[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-169040-en":3,"doc-seo-169040-105":30,"detail-sidebar-cat-1-en-105":93},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":11,"category_id":12,"category_name":13,"doc_title":14,"doc_description":15,"doc_content":16,"file_id":17,"file_url":18,"file_type":19,"file_size":20,"view_count":4,"is_deleted":4,"is_public":11,"is_downloadable":11,"audit_status":11,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":15,"update_tm":28,"read_time":29},169040,962084928432,"Maya Linwood","https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d",1,11,"Presentations","Psychopharmacology in the Medically Ill - ACLP Resident Education Curriculum - Revised 2019","ACLP Resident Education Curriculum presents a clinical framework for using psychotropic medications in medically ill patients, integrating evidence considerations and the impact of co-morbid illness on efficacy and safety. It contrasts central versus peripheral drug effects and explains pharmacokinetic phases—absorption, distribution, metabolism, and elimination—highlighting organ insufficiency and medication interactions. Detailed attention is given to CYP450, P-glycoprotein, UGT enzymes, protein binding and monitoring, and practical dosing concepts such as bioavailability and renal clearance.","Psychopharmacology in the Medically Ill\nACLP Resident Education Curriculum\nRevised 2019: Paula Zimbrean, MD, Associate Professor of Psychiatry, Yale School of Medicine\nOriginal version 2013: Paula Zimbrean, MD, Assistant Professor of Psychiatry, Yale School of Medicine\nReviewer: Ryan Kimmel, MD, Assistant Professor of Psychiatry, University of Washington School of Medicine\nVersion of March 15, 2019\n2\nOutline\nA. General issues in psychopharmacology for medically ill\nB. Psychopharmacology of organ insufficiency\nC. Special populations (Neurological disorders, Transplantation, OBGYN)\nD. Special topics\nNon psychiatric use of psychotropic medications\nMajor drug to drug interactions\nAlternate routes of administration\nOther agents used in the CL setting\nLearning Objectives\nName several important considerations before using pharmacologic treatment for psychiatric symptoms in medically ill\nDescribe pharmacokinetic changes in patients with significant medical comorbidities\nDescribe unique pharmacological concerns in the management of patients with cardiovascular disease, liver disease, renal insufficiency/dialysis, respiratory and neurological disease\n3\nA. A. General issues in psychopharmacology for medically ill\nConsiderations before using pharmacologic treatment for psychiatric symptoms in medically ill\nWhat is the evidence for efficacy of specific agents for psychiatric illness associated with specific medical problem?\nWhat is the evidence in regards to the safety of psychotropic medications for a specific psychiatric condition with co-morbid medical illness?\nDoes the psychiatric treatment need to be adjusted due to pharmacokinetics/dynamics?\n5\nLimitations of practicing evidence based medicine in the CL context\nStudies, if any, are typically small or open\nPatients with significant medical problems are typically excluded from medication trials in psychiatric studies\n6\nPsychodynamics (what the drug does to the body)\nCentral effect (impact on the brain)\nThe focus of most of general psychopharmacology studies\nImpacted in CNS disorders (e.g. brain tumors or traumatic brain injury)\nB. Peripheral effect (impact on organs outside the brain)\nIn CL this receives more consideration than in general psychiatry\nOften the basis of use of psychotropic medications for non-psychiatric indications (e.g. Duloxetine for neuropathic pain)\nExamples: SSRIs and serotonin receptors in the GI tract, TCAs’ anticholinergic effect on urinary