DOCSLIB.ORG

CCHCS Care Guide: Substance Use Disorder

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
CCHCS Care Guide: Substance Use Disorder May 2020 CCHCS Care Guide: Substance Use Disorder SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT GOALS ALERTS Reduce Substance Use Disorder (SUD) related Patients on buprenorphine or naltrexone may require transfer to a morbidity and mortality. triage and treatment area (TTA) or hospital, as medically indicated, if opioids are required for acute pain management. Equip patients with tools, techniques, and treatments Individuals leaving prison are at high risk for overdose-related necessary to successfully manage their addiction. harms and will be offered naloxone upon release. Ensure continuity of care while incarcerated and Pregnant patients with SUD/Opioid Use Disorder (OUD) require when reintegrating into the community when leaving specialist management. See CCHCS Care Guide: MAT for OUD in the California Department of Corrections and Pregnancy. Rehabilitation (CDCR). Recognizing signs of withdrawal and supporting relapse prevention SCREENING is a shared responsibility with the entire treatment team The treatment team is multidisciplinary, and team members have unique roles and responsibilities in delivering major components of the program including screening, assessment, treatment, monitoring and transitional services – see page 2. Screening for SUD is done using the National Institute for Drug Abuse (NIDA) Quick Screen. This tool poses 4 questions regarding the use of alcohol, tobacco, prescription drugs for non-medical reasons, & illegal drugs. Affirmative answers (except to tobacco which triggers counseling) would trigger further assessment. For details see page 4 and Attachment A. ASSESSMENT Assessment provides additional risk stratification using the NIDA Modified Assist (MA) and/or a multidimensional assessment developed by the American Society of Addiction Medicine (ASAM) that provides a common language for a holistic, biopsychosocial assessment that is used for service planning and treatment – known as the ASAM Criteria – see page 4. Motivational Interviewing techniques may assist with obtaining accurate assessments – see page 6. Diagnostic coding can be derived from 2 differing systems – DSM-V and ICD-10 – see page 8. The Addiction Medicine Central Team (AMCT) will evaluate and initiate patients who are eligible to receive Medication Assisted Treatment (MAT) or oversee other trained providers in doing so. Primary Care Providers (PCP) will need to integrate SUD treatment into their overall patient care plans. TREATMENT The cornerstone for treatment is behavioral, but for some may include pharmacologic and housing modalities as well. Behavioral treatment includes cognitive behavioral intervention (CBI) and peer support. Supportive Housing provides designated space where patients can be active participants in their own and each other's recovery and where they share responsibility for the daily running of the community with staff. Studies find that participants in such therapeutic communities reduce substance abuse, criminal behavior, and mental health symptoms. Pharmacological treatment is available for patients with OUD or Alcohol Use Disorder (AUD). If considered a candidate for MAT, the AMCT will evaluate the patient and initiate accordingly. The AMCT will also be responsible for ongoing management and monitoring of patients on MAT and assisting with providing MAT prescriptions at the time of release from CDCR. MONITORING Follow-up appointments for patients on MAT are scheduled according to medication and duration of stability – see page 14. Urine drug screening (UDS) is used to monitor MAT adherence and should be performed randomly at defined intervals. Annual labs and other diagnostic tests (e.g., EKG for patients on methadone) should be done as recommended see page 14. Follow-up appointments for patients with SUD, but not on MAT, will be based on other clinical conditions. Patients will be monitored for their participation in the Integrated Substance Use Disorder Treatment (ISUDT) Program. TRANSITION SERVICES Transition services will be provided for those patients who are part of the ISUDT Program at the time of release in order to facilitate their ongoing treatment and recovery without interruption. See page 18 for more details. Questions: [email protected] TABLE OF CONTENTS ISUDT Program .................................................................... 