If you are a pharmacist, nurse practitioner, or other health care professional involved in the comprehensive medication management of individuals living with mental health and/or substance use disorders, we invite you to participate in this online course.
Session Summary
CPNP members share their experiences dealing with clinical problems.
Parkinsonism-Hyperpyrexia Syndrome
Joseph Cusimano, PharmD, BCPP
Parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially lethal syndrome that can occur when antiparkinson therapy is abruptly stopped or decreased. The clinical features of PHS and a better-known, also medication-related, syndrome called neuroleptic malignant syndrome (NMS) overlap substantially, which may delay accurate diagnosis and effective treatment. In the present case, the team was unfamiliar with PHS, leading to an initial misdiagnosis as NMS due to the presence of a second-generation antipsychotic on the patient’s medication regimen.
Antipsychotic-Induced Hyperprolactinemia: An Approach to Medication Management
Shadi Doroudgar, PharmD, APh, BCPS, BCGP, BCPP
Hyperprolactinemia has been associated with multiple long-term complications. Drug-induced hyperprolactinemia is an important topic that deserves greater clinical attention. Antipsychotic medications are the most common cause of pharmacologically induced hyperprolactinemia. Identification and appropriate management of hyperprolactinemia is essential given that it is a common side effect of antipsychotic medications.
Clozapine: Removing the Smoke Screen
Carolina Liriano, PharmD
Clozapine is an antipsychotic indicated for treatment resistant schizophrenia. Due to the many risks associated with use, close monitoring is required. The polycyclic aromatic hydrocarbons found in cigarette tar is a known inducer of clozapine metabolism. Considering that upwards of 80% of patients with schizophrenia are smokers, this interaction becomes very relevant to this patient population. In addition, upon inpatient admission to non-smoking facilities clozapine levels may rise in those who are forced to quit during their hospitalization. This clinical pearl reviews current literature to help quantify the clinical significance of the interaction between clozapine and smoking, in addition explores current recommendations for management.
Course Requirements
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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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Joseph Cusimano, PharmD, BCPP
Assistant Professor
Bernard J. Dunn School of Pharmacy, Shenandoah University
Winchester, VA
No Relevant Financial Relationships to Disclose
My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Off-label use of dopaminergics (levodopa, bromocriptine, ropinirole, pramipexole, amantadine, apomorphine, and rotigotine) for PHS and dantrolene (FDA-approved for malignant hyperthermia, but not NMS or PHS).
Joseph Cusimano, PharmD, BCPP is an assistant professor at the Bernard J. Dunn School of Pharmacy at Shenandoah University. He practices as a clinical pharmacy specialist in psychiatry at Winchester Medical Center in Virginia, where he provides pharmaceutical care for a 36-bed inpatient psychiatric unit. He completed his residency training at Michigan Medicine, in affiliation with the University of Michigan College of Pharmacy, in Ann Arbor, Michigan, where he served one year as chief resident. Dr. Cusimano completed his PharmD from The Ohio State University, but is originally from the sunny state of Arizona. Outside of work, he enjoys cooking, baking, and bicycling. He and his fiancée Lauren adore the company of their two cats, Kovu and Muffins.
Shadi Doroudgar, PharmD, APh, BCPS, BCGP, BCPP
Associate Professor, Clinical Sciences Department
Residency Research Coordinator
Touro University California College of Pharmacy
Vallejo, CA
No Relevant Financial Relationships to Disclose
My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: aripiprazole and topiramate for the treatment of antipsychotic-induced hyperprolactinemia
Dr. Shadi Doroudgar is an Associate Professor of Clinical Sciences at Touro University California College of Pharmacy. She is also the Research Lead in the Clinical Sciences Department and the Residency Research Coordinator at Touro University California College of Pharmacy. Additionally, she is a Clinical Assistant Professor in the Department of Medicine, Division of Primary Care and Population Health and an Associate Course Director of the Clinical Therapeutics Curriculum for the Stanford School of Medicine, Master of Science in PA Studies program. She currently serves the moderate to severe psychiatric patient population at Pathways to Wellness - Downtown Oakland as the Lead Clinical Psychiatric Pharmacist. She is a Board Certified Pharmacotherapy Specialist, a Board Certified Psychiatric Pharmacist, and a Board Certified Geriatric Pharmacist. Her research interests include studying the effects of various drugs on driving, sleep and actigraphy, and pharmacy education.
Carolina Liriano, PharmD
PGY2 Pharmacy Resident
North Florida South Georgia Veterans Health System
Gainesville, FL
No Relevant Financial Relationships to Disclose
Carolina Liriano is a PGY2 Psychiatry Pharmacy Resident at North Florida/South Georgia Veteran’s Healthcare System. She completed her PGY1 residency at the same site after graduating from Nova Southeastern University with her PharmD degree in the year 2020. She currently manages the Benzodiazepine Taper Clinic in her facility and is the New Practitioner Mentor for APhA at the University of Florida College of Pharmacy. Carolina is passionate about education and tackling the sigma surrounding mental health. On her free time she enjoys salsa dancing and spending time with friends.
