Page 59 - Demo

CONTINUING PROFESSIONAL DEVELOPMENT
MEDICATION REVIEW
Recommendations suggested
• Advise nursing staff to stop administering sertraline.
• Educate staff about medication administration at next medication advisory committee meeting (including a root cause analysis of this medication incident).
• Consider ceasing risperidone. Advise GP that Mrs LC may be suffering from serotonin discontinuation syndrome following the abrupt withdrawal of sertraline. Her declining mental health and increased falls should resolve over the next few weeks providing no more sertraline is administered. Another
KEY LEARNING POINTS
reason to stop risperidone is the
increased risk of stroke.
• Suggest that the GP increase
mirtazapine to 30 mg at night as originally intended because Mrs LC is showing symptoms of untreated depression.
• Advise nursing staff that risedronate should not be sucked. If Mrs LC is unable or unwilling to do this, the
GP should consider an alternative anti-osteoporotic agent with a different route of administration such as intravenous zoledronic acid or subcutaneous denosumab.
• Advise nursing staff that rivastigmine patch should be applied to Mrs LC’s back so she would not have easy access to remove it.
• Advise GP to review Mrs LC’s INR.
Outcomes of RMMR
• Mrs LC’s behaviours now more settled with the increased dose of mirtazapine.
• Inappropriate use of risperidone ceased. • Better management of her osteoporosis with cessation of risedronate, and use
of denosumab or zoledronic acid being
considered (subject to the patient wishes).
• INR stabilised at 2–3.
• Rivastigmine patch now being applied to Mrs
LC’s back.
References
1. McKeith I, Cummings J. Behavioural changes and psychological symptoms in dementia disorders. Lancet Neurol 2005;4(11).
2. Kitching D. Depression in dementia. Aust Prescr 2015;38(6):209–11. 3. Banerjee S, Hellier J, Dewey M et al. Sertraline or mirtazapine for
depression in dementia (HTA-SADD): a randomised, multicentre,
double-blind, placebo-controlled trial. Lancet 2011;378(9789):403–11. 4. Warner CH, Bobo W, Warner C et al. Antidepressant discontinuation
syndrome. Am Fam Physician 2006;74(3):449–56.
5. Keks N, Hope J, Keogh S. Switching and stopping antidepressants. Aust
Prescr 2016;39:76–83.
6. Fava GA, Gatti A, Belaise C et al. Withdrawal symptoms after selective
serotonin reuptake inhibitor discontinuation: a systematic review.
Psychother Psychosom 2015;84:72–81.
7. Rossi S, ed. Australian medicines handbook. Adelaide: Australian
Medicines Handbook; 2016.
• Symptoms from abrupt discontinuation of an antidepressant may occur when a patient decides to stop their medicine without medical input, or when antidepressant therapy is switched.
• The range, longevity and severity of antidepressant withdrawal symptoms vary according to the type of antidepressant.
• Switching antidepressants in the community setting should involve gradually tapering the dose of the initial antidepressant and having a washout period before introducing a new antidepressant at its usual starting dose.
QUESTIONS
1.5
CPD CREDIT
GROUP 2
Each question has only one correct answer.
1. Which of the following statements is INCORRECT?
a) Sweating, flushing and tremor are likely symptoms of selective serotonin re-uptake inhibitor (SSRI) withdrawal.
b) Visual and sleep disturbances are symptoms that may occur with dementia associated with Parkinson’s disease.
c) Tricyclic antidepressants and SSRIs can have similar withdrawal symptoms.
d) The severity of withdrawal symptoms are the same for the various classes of antidepressants.
2. Which of the following statements is CORRECT?
a) Fluoxetine has a short half-life.
b) Fluoxetinecanrequireawashoutperiodof
5 weeks when switching to a monoamine
oxidase inibitor (MAOI).
c) Fluoxetine should be ceased for 2–4 days
before switching to clomipramine.
d) Fluoxetine is not associated with serotonin
syndrome.
3. In what percentage of patients
may abrupt discontinuation of an antidepressant taken for at least
6 weeks result in withdrawal syndrome?
b) 10%.
c) 20%.
d) 30%.
4. Which of the following statements is CORRECT?
a) Cross-taper switching of antidepressants has a low risk of drug interactions.
b) Direct switches of antidepressants are recommended in general practice settings.
c) Conservative switches of antidepressants have a low risk of drug interactions.
d) Moderateswitchesofantidepressantshave no risk of discontinuation symptoms.
JANUARY 2017
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