2 Transition Services ............................................................. 18 Treatment Algorithm ............................................................. 3 Special Circumstances ....................................................... 19 Screening ............................................................................. 4 Medication Tables.......................................................... 19-22 Assessment ....................................................................... 4-8 Patient Education .............................................. PE-1 to PE-4 Treatment - Behavioral ......................................................... 9 Patient Education (Spanish) .............................. PE-5 to PE-8 Treatment - Supportive Housing ........................................... 9 NIDA Quick Screen ............................................Attachment A Treatment - Pharmacologic ........................................... 10-13 NIDA Modified ASSIST ......................................Attachment B Monitoring for Patients on MAT ..................................... 14-17 UDS Metabolites and Detection Time ............... Attachment C Information contained in the Care Guide is not a substitute for a health care professional's clinical judgment. Evaluation and treatment should be tailored to the individual patient and the clinical circumstances. Furthermore, using this information will not guarantee a specific outcome for each patient. Refer to “Disclaimer Regarding Care Guides” for further clarification: https://cchcs.ca.gov/clinical-resources/ 1 May 2020 CCHCS Care Guide: Substance Use Disorder SUMMARY DECISION SUPPORT PATIENT EDUCATION / SELF-MANAGEMENT ISUDT Program Team Composition The ISUDT Treatment team is multidisciplinary and composed of staff positions within California Correctional Population Health Care Services (CCHCS), the Division of Rehabilitative Programs (DRP) and the Division of Adult Served EPRD 15 EPRD MAT Arriving on Institutions. Each team member has unique roles and responsibilities in delivering major components of the Here Already program including screening, assessment, treatment, and transitional services that support the patient. Sometimes the roles vary depending on where the patient is in their incarceration lifecycle. - There are other staff who play important roles for patients, however, this table focuses on new positions and/or 24 months specific functions related to the ISUDT program. Team Member Roles Reception Center Registered Initial health screening/screen for patients arriving on MAT X Nurse (RN) Release of information (CDCR 7385) to confirm medication/dosage X If on MAT, alert Resource RN X Referrals to Licensed Clinical Social Worker (LCSW) and AMCT X If on methadone, order Narcotics Treatment Program (NTP) (transport) X Orders baseline labs per protocol X Primary Care RN NIDA Quick Screen X Refers Positive screen to LCSW for NIDA MA X Triage 7362 X Resource RN Coordinates all transitions between Primary Care Teams (PCTs), jails, X X counties, parole, probation, with assistance of LCSW Performs NIDA QS and/or NIDA MA in some cases (i.e., 7362) X May refer positive screens to LCSW for NIDA MA X Supervisory Nurse (SRNII) Oversees program components for Whole Person Care X X X Support Staff Provides support to nursing staff in various programmatic roles X X X Licensed Clinical Social Assess patients with an earliest possible release date (EPRD) of 15‐24 X Workers months using NIDA MA Assess patients with SUD complications using NIDA MA/ASAM X Assess patients arriving on MAT using ASAM X Refer to the DRP’s certified Alcohol and Other Drug Counselor for CBI X X X Refer to AMCT if high risk OUD/AUD X X X Alcohol and Other Drug Provides emotional support for individuals going through treatment X X X Counselors Conducts group (CBI) sessions that help to get to the root of addiction X X X Helps provide insight into the patient's recovery while participating in CBI X X X Correctional Counselors (CC-III) Case manage patients toward their goals in rehabilitation X X X Assist with developing relapse‐prevention plans X X X Provide counseling, assign job skills training, and encourage education X X X Addiction Medicine Central Evaluate for and Initiate MAT X X X Team (AMCT) Ongoing management and