This course is designed for pharmacists, nurse practitioners or other health care professionals involved in the comprehensive medication management of psychiatric and/or neurological patients.
Session Summary
Older psychiatric medications are still used in psychiatric practice. However, some pharmacists may not be as familiar with or comfortable using them due to side effects, drug-drug interactions, or general lack of direct experience. Following these clinical pearls presentations, participants will learn about the role older medications have in clinical practice and be better prepared to monitor or advise on their use.
This session will feature 3 presentations about older psychiatric medications are still used in psychiatric practice, including Tricyclic Antidepressants, Monoamine Oxidase Inhibitors (MAOIs), and First Generation Antipsychotics (Neuroleptics).
Course Requirements
To receive ACPE credit for the live session at the Annual Meeting, you must:
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Attend and participate in the entire session and reflect upon its teachings.
Complete the evaluation at the end of the activity.
Provide the necessary details in your profile to ensure correct reporting by AAPP to CPE Monitor.
Upon successful completion, ACPE credit is reported within 24 hours to CPE Monitor although transcripts can be retrieved by participants online in their ACPE Transcript.
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Faculty Information and Disclosures
M. Lynn Crismon, PharmD, FCCP, DABCP, BCPP Cynthia K. Kirkwood, PharmD, BCPP Rex Lott, PharmD, BCPP
M. Lynn Crismon, PharmD, FCCP, DABCP, BCPP
Behrens Centennial Professor of Pharmacy, College of Pharmacy
Professor of Psychiatry, Dell Medical School
The University of Texas at Austin
Austin, TX
M. Lynn Crismon is the Behrens Centennial Professor of Pharmacy in the College of Pharmacy and Professor of Psychiatry in the Dell Medical School at The University of Texas at Austin. From 2007 until 2020 he served as Dean and James T. Doluisio Regents Chair of the College of Pharmacy. He received his BS in Pharmacy from The University of Oklahoma and his Doctor of Pharmacy degree from a joint degree program of UT Austin and UT Health San Antonio. He completed residencies in pharmacy practice at the USPHS Gallup Indian Medical Center and in psychiatric pharmacy at The University of Texas and San Antonio State Hospital. He is board certified in psychiatric pharmacy, and he is a Diplomate of the American Board of Clinical Pharmacology.
His research has focused on strategies to improve the pharmacotherapy and health outcomes of adults and children with severe mental disorders. He was one of the lead investigators in the Texas Medication Algorithm Project and the Children’s Medication Algorithm Project. Since 2004, he has helped lead the development and revision of psychotropic medication prescribing parameters for use in children and youth residing in Texas foster care with the 6th edition released in 2019 as the Psychotropic medication utilization parameters for children and youth in Texas Public Behavioral Health. He has published over 260 articles, chapters, or handbooks. He is past chair of the AACP Council of Deans and past AACP board member. He served as a member of the ACCP Board of Regents, the ACCP Research Institute Board of Trustees, and the NIPTE Board of Directors. He was the first chair of the BPS Specialty Council on Psychiatric Pharmacy, and he is currently chair of the ASHP Foundation Research Advisory Council. He served as a member of the National Academies of Science, Engineering, and Medicine Committee that developed the 2019 consensus report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. He was a founding CPNP member, and he is a past recipient of the CPNP Judith Saklad Lecture Award.
No Relevant Financial Relationships to Disclose
My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Use of chlorpromazine as an adjuvant in the treatment of pain.
Cynthia K. Kirkwood, PharmD, BCPP
Professor, Executive Associate Dean for Academic Affairs
Virginia Commonwealth University School of Pharmacy
Richmond, VA
Cynthia K. Kirkwood, Pharm.D., BCPP is Executive Associate Dean for Academic Affairs and Professor (tenured) in the School of Pharmacy at Virginia Commonwealth University. She obtained her B.S. and Doctor of Pharmacy degrees from Virginia Commonwealth University and completed an ASHP Research and Education Fellowship in Psychiatric Pharmacy Practice at this institution. She previously practiced as a clinical specialist in psychiatry on the adult inpatient psychiatry unit of the Virginia Commonwealth University Health System. She has served as a consultant for Richmond Behavioral Health Authority, Virginia Office of Protection and Advocacy, Department of Medical Assistance Services Pharmacy & Therapeutics Committee, and Richmond Psychiatric Institute for Children and Adolescents. She served on the Treatment Workgroup of the Governor’s Task Force on Prescription Drug and Heroin Abuse 2014-2015. She is a member of AACP, ACCP, ASHP, CPNP, VSHP, and VPhA. She was the Board Certified Psychiatric Pharmacists Recertification Director for the College of Psychiatric and Neurologic Pharmacists from 2007-2016 and oversaw the activities of the editorial boards for the recertification and review course products. In both 1999 and 2007 she was awarded the VCU School of Pharmacy Teaching Excellence Award. She is a past president of the College of Psychiatric and Neurologic Pharmacists Foundation. She received the Judith J. Saklad Memorial Award from the College of Psychiatric and Neurologic Pharmacists in 2014. She has served as a reviewer for Currents in Pharmacy Teaching and Learning, Annals of Pharmacotherapy, and American Journal of Pharmaceutical Education. Her research interests have included pharmacokinetics, pharmacodynamics, and outcomes of psychiatric drugs in adults and children, and the assessment of learning outcomes, interprofessional education, and team work in pharmacy students. She has provided invited lectures and authored book chapters and articles on anxiety and sleep disorders, and active learning.