Learning Objectives
Parkinsonism-Hyperpyrexia Syndrome
Identify the signs, symptoms, and risk factors for parkinsonism-hyperpyrexia syndrome.
Develop a pharmacotherapy plan for mitigating parkinsonism-hyperpyrexia syndrome.
Antipsychotic-Induced Hyperprolactinemia: An Approach to Medication Management
Identify signs and symptoms of hyperprolactinemia in patients treated with antipsychotic medications.
Discuss treatment options for the management of hyperprolactinemia.
Clozapine: Removing the Smoke Screen
Describe and quantify the interaction between smoking and clozapine serum concentration.
Review current recommendations for the management of smoking cessation in clozapine patients.
Continuing Education Credit and Disclosures
Activity Date: 04/26/2022 ACPE Contact Hours: 1 ACPE Number: 0284-0000-22-046-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.
Elayne D. Ansara, PharmD, BCPP, BCPS
Clinical Pharmacy Specialist
Veteran Health Indiana
Indianapolis, IN
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.: ACCP PSAP May 2021, Neurology and Psychiatry Book
Educational Grants, Research Grants or Contracts: NACDS Community Pharmacy Residency Grant
Austin R. Campbell, PharmD, BCPP
Program Committee Chair
Clinical Pharmacy Specialist - Psychiatry
University of Missouri Health Care
Columbia, MO
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Sunovion Pharmaceuticals Inc. Speakers Bureau
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 School of Pharmacy
Catonsville, MD
No Relevant Financial Relationships to Disclose
Dana Chiulli, PharmD, BCPP
Clinical Pharmacist - Mental Health
VISN 06 Mental Health Clinical Resource Hub
Savannah, GA
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
Bennett J. Doughty, PharmD, BCPP, BCPS
Clinical Assistant Professor
Binghamton University School of Pharmacy and Pharmaceutical Sciences
Binghamton, NY
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Achieve CE - CE provided for compensation
Educational Grants, Research Grants or Contracts: SUNY Germination Space Grant. $50,000. Awarded July 2019.
Non-Financial Interests: New York State American College of Clinical Pharmacists Executive Board
Amber R. Douglass, PharmD, BCPS, BCPP
Clinical Pharmacy Specialist - Mental Health
VISN 1 Clinical Resource Hub - VA Connecticut Healthcare System
West Haven, CT
No Relevant Financial Relationships to Disclose
Megan J. Ehret, PharmD, BCPP, MS
BCPP Program Director
Professor
University of Maryland
Baltimore, MD
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Psych U Section Advisor, Lexi-Comp Consultant/Reviewer
Educational Grants, Research Grants or Contracts: FDA/University of Maryland CERSI, Maryland Behavioral Health Department, NIH
Kristen N. Gardner, PharmD, BCPP
Clinical Pharmacy Specialist - Behavioral Health
Kaiser Permanente Colorado
Denver, CO
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Biostrategies - one time consultant re:LAIAs (2019)
Educational Grants, Research Grants or Contracts: ACCP PSAP author (2021-2022); ACCP annual meeting speaker (2020)
Michelle L. Geier, PharmD, BCPP
Psychiatric Clinical Pharmacist Supervisor
San Francisco Department of Public Health
San Francisco, CA
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Weitzman Institute Project ECHO Faculty
Nicole Hahn, PharmD, BCACP
Clinical Pharmacy Specialist - Neurology
Kaiser Permanente
Denver, CO
No Relevant Financial Relationships to Disclose
Kayla D. Johnson, PharmD, BCPP, BCPS
Vanderbilt University Medical Center
Thompsons Station, TN
No Relevant Financial Relationships to Disclose
Erin D. Knox, PharmD, BCPP
Director of Experiential Education
UCI School of Pharmacy & Pharmaceutical Sciences
Irvine, CA
Non-Financial Interests: Santa Ana Community College, Pharmacy Technology Program, Advisory Committee
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 Neuroilogy,
consultant for Lexicomp as a clinical specialist in neurology and psychiatry
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, Otsuka - PsychU.org Speaker
Thea R. Moore, PharmD, BCPP
Associate Professor
University of South Florida
Tampa, FL
No Relevant Financial Relationships to Disclose
Lindsey Peters, PharmD, BCPS
Associate 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
Educational Grants, Research Grants or Contracts: HEALing Communities NIH grant- pharmacy lead Athens Cty, Ohio
Michael D. Shuman, PharmD, BCPP
Staff Pharmacist
Central State Hospital
Lousiville, KY
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
Nina Vadiei, PharmD, BCPP
Assistant Professor
University of Arizona Colleges of Pharmacy and Medicine
Tucson, AZ
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: Jospeh Cusimano: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Off-label use of dopaminergics (levodopa, bromocriptine, ropinirole, pramipexole, amantadine, apomorphine, and rotigotine) for PHS and dantrolene (FDA-approved for malignant hyperthermia, but not NMS or PHS).
Shadi Doroudgar: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: aripiprazole and topiramate for the treatment of antipsychotic-induced hyperprolactinemia
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
Austin R. Campbell, PharmD, BCPP