monitoring X X X Discharge planning including MAT prescriptions X Provide consultation and technical support for PCPs and mental health X X X (MH) providers Primary Care Providers (PCP) * Bridge orders at reception & inter-facility transfers to ensure continuity X X Order methadone (administered by NTP) & medical hold for methadone X Identify SUD-related complications X Refer to LCSW and AMCT X Use Motivational Interviewing to encourage initial and ongoing participation X X X Integrate SUD care Into overall care management and care coordination X X X Pharmacists Process and ensure appropriate MAT bridge orders X Assists with medication reconciliation (transfers) X Assure prescriber X‐waivers for buprenorphine orders X X X Fills and dispenses 30-day medication supply upon release X Arranges naloxone on release via standing order
Load more

Recommended publications
  • Effects of Acute Intravenous Administration of Pentamidine, a Typical Herg-Trafficking Inhibitor, on the Cardiac Repolarization Process of Halothane-Anesthetized Dogs
    J Pharmacol Sci 110, 476 – 482 (2009)4 Journal of Pharmacological Sciences ©2009 The Japanese Pharmacological Society Full Paper Effects of Acute Intravenous Administration of Pentamidine, a Typical hERG-Trafficking Inhibitor, on the Cardiac Repolarization Process of Halothane-Anesthetized Dogs Hirofumi Yokoyama1,2, Yuji Nakamura1, Hiroshi Iwasaki1, Yukitoshi Nagayama1,2,3, Kiyotaka Hoshiai1,2,3, Yoshitaka Mitsumori1, and Atsushi Sugiyama1,2,* 1Department of Pharmacology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan 2Yamanashi Research Center of Clinical Pharmacology, Fuefuki, Yamanashi 406-0023, Japan 3Sugi Institute of Biological Science, Co., Ltd., Hokuto, Yamanashi 408-0044, Japan Received February 27, 2009; Accepted June 16, 2009 Abstract. Although acute treatment of pentamidine does not directly modify any ionic channel function in the heart at clinically relevant concentrations, its continuous exposure can prolong QT interval. Recent in vitro studies have indicated that hERG trafficking inhibition may play an important role in the onset of pentamidine-induced long QT syndrome. In this study, we examined acute in vivo electropharmacological effects of pentamidine using the halothane- anesthetized canine model (n = 5). The clinically relevant total dose of 4 mg/kg of pentamidine (namely, 1 mg/kg, i.v. over 10 min followed by 3 mg/kg, i.v. over 10 min with a pause of 20 min) decreased the mean blood pressure, ventricular contraction, preload to the left ventricle, and peripheral vascular resistance. Pentamidine also enhanced the atrioventricular conduction in parallel with its cardiohemodynamic actions, but it gradually prolonged both the ventricular repolarization period and effective refractory period, whereas no significant change was detected in the intraventricular conduction.
    [Show full text]
  • Positively Selected Modifications in the Pore of Tbaqp2 Allow Pentamidine to Enter
    bioRxiv preprint doi: https://doi.org/10.1101/2020.03.08.982751; this version posted March 10, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 1 Positively selected modifications in the pore of TbAQP2 allow pentamidine to enter 2 Trypanosoma brucei 3 4 Ali H. Alghamdi1, Jane C. Munday1, Gustavo D. Campagnaro1, Dominik Gurvič2, Fredrik 5 Svensson3, Chinyere E. Okpara4, Arvind Kumar ,5 Maria Esther Martin Abril1, Patrik Milić1, 6 Laura Watson1, Daniel Paape,1 Luca Settimo,1 Anna Dimitriou1, Joanna Wielinska1, Graeme 7 Smart1, Laura F. Anderson1, Christopher M. Woodley,4 Siu Pui Ying Kelley1, Hasan M.S. 8 Ibrahim1, Fabian Hulpia6 , Mohammed I. Al-Salabi1, Anthonius A. Eze1, Ibrahim A. Teka1, 9 Simon Gudin1, Christophe Dardonville7, Richard R Tidwell8, Mark Carrington9, Paul M. 10 O’Neill4, David W Boykin5, Ulrich Zachariae2, Harry P. De Koning1,* 11 12 1. Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 13 8TA, UK 14 2. Computational Biology Centre for Translational and Interdisciplinary Research, 15 University of Dundee, Dundee DD1 5EH, UK 16 3. IOTA Pharmaceuticals Ltd, St Johns Innovation Centre, Cowley Road, Cambridge CB4 17 0WS 18 4. Department of Chemistry, University of Liverpool, Liverpool, UK 19 5. Chemistry Department, Georgia State University, Atlanta, GA, US 20 6. Laboratory for Medicinal Chemistry, University of Ghent, Ghent, Belgium 21 7. Instituto de Química Médica - CSIC, Madrid, Spain 22 8.