Financial interest (stock): Johnson & Johnson
My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: amitriptyline, doxepin, imipramine, nortriptyline
Rex Lott, PharmD, BCPP
Professor Emeritus
Idaho State University College of Pharmacy
Meridian, ID
Dr. Lott earned a Bachelor of Pharmacy at Washington State University in 1972 and a Doctor of Pharmacy at the University of Minnesota in 1977. He has been a Board Certified Psychiatric Pharmacist since 2007. Has held faculty positions at Washington State University, the University of Minnesota and Idaho State University. Dr. Lott retired from Idaho State University College of Pharmacy as a Professor Emeritus in 2016 after 19 years of service. Held an affiliate faculty appointment as Clinical Associate Professor with the University of Washington School of Medicine in the Department of Psychiatry and Behavioral Science. He practiced in the Minnesota State Hospital System from 1978 to 1985, in Washington State institutions for the developmentally disabled from 1985 to 1987 and from 1991 to 1997. From 1987 to 1991, he practiced as a consultant pharmacist for long-term care facilities. His most recent practice site was at the Boise, Idaho Veterans Affairs Medical Center. Dr. Lott was responsible for extensive didactic instruction and for providing Introductory and Advanced Pharmacy Practice Experiences for pharmacy students. He also provided didactic and clinical instruction to PGY-3 & PGY-4 Psychiatry Residents.
Dr. Lott published extensively in the area of neuropsychiatric pharmacotherapy.He authored/co-authored the Epilepsy/Seizure Disorders Chapter in Koda-Kimble & Young’s Applied Therapeutics: The Clinical Use of Drugs from 1980 to 2012. He authored/co-authored several peer-reviewed papers concerning antiepileptic drugs and psychotropic medications. Most recently he was co-editor and author for a NAPLEX review book, Capstone Pharmacy Review.
Dr. Lott is an active member of the College of Psychiatric and Neurologic Pharmacists (CPNP). He was elected to CPNP’s Board of Directors in 2010 and was elected as President-Elect in 2011. He served as President of CPNP in 2012 – 2013. He also served as co-senior editor on CPNP’s Psychiatric Pharmacotherapy Review Course Editorial Board. Dr. Lott served on CPNP’s Recertification Editorial Board and chaired that board from 2008 to 2010. Most recently, Dr. Lott served as CPNP’s BCPP Program Director from 2016 - 2020. He also served as member of the CPNP Foundation Board of Directors.
No Relevant Financial Relationships to Disclose
My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Tranylcypromine, isocarboxazid, phenelzine, selegeline, moclobemide
MAOI treatment of anxiety disorders
MAOI use with “triptans"
Use of moclobemide
MAOI use with tricyclic antidepressants
Learning Objectives
Describe the role of monoamine oxidases A and B in neurotransmission related to the mechanism of action in depression and anxiety.
Recognize accepted indications for the use of MAOIs.
Identify significant interactions and dietary restrictions when using MAOIs.
Identify potential therapeutic uses of tricyclic antidepressants.
Discuss the contraindications, adverse effects, and drug-drug interactions for tricyclic antidepressants.
Discuss the side effects of different first generation antipsychotics.
List unique characteristics of select first generation antipsychotics.
Continuing Education Credit and Disclosures
Activity Date: 04/21/2021 ACPE Contact Hours: 1.25 ACPE Number: 0284-0000-21-009-L01-P (Knowledge) Nursing Credit Reminder: Note that ACPE credit is accepted for certification renewal.
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
AAPP owns the copyright, is licensed or has received permissions for use of, or is otherwise permitted to use copyrighted materials within any CPE activity. Authors and speakers are required to obtain necessary copyright permissions for content in CPE activities. AAPP complies with copyright laws and regulations.
