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Benzos and COVID-19?
Benzos don& #39;t cause respiratory depression in therapeutic doses or overdose, unless taken w/ CNS depressants
Data on benzos on people w/ comorbid respiratory conditions like pneumonia, COPD are conflicting
#psychiatryofpandemics
Benzos don& #39;t cause respiratory depression in therapeutic doses or overdose, unless taken w/ CNS depressants
Data on benzos on people w/ comorbid respiratory conditions like pneumonia, COPD are conflicting
#psychiatryofpandemics
Acute use of benzos, unlikely to cause respi depression
Chronic use - increased risk of pneumonia (sedation --> aspiration pneumonia, etc.). Not big risk but understandable concern
Pragmatic: Avoid benzos if possible, choose short-acting , lowest dose, shortest time
Chronic use - increased risk of pneumonia (sedation --> aspiration pneumonia, etc.). Not big risk but understandable concern
Pragmatic: Avoid benzos if possible, choose short-acting , lowest dose, shortest time
Vitamin D and COVID-19!
Treating vit D deficiency to decrease respiratory disease: NNT = 3, drops to NNT = 8 in severe deficiency.
High levels of vitamin D associated to lowest severity of respiratory infection, now including COVID-19 (Indonesian study). #psychiatryofpandemics
Treating vit D deficiency to decrease respiratory disease: NNT = 3, drops to NNT = 8 in severe deficiency.
High levels of vitamin D associated to lowest severity of respiratory infection, now including COVID-19 (Indonesian study). #psychiatryofpandemics
Recommendation: give vitamin D supplementation to all patients with psychosis
#psychiatryofpandemics
#psychiatryofpandemics
Lithium!
Exclusively renal secretion. In AKI sudden increase in Li levels. CKD assoc. with poorer outcomes in COVID-19
Those with COVID - 2 risks: AKI leads to acute Li toxicity, and chronic lithium use can increase risk of CKD (poorer COVID-19 outcomes)
#psychiatryofpandemics
Exclusively renal secretion. In AKI sudden increase in Li levels. CKD assoc. with poorer outcomes in COVID-19
Those with COVID - 2 risks: AKI leads to acute Li toxicity, and chronic lithium use can increase risk of CKD (poorer COVID-19 outcomes)
#psychiatryofpandemics
Do ***NOT*** stop lithium suddenly!!! Educate people taking lithium about signs of toxicity #psychiatryofpandemics
Don& #39;t use medications in delirium
Save for last line for targetted symptoms (if really needed, antipsychotics preferred)
#psychiatryofpandemics
Save for last line for targetted symptoms (if really needed, antipsychotics preferred)
#psychiatryofpandemics
Clozapine and COVID-19
Key message: Make every effort to keep them on clozapine. It is a uniquely effective drug, and stopping is likely to lead to relapse.
#psychiatryofpandemics
Key message: Make every effort to keep them on clozapine. It is a uniquely effective drug, and stopping is likely to lead to relapse.
#psychiatryofpandemics
Clozapine itself doesn& #39;t put you at risk of COVID-19
It& #39;s the person& #39;s cardiovascular comorbidities and metabolic syndrome from the drug that puts them at risk
+risk of superimposed pneumonia from clozapine #psychiatryofpandemics
It& #39;s the person& #39;s cardiovascular comorbidities and metabolic syndrome from the drug that puts them at risk
+risk of superimposed pneumonia from clozapine #psychiatryofpandemics
Clozapine and COVID-19:
Treat comorbidities and side effects as much as possible
Hypersalivation
Pneumococcal, flu shots
Address Vitamin D deficiency
#psychiatryofpandemics
Treat comorbidities and side effects as much as possible
Hypersalivation
Pneumococcal, flu shots
Address Vitamin D deficiency
#psychiatryofpandemics
Clozapine and COVID-19
ANC monitoring (ah hello, old friend). Focus on NOT total WBC, but neutropenia.
>80% of aranulocytosis occurs in 1st 18 weeks, After that, risks comparable to other antipsychotics
#psychiatryofpandemics
ANC monitoring (ah hello, old friend). Focus on NOT total WBC, but neutropenia.
>80% of aranulocytosis occurs in 1st 18 weeks, After that, risks comparable to other antipsychotics
#psychiatryofpandemics
People with respiratory illness on Clozapine: plasma levels can rise due to reduced CYP1A2 induction
-unable to inhale cigarette smoke/stop smoking
-changes in CYP1A2 levels
#psychiatryofpandemics
-unable to inhale cigarette smoke/stop smoking
-changes in CYP1A2 levels
#psychiatryofpandemics
Continue Clozapine
Pay attention to neutrophils
Check plasma levels
Monitor other side effects
#psychiatryofpandemics
Pay attention to neutrophils
Check plasma levels
Monitor other side effects
#psychiatryofpandemics
Depot medication (long-acting injectables) and COVID-19
To reduce no. of depot admins without reducing efficacy of regimen, remmeber basic depot kinetics
Longer dosing interval can be compensated by ensuring overall dose is same. BUT don& #39;t stop reviewing #psychiatryofpandemics
To reduce no. of depot admins without reducing efficacy of regimen, remmeber basic depot kinetics
Longer dosing interval can be compensated by ensuring overall dose is same. BUT don& #39;t stop reviewing #psychiatryofpandemics
What does the psych- in psychopharmacology mean?
Soul. The pharmacology of the soul. You are a soul chemist (if you believe the soul resides in the brain)
I LOVE THIS #psychiatryofpandemics
Soul. The pharmacology of the soul. You are a soul chemist (if you believe the soul resides in the brain)
I LOVE THIS #psychiatryofpandemics