    [Show full text]
  • New Approaches from Nanomedicine for Treating Leishmaniasis
    Chemical Society Reviews New approaches from nanomedicine for treating Leishmaniasis Journal: Chemical Society Reviews Manuscript ID CS-REV-08-2015-000674.R1 Article Type: Review Article Date Submitted by the Author: 09-Oct-2015 Complete List of Authors: Gutiérrez, Victor; Freie Universität Berlin, Seabra, Amedea; Universidade Federal de São Paulo, Departamento de Ciências Exatas e da Terra Reguera Torres, Rosa; Universidad de León, Departamento de Ciencias Biomédicas Khandare, Jayant; Maharastra Institute of Pharmacy, Calderon, Marcelo; Freie Universität Berlin, Page 1 of 28 Chemical Society Reviews New approaches from nanomedicine for treating Leishmaniasis Víctor Gutiérrez 1, Amedea B. Seabra 2, Rosa M. Reguera 3, Jayant Khandare 4, Marcelo Calderón 1* 1 Freie Universität Berlin, Institute for Chemistry and Biochemistry, Takustrasse 3, 14195 Berlin, Germany 2 Exact and Earth Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil 3 Departamento de Ciencias Biomédicas, Universidad de León, León, Spain 4 Maharashtra Institute of Pharmacy, MIT Campus, Paud Road, Kothrud, Pune 411038 India * Corresponding Author: Prof. Dr. Marcelo Calderón Takustrasse 3, 14195 Berlin, Germany Phone: +49-30-83859368. Fax: +49-30-838459368 E.mail address: [email protected] Abstract Leishmaniasis, a vector-borne disease caused by obligate intramacrophage protozoa, threatens 350 million people in 98 countries around the world. There are already 12 million infected people worldwide and two million new cases occur annually. Leishmaniasis has three main clinical presentations: cutaneous (CL), mucosal (ML), and visceral (VL). It is considered an opportunistic, infectious disease and the HIV-Leishmaniasis correlation is well known. Antimonial compounds are used as first-line treatment drugs, but their toxicity, which can be extremely high, leads to a number of undesirable side effects and resultant failure of the patients to adhere to treatment.
    [Show full text]
  • PENTAMIDINE What Should You Do If You Short of Breath), Neutropenia (A FORGET a Dose? Reduced Number of White Blood Cells
    PENTAMIDINE What should you do if you short of breath), neutropenia (a FORGET a dose? reduced number of white blood cells that help you fight infections), Other NAMES: Pentacarinat If you miss doses of inhaled thrombocytopenia (reduced number of pentamidine, you are increasing your risk platelets that can increase your risk of WHY is this drug prescribed? of catching PCP. If you have missed an bleeding or developing bruises), rapid appointment, call your clinic immediately and irregular heartbeat, liver, kidney and Pentamidine is used in the prevention to rebook an appointment to receive your pancreas problems. Because of the and treatment of pneumocystis carinii pentamidine dose as soon as possible. effect of pentamidine on the pancreas, pneumonia (PCP). It is also used as an decreases or increases in your blood antiparasitic agent for the treatment of What ADVERSE EFFECTS can this sugar level may occur. Blood tests parasites. Pentamidine is used when a drug cause? What should you do must be done regularly to watch for the person has experienced adverse effects about them? presence of these adverse effects. or toxicity to other drugs, such as trimethoprim-sulfamethoxazole (TMP- Inhalation of pentamidine can cause you When given by the intramuscular route, SMX, Bactrim , Septra ) or dapsone. to cough , especially if you smoke or pain and tenderness at the site of have asthma. This can be controlled by injection may occur. HOW should this drug be taken? another drug called a bronchodilator [eg. salbutamol (Ventolin )]. This will If you are experiencing any adverse For the prevention of PCP, pentamidine help you breathe more easily.
