for suicidal risk when “energy” increased but still despondent. Max. recommended dose: 300 mg daily Dry mouth, Appetite loss, Nausea, Constipation
Not for use with persons with liver disease and/ Equilibrium (dizziness), Somnolence or
glaucoma. Watch for drug-drug interaction (i.e. not with fluvoxamine, MAOI some antibiotics i.e. Cipro etc) Dry mouth, drowsiness, weight gain, dizziness: mild Seizures, Headache, Agitation, Rash,
Emesis, Sleep disturbance
Used more for sedation than for antidepressant Monitor for hypotension. When combined with MAO-B In doses up to 600 mg per day, no dietary (Eldepryl), MAOI diet/full precautions needed precautions required. Given BID from 300 mg to 600 mg daily STIMULANT Methylphenidate (5 mg in morning) Cardiovascular risks: high BP, agitation, sleeplessness Usually not a first line treatment (C)ardiovascular: Orthostatic hypotension
Anti(C)holinergic: Urinary retention
3 C’s
constipation, dry mouth, blurred vision
(C)onfusion: Monitor with the C.A.M.
Atypical Antipsychotics
Newer Antipsychotics – Side Effects to Monitor
Clinical Response
Dizziness, Agitation (early), Somnolence, Hypotension
The clinical factors to monitor include the May cause tachycardia, with higher doses – EPS DASH
Dangerous, threatening
Distressing to self
Advantages of New Antipsychotics
Disturbing to others
Direct Action, if acting on them
Less risk of developing tardive dyskinesia 5. JeoparDizing independence
Distant or present
Definite (fixed) vs insight
Tranquilizing effect usually occurs early; however, resolution of psychosis may take 1-2 months Traditional antipsychotics or neuroloeptics
Traditional Antipsychotics - Side Effects to Monitor
Mainly used if delirium
Constriction: EPS: rigidity, tremors, showed movements, drooling, leaning
to one side, parkinsonian gait and falls 4C’s
Less EPS but more anti-cholinergic than haloperidol • Anti-Cholinergic side effects, Confusion, Cardiovascular side effects
If it is an anxiolytic, what class is it?
Side Effects to Monitor
Confusion and memory problems, ataxia (poor balance) and falls, disinhibition leading to inappropriate or aggressive behaviour Best in panic attacks or catastrophic reactions Mood stabilizers
Side Effects to Monitor
Lithium Carbonate
stabilization of mood and behaviour within 2-4 Ataxia and falls, confusion, weakness, diarrhea usually when serum level is Mostly used when previous recurrent mood some GI upset in early treatment. Polyuria, tremor may occur at therapeutic doses. Maintain serum levels between 0.4 to 0.7 mMol/L Valproate, Sedation, ataxia, nausea; if there is bruising or bleeding of any type, May be considered in lability of mood and call physician. Check if drug levels and blood work done regularly (liver, hematology). Watch for rashes particularly with Lamotrigine. Drugs to treat Dementia
Side Effects to Monitor
Improve or prevent decline in ADLs, Behaviour, Muscle cramp, Insomnia, Nausea, Diarrhea and weight loss
Cognitive Enhancers (Potential Problems)
P.I.E.C.E.S.TM Consultation Team & Associates January 2009
Pam Hamilton BA Curriculum and Clinical and Education Consultant. Joanne Collins. RSW. Curriculum and Education Consultant> Nova Socita Coordinator. Diane Harris R.N. MSc CHRD, CPT. Performance & Learning Consultant, Project Coordinator Nausea and peptic ulcer Low pulse (bradycardia) J. Kenneth LeClair MD, FRCP(C). Clinical Advisor, Curriculum & Education Consultant Marie France Rivard MD, FRCPC(C). Chair, Steering Committee for P.I.E.C.E.S. for Family Physicians Glutaminergic agent
Side Effects to Monitor
Confusion, Headache, Equilibrium, Constipation, CHECK
Indicated for moderate to severe dementia Excessive activity/irritability decreased


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