Shari N. Allen, PharmD, BCPP
Assistant Professor
PCOM-SOP
Suwanee, GA
No Relevant Financial Relationships to Disclose
Jolene R. Bostwick, PharmD, BCPP, BCPS
Program Administrative Chair
Assistant Dean for Co-Curriculum and Professional Development & Clinical Professor
University of Michigan College of Pharmacy
Ann Arbor, MI
No Relevant Financial Relationships to Disclose
Bridget Bradley, PharmD, BCPP
Associate Professor
Pacific University School of Pharmacy
Hillsboro, OR
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: PSAP May 2021, Neurology and Psychiatry Book
Educational Grants, Research Grants or Contracts: NACDS Community Pharmacy Residency Grant
Lauren M. Brown, PharmD, BCPP
Clinical Pharmacy Specialist, Psychiatry
South Texas Veterans Health Care System
San Antonio, TX
No Relevant Financial Relationships to Disclose
Austin R. Campbell, PharmD, BCPP
Clinical Pharmacy Specialist - Psychiatry
University of Missouri Health Care
Columbia, MO
Financial Interests: Up To Date Contributor "Pharmacotherapy for schizophrenia: Long-acting injectable antipsychotic drugs"
Non-Financial Interests: Extension for Community Healthcare Outcomes, Show-Me ECHO Project
Chelsea N. Carr, PharmD, BCPP
Advanced Practice Pharmacist - Psychiatry
University of Maryland - Spring Grove Hospital Center
Catonsville, MD
No Relevant Financial Relationships to Disclose
Jordan Cooler, PharmD, BCPP
Clinical Assistant Professor
University of South Carolina College of Pharmacy
Columbia, SC
No Relevant Financial Relationships to Disclose
Amber R. Douglass, PharmD, BCPS, BCPP
Clinical Pharmacy Specialist - Mental Health
VA Tennessee Valley Healthcare System
Murfreesboro, TN
No Relevant Financial Relationships to Disclose
Kristen N. Gardner, PharmD, BCPP
Program Committee Chair
Clinical Pharmacy Specialist - Behavioral Health
Kaiser Permanente Colorado
Denver, CO
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Biostrategies - one time consultant re:LAIAs
Robert J. Haight, PharmD, BCPP
Clinical Pharmacist | Forensic Services
Saint Peter Regional Treatment Center (SPRTC), Minnesota Department of Human Services
Saint Peter, MN
No Relevant Financial Relationships to Disclose
Suzanne C. Harris, PharmD, BCPP
Clinical Assistant Professor/UNC Hospitals Region Experiential Director/Clinical Pharmacist Practitioner
UNC Eshelman School of Pharmacy
Chapel Hill, NC
Educational Grants, Research Grants or Contracts: North Carolina AHEC Campus Innovations Grants
Kayla D. Johnson, PharmD, BCPS, BCPP
Vanderbilt Psychiatric Hospital
Spring Hill, TN
No Relevant Financial Relationships to Disclose
Erin D. Knox, PharmD, BCPP
Pharmacy Education Specialist
UC Irvine Health
Orange, CA
No Relevant Financial Relationships to Disclose
Marketa Marvanova, PharmD, PhD, BCGP, BCPP, FASCP
Dean and Professor
University of Montana, Skaggs School of Pharmacy
Missoula, MT
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Editorial Board member: Continuum: Lifelong Learning in Neurology, consultant for Lexicomp as a clinical specialist in neurology and psychiatry
Educational Grants, Research Grants or Contracts: AACP/NABP: District V grant, Dakota Medical Foundation
Melissa Mitchell, PharmD, BCGP, BCPP, BCPS
Senior Clinical Pharmacist
RUHS MC
Moreno Valley , CA
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Neurocrine Speakers Bureau - Ingrezza, Janssen Speakers Bureau - Spravato
Thea R. Moore, PharmD, BCPP
Associate Professor
University of South Florida
Tampa, FL
Educational Grants, Research Grants or Contracts: Agency for Health Care Administration
Kristen Neumeister, PharmD, BCPP
Clinical Pharmacist- Mental Health
John Peter Smith Hospital
Fort Worth, TX
No Relevant Financial Relationships to Disclose
Melissa C. Palmer, PharmD, BCPP, BCPS
Clinical Assistant Professor
University of Missouri-Kansas City School of Pharmacy
Kansas City, MO
No Relevant Financial Relationships to Disclose
Lindsey Peters, PharmD, BCPS
Assistant Professor of Pharmacy Practice
Ohio Northern University
Ada, OH
No Relevant Financial Relationships to Disclose
Kristina Reinstatler, PharmD, BCPP, MBA
Clinical Pharmacy Specialist
UC Health University of Cincinnati Medical Center
Cincinnati, OH
No Relevant Financial Relationships to Disclose
Michael D. Shuman, PharmD, BCPP
Staff Pharmacist
Central State Hospital
Louisville, KY
No Relevant Financial Relationships to Disclose
Sheryl Thedford, PharmD, PhD, BCPS, BCPP
Clinical Psychiatric Pharmacist
University of Maryland, Spring Grove Hospital Center
Catonsville, MD
No Relevant Financial Relationships to Disclose
Taylor A. Thomas, PharmD, BCPP
Clinical Pharmacy Specialist- Mental Health
VA Northern Indiana Health Care System
Fort Wayne, IN
No Relevant Financial Relationships to Disclose
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information and disclosures). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: M. Lynn Crismon: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Use of chlorpromazine as an adjuvant in the treatment of pain.
Cynthia K. Kirkwood: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: amitriptyline, doxepin, imipramine, nortriptyline
Rex Lott: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Tranylcypromine, isocarboxazid, phenelzine, selegeline, moclobemide
MAOI treatment of anxiety disorders
MAOI use with ?triptans?
Use of moclobemide
MAOI use with tricyclic antidepressants
It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by AAPP for any product or manufacturer identified.
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The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Jolene R. Bostwick, PharmD, BCPP, BCPS
Kristen N. Gardner, PharmD, BCPP