    [Show full text]
  • Drug-Induced Lung Disease: 1990 Review
    Eur Resplr J REVIEW 1991, 4, 465-478 Drug-induced lung disease: 1990 review D. lsraei-Biet*, S. Labrune**, G.J. Huchon** Drug-induced lung disease: 1990 review. D. Israel-Biet, S. Labrune, G.J. • Universit6 Ren6 Descartes, Hopital Lai!nnec, 42 rue Huchon. de Sevres, F-75340 Paris, France. ABSTRACT: Numerous drug-induced pulmonary manifestations have been •• HOpital Arnbroise Par6, 9 avenue Charles de Gaulle, reported but studies of their pathogenic mechanisms are still rare. These F-92104 Boulogne, France. mechanisms should, however, be precisely determined in order to Identify Correspondence: G.J. Huchon, Hopital Arnbroise Par6, subjects at risk and to prevent some of these complications by the proper 9 avenue Charles de Gaulle, F-92104 Boulogne, use of certain drugs In more appropriate conditions. The possibility of an France. iatrogenic manifestation should always be considered in patients developing pulmonary sympt·oms. Data from biological investigations, although not Keywords: Asthma; drugs; hypersensitivity lung speclfk, contribute to the understanding of lung Injury mechanisms. disease; iatrogeny; pulmonary fibrosis; pulmonary Eur Respir J, 1991, 4, 465-478. hypertension; pulmonary oedema. Received: May 9, 1990; accepted after revision October 31, 1990. This work was supported by a grant from Association pour l'Etude de la Respiration et de l'Environnement. Pulmonary side-effects are frequently ascribed to drugs does not automatically mean drug sensitization but that have recently, or even not so recently, arrived on the sometimes simply reflects the irritating effect of the drug. market. An exhaustive list of incriminated substances Skin tests should be carried out with a titrated solution would probably be just as impossible to draw up as it and read at repeated intervals in order to discriminate would be to identify precisely the mechanism(s) between early reaction, possibly involving immu­ responsible for the observed symptoms which are often noglobulin E (IgE), and 48 h late reaction reflecting intricate.
    [Show full text]
  • Spring 2015, Issue 6 a Publication of the Department of Pharmacy, Norman Regional Health System
    The Script The Script Spring 2015, Issue 6 A Publication of the Department of Pharmacy, Norman Regional Health System Vitamin K Route of Administration for Warfarin Reversal By Elizabeth Rathgeber, Pharm.D., Samantha Sepulveda, Pharm.D., Lysse Vadder, Pharm.D. In This Issue: Warfarin is an anticoagulant that works by inhibiting the synthesis of vitamin K-dependent clotting factors. Excessive anticoagulation can lead to an elevated international normalized ratio (INR), increasing the risk of bleeding complications. Vitamin K Route of Administration Phytonadione (vitamin K1) is used to reverse the effects of warfarin by promoting synthesis of for Reversal of Warfarin . 1 clotting factors. Vitamin K is available for several routes of administration: oral (PO), intravenous (IV), subcutaneous (SC), and intramuscular (IM). The low-dose (1 to 2.5 mg) PO formulation should The 2014-2015 NRHS be used in patients not requiring urgent reversal, which takes approximately 1.4 days for the INR to Pharmacy Residents . 2 reach less than 4.0 if the INR is between 6 and 10. Vitamin K 5 mg PO and 1 mg IV produce similar effects at twenty-four hours after administration.1 Higher doses of vitamin K can lead to warfarin Pharmacy and Therapeutics resistance and thrombosis. The IV route works more rapidly than PO or SC administration with INR Committee Update. 2 reduction beginning within 2 hours and full correction occurring within 24 hours. However, IV Humulin® R U-500 (Concentrated) administration has been associated with a small risk of anaphylactic reactions and is not 2 Added to NRHS Formulary . 3 recommended unless another route is not feasible and the increased risk involved is justified.
    [Show full text]
  • WHO Model List (Revised April 2003) Explanatory Notes
    13th edition (April 2003) Essential Medicines WHO Model List (revised April 2003) Explanatory Notes The core list presents a list of minimum medicine needs for a basic health care system, listing the most efficacious, safe and cost-effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment. The complementary list presents essential medicines for priority diseases, for which specialized diagnostic or monitoring facilities, and/or specialist medical care, and/or specialist training are needed. In case of doubt medicines may also be listed as complementary on the basis of consistent higher costs or less attractive cost-effectiveness in a variety of settings. When the strength of a drug is specified in terms of a selected salt or ester, this is mentioned in brackets; when it refers to the active moiety, the name of the salt or ester in brackets is preceded by the word "as". The square box symbol (? ) is primarily intended to indicate similar clinical performance within a pharmacological class. The listed medicine should be the example of the class for which there is the best evidence for effectiveness and safety. In some cases, this may be the first medicine that is licensed for marketing; in other instances, subsequently licensed compounds may be safer or more effective. Where there is no difference in terms of efficacy and safety data, the listed medicine should be the one that is generally available at the lowest price, based on international drug price information sources.
