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The Carlat Psychiatry Podcast

Psychopharm Commandment 7A: Red Flags & Controlled Meds

The Carlat Psychiatry Podcast

Pocket Psychiatry: A Carlat Podcast

Health & Fitness, Mental Health, Medicine, Alternative Health

4.8440 Ratings

🗓️ 3 April 2023

⏱️ 15 minutes

🧾️ Download transcript

Summary

The DEA has warned pharmacists to watch for Red Flags in controlled prescriptions, and we’ll show you what they are and how to use them therapeutically in practice.CME: Take the CME Post-Test for this Episode (https://thecarlatcmeinstitute.com/mod/quiz/view.php?id=3246)Published On: 04/03/2023Duration: 15 minutes, 25 secondsChris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Transcript

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0:00.0

The DEA has deputized us to enforce regulations around controlled substances, but they haven't

0:06.6

exactly made those regulations clear. Today, we'll bring some need of clarity with the seventh

0:11.7

psychopharm commandment. Controlled substances shall be controlled. Welcome to the Carlite Psychiatry Podcast, keeping psychiatry honest since 2003.

0:27.6

I'm Chris Aiken, the editor-in-chief, and the author of the Depression and Bipolar Workbook.

0:33.5

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

0:40.0

On May 11, 2023, the COVID-19 public health emergency will come to an end.

0:47.3

But there's another public health emergency that we're still in the middle of, the opioid crisis.

0:53.3

Both of these emergency states have impacted the

0:55.8

regulation of controlled substances, and we are on the front lines of that regulation. Today,

1:02.2

we're going to offer guidance on how to navigate controlled regulations in this emergency

1:07.0

climate with the seventh cycle farm commandment, but first, a replay of the previous six.

1:14.1

1. Do not worsen mental illness with psych meds, like don't use antidepressants during mania or

1:20.7

psychostimulants in psychotic disorders. Two, avoid stopping meds abruptly, particularly benzodiazepines, serotonergic antidepressants, and lithium.

1:32.1

Patients rank withdrawal problems as one of their top concerns. Unless there's a dinee to get

1:37.2

off the med, like a Lomotrogen rash, we recommend stopping psych meds gradually over at least two weeks.

1:44.4

3. Stop Lomotetrogen if any rash develops in the first three months of treatment with it.

1:51.0

Even mild rashes can progress to fatal ones, and you can't be sure which way this wind is blowing.

1:57.6

Four, watch out for lithium toxicity by staying on top of drug interactions, dehydration,

2:03.8

and your patient's age and renal function.

2:06.6

5. Do not give benzodiazepines to patients who have an elevated risk of opioid overdose deaths.

2:13.3

Benzos increase the overdose risk fourfold.

2:17.5

Rewind to a September, November 2022 episode for more details on the first five,

...

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