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Benzos and COVID-19?
Benzos don'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'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'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't put you at risk of COVID-19
It's the person's cardiovascular comorbidities and metabolic syndrome from the drug that puts them at risk
+risk of superimposed pneumonia from clozapine #psychiatryofpandemics
It's the person'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'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'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