    [Show full text]
  • 2021 Formulary List of Covered Prescription Drugs
    2021 Formulary List of covered prescription drugs This drug list applies to all Individual HMO products and the following Small Group HMO products: Sharp Platinum 90 Performance HMO, Sharp Platinum 90 Performance HMO AI-AN, Sharp Platinum 90 Premier HMO, Sharp Platinum 90 Premier HMO AI-AN, Sharp Gold 80 Performance HMO, Sharp Gold 80 Performance HMO AI-AN, Sharp Gold 80 Premier HMO, Sharp Gold 80 Premier HMO AI-AN, Sharp Silver 70 Performance HMO, Sharp Silver 70 Performance HMO AI-AN, Sharp Silver 70 Premier HMO, Sharp Silver 70 Premier HMO AI-AN, Sharp Silver 73 Performance HMO, Sharp Silver 73 Premier HMO, Sharp Silver 87 Performance HMO, Sharp Silver 87 Premier HMO, Sharp Silver 94 Performance HMO, Sharp Silver 94 Premier HMO, Sharp Bronze 60 Performance HMO, Sharp Bronze 60 Performance HMO AI-AN, Sharp Bronze 60 Premier HDHP HMO, Sharp Bronze 60 Premier HDHP HMO AI-AN, Sharp Minimum Coverage Performance HMO, Sharp $0 Cost Share Performance HMO AI-AN, Sharp $0 Cost Share Premier HMO AI-AN, Sharp Silver 70 Off Exchange Performance HMO, Sharp Silver 70 Off Exchange Premier HMO, Sharp Performance Platinum 90 HMO 0/15 + Child Dental, Sharp Premier Platinum 90 HMO 0/20 + Child Dental, Sharp Performance Gold 80 HMO 350 /25 + Child Dental, Sharp Premier Gold 80 HMO 250/35 + Child Dental, Sharp Performance Silver 70 HMO 2250/50 + Child Dental, Sharp Premier Silver 70 HMO 2250/55 + Child Dental, Sharp Premier Silver 70 HDHP HMO 2500/20% + Child Dental, Sharp Performance Bronze 60 HMO 6300/65 + Child Dental, Sharp Premier Bronze 60 HDHP HMO
    [Show full text]
  • Drug-Induced Glucose Alterations Part 1: Drug-Induced Hypoglycemia Mays H
    Pharmacy and Therapeutics Drug-Induced Glucose Alterations Part 1: Drug-Induced Hypoglycemia Mays H. Vue, PharmD, and Stephen M. Setter, PharmD, CDE, CGP Many pharmacological agents com- on Hypoglycemia has defined and monly used in clinical practice affect classified hypoglycemia based on glucose homeostasis, interfering with the severity of symptoms in patients the body’s balance between insulin, diagnosed with diabetes as outlined glucagon, catecholamines, growth in Table 2.2 In general, severe hypo- hormone, and cortisol. Drug-induced glycemia develops when a reduction serum glucose alterations manifested in blood glucose is enough to require as hyperglycemia or hypoglycemia assistance from another person and ranging from mild to moderate to actively administer carbohy- to severe symptoms either appearing drate, glucagon, or other corrective acutely or chronically, have perpetual actions.2 Severe hypoglycemia is effects on the body, particularly in a serious clinical syndrome that patients with diabetes. This article continues to be the most common and a second one that will appear in endocrine emergency faced by health the next issue of this journal review care providers and remains the drug-induced serum glucose altera- limiting factor in effective diabetes tions in a two-part series. In this management for many patients.6 article, we review pertinent clini- Hypoglycemia has been associ- cal information on the incidence of ated with a higher number of hospital drug-induced hypoglycemia and admissions, longer hospital stays, and
    [Show full text]
  • World Health Organization Model List of Essential Medicines, 21St List, 2019
    World Health Organizatio n Model List of Essential Medicines 21st List 2019 World Health Organizatio n Model List of Essential Medicines 21st List 2019 WHO/MVP/EMP/IAU/2019.06 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. World Health Organization Model List of Essential Medicines, 21st List, 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
