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St Andrews Presentation.
- 2. CLINICAL INTERVENTION A DEFINITION A process of identifying, and making a recommendation in an attempt to prevent or resolve a medicine related problem that actually or potentially interferes with the patient experiencing optimum outcome of medical care.
- 3. Clinical Management THE ISSUES Modecate shortage-withdrawal problematic EPS (Tardive Dyskinesia) Raised Hb1Ac Patient Compliance Workload Priority Administration Issue Switching appropriate? Male-67-Schizophrenia-learning disabilities Reason for admission-Subarachnoid Haemorrhage
- 4. OUTCOMES •Drug Sourced-Symptoms controlled •Monitor U&Es - FBC – LFTs –ECG- Glucose •Metformin prescribed (monitor eGFR) •Staff informed of administration •Dose reduction Vs Aripiprazole switch •NH kept updated OUTCOMES
- 6. References • Psychosis and Schizophrenia in Adults: Prevention and Management: Clinical Guideline[CG178] https://www.nice.org.uk/guidance/cg178/chapter/1 Recommendations choice-of- antipsychotic-medication Accessed 31/10/16 • Practice Guidance: Pharmaceutical Care in Psychosis and Schizophrenia http://www.rpharms.com/support-pdfs/mental-health-schizophrenia-a4.pdf Accessed 01/11/16 • Guidelines for Antipsychotic Medication Switches http://www.humber.nhs.uk/Downloads/Services/Pharmacy/Guidelines/Antipsychotic%20med ication%20switches%20guidelines.pdf Accessed 07/11/16 • Type 2 Diabetes: The Management of Type 2 Diabetes Clinical Guideline [CG87] https://www.nice.org.uk/guidance/cg87?unlid=99536709620163319483 Accessed 13/11/16
Notas do Editor
- SCR Accessed –Also confirmed with patient’s CPN Symptoms-Permanent involuntary movements including: repetitive chewing, facial grimacing (sucking/kissing actions) twisted neck, drooling, limited facial expression
- [1] Prescribing of most antipsychotic drugs requires full blood count, urea and electrolytes, and liver function tests to be checked before starting treatment and annually thereafter. Blood lipids and weight should be measured at baseline, at three months (weight should be measured at frequent intervals during the first three months), and then yearly [2]Which ? antipsychotic drugs are least likely to cause extrapyramidal side effects? The prescribing notes on antipsychotic drugs in BNF 63 recommend that second generation antipsychotic drugs should be prescribed if extrapyramidal side effects are a particular concern. Of these, aripiprazole, clozapine, olanzapine and quetiapine are least likely to cause extrapyramidal effects. [3] What would be a more appropriate choice of antipsychotic drug for this patient? With the exception of clozapine, there is little meaningful difference in efficacy between the different antipsychotic drugs, and response and tolerability to each drug varies. Choice is influenced by the patient’s medication history, the degree of sedation required, and consideration of individual patient factors such as risk of extrapyramidal side effects, weight gain, impaired glucose tolerance, QT interval prolongation or the presence of negative symptoms of schizophrenia (eg, apathy, social withdrawal and emotional flatness). Aripiprazole would be a more suitable choice for this patient because it has a low risk of extrapyramidal effects