    [Show full text]
  • Dialyzability of Medications During Intermittent Hemodialysis
    DialyzeIHD: Dialyzability of Medications During Intermittent Hemodialysis % Dialyzed % Dialyzed % Dialyzed % Dialyzed IHD Dosing; Administration IHD Dosing; Administration IHD Dosing; Administration IHD Dosing; Administration Timing Drug (Type of Drug (Type of Drug (Type of Drug (Type of Timing Around HD Session Timing Around HD Session Around HD Session Dialyzer) Timing Around HD Session Dialyzer) Dialyzer) Dialyzer) 0.25-0.5mg PO Q8H PRN, Insulin Aspart, Pentamidine 0 4mg/kg IV Q24-36H, Not recommended for use, Clonazepam N/A Reduce to 25-50% of normal dose Acarbose N/A Administer anytime during HD Insulin Detemir, Isethionate (N/A) Administer anytime during HD Administer anytime during HD N/A and titrate, Administer anytime Insulin Glargine, 0.1-0.4mg PO Q8-12H, during HD Normal dose and titrate based on 100-150mg PO Q12-24H, <5 Insulin Lispro Acebutolol N/A Clonidine Administer anytime during HD; No target free or corrected total Administer post-HD (Low Flux) Phenytoin Dose post-HD if hypotensive 75-300mg PO Q24H, (Low Flux) phenytoin level, Normal dose based on indication, 0 Administer anytime during HD Acetaminophen N/A 75mg PO Q24H, Irbesartan Administer anytime during HD; Dose Administer anytime during HD Clopidogrel N/A (N/A) Administer anytime during HD post-HD if hypotensive No 15-45mg PO Q24H, Pioglitazone 2.5-5mg/kg IV/PO Q24H, (N/A) Administer anytime during HD 40-60 250-500mg PO Q6H or 1-2g IV Q4- 100mg IV weekly to monthly, Acyclovir Administer post-HD over 60 Cloxacillin N/A Iron Dextran N/A (N/A) 6H, Administer anytime
    [Show full text]
  • Ketamine Lifted Bipolar Depression in 40 Minutes
    26 MENTAL HEALTH SEPTEMBER 1, 2010 • FAMILY PRACTICE NEWS Ketamine Lifted Bipolar Depression in 40 Minutes Major Finding: In patients with treatment-resistant bipolar depression, an BY ROBERT FINN Dr. Nancy Diazgranados and her col- leagues from the National Institute of infusion of 0.5 mg/kg of ketamine significantly relieved depression within FROM ARCHIVES OF GENERAL PSYCHIATRY 40 minutes, an effect that lasted at least 3 days. Mental Health. Data Source: Randomized, placebo-controlled, double-blind, crossover single infusion of ketamine re- The participants in the study were an VITALS study involving 18 patients. lieved bipolar depression within average of 48 years old, had suffered 40 minutes in patients with treat- from bipolar I or bipolar II depression Disclosures: The National Institute of Mental Health and the National Al- A liance for Research on Schizophrenia and Depression funded the study. A ment-resistant bipolar disorder, according for an average of 28 years, and had failed patent application for the use of ketamine for depression has been submit- to a randomized, placebo-controlled, dou- an average of seven antidepressant treat- ted, listing two of the investigators among the inventors; they have as- ble-blind, crossover study involving 18 ments before the ketamine study. Fifty- signed their rights on the patent to the U.S. government. patients. five percent of the participants had failed The effect lasted at least 3 days, wrote to respond to electroconvulsive therapy. Two-thirds of participants were on psy- chiatric disability, and all but one were LANTUS® (insulin glargine [rDNA origin] injection) solution for subcutaneous injection unemployed (Arch.
    [Show full text]