incontinence\n7\nPharmacokinetics (what body does to drugs)\nPhase\nLocation\nFactors that may impact this phase in medically ill\nAbsorption and bioavailability\nGastric and intestinal\nFirst pass metabolism\nGastro-intestinal disorders and surgeries\nFood\nCYP Enzymes\nP-Glycoprotein system\nDistribution\nVolume (overload, edema)\nProtein binding\nMetabolism\nMostly hepatic\nPhase 1: CYP enzymes\nPhase 2: UGT (Uridine 5’-diphosphateglucoronosyltransferase)\nAll major organ diseases (nor just hepatic)\nOther medications\nExcretion\nRenal (mostly)\nRenal impairment\n8\nHelpful facts regarding pharmacokinetics in medically ill\nIV and rectal administration bypass the first-pass metabolism.\nN.B: While IV administration has 100% bioavailability, the rectal absorption is erratic.\nMost drug to drug interactions occur through inhibition/competition on the CYP450 system. For a comprehensive table about this please see Levenson-Ferrando- Clinical Manual of Psychopharmacology in the Medically Ill, second edition, p 35-44.\nEmerging data indicate drug-to-drug interactions can also occur at the P-gp transporter (paroxetine-itraconazole) and UGT(Divalproate-Lamotrigine).\nProtein binding can impact the significance of drug monitoring in medically ill. In these cases, free-drug levels (as opposed to total drug levels) can be more helpful.\n9\nPharmacokinetics- Absorption\nRate- influenced by formulation, drug interactions, GI motility and absorptive surface\nBioavailability - describes the fraction of an administered dose of unchanged drug that reaches the systemic circul","cbCaihDf24Phx4Bt","https://ap.wps.com/l/cbCaihDf24Phx4Bt","pptx",1477749,61,"English","en",105,"# Outline\n## General issues in psychopharmacology for medically ill\n## Psychopharmacology of organ insufficiency\n## Special populations\n## Special topics\n## Learning Objectives\n# Key Content\n## Considerations before using pharmacologic treatment\n## Limitations of evidence-based medicine in CL context\n## Psychodynamics and peripheral effects\n## Pharmacokinetics: absorption, distribution, metabolism, elimination\n## Drug-drug interactions and monitoring considerations","[{\"question\":\"在给合并躯体疾病的患者使用精神科药物前需要重点考虑什么？\",\"answer\":\"需要考虑针对特定医学问题与精神症状的用药证据、该精神疾病在合并躯体共病条件下的安全性证据，以及是否必须因药代/药效动力学改变而调整治疗方案。\"},{\"question\":\"为什么在重症或器官功能受损的患者中要重点关注药物相互作用？\",\"answer\":\"很多药物相互作用通过CYP450系统的抑制或竞争发生，同时也可能涉及P-gp转运体与UGT相关代谢通路；此外蛋白结合改变会影响药物监测时“游离药物”与“总药物”的解读。\"},{\"question\":\"药代动力学中的哪些环节最影响合并内科疾病患者的用药？\",\"answer\":\"吸收与生物利用度受胃肠功能、首过代谢、进食及CYP相关因素影响；分布受血清pH、血流、脂溶性与蛋白结合影响；代谢主要与肝脏和肠壁相关并涉及CYP与UGT等酶；排泄则与肾功能及透析清除能力相关。\"}]","Psychopharmacology in the Medically Ill - ACLP Resident Education Curriculum - Revised 2019 | PPTX",1788243668,21,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":14,"keywords":34,"description":15,"schema_data":35,"social_meta":88,"head_meta":90,"extra_data":92,"updated_unix":28},"psychopharmacology-in-the-medically-ill-aclp-resident-education-curriculum-revised-2019","",{"@graph":36,"@context":87},[37,54,70],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":11},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/template/","Template",2,{"item":49,"name":13,"@type":43,"position":50},"https://docshare.wps.com/template/presentations/",3,{"item":52,"name":14,"@type":43,"position":53},"https://docshare.wps.com/template/psychopharmacology-in-the-medically-ill-aclp-resident-education-curriculum-revised-2019/169040/",4,{"url":52,"name":14,"@type":55,"author":56,"headline":14,"publisher":58,"fileFormat":61,"inLanguage":23,"description":15,"dateModified":62,"datePublished":63,"encodingFormat":61,"isAccessibleForFree":64,"interactionStatistic":65},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/vnd.openxmlformats-officedocument.presentationml.presentation","2026-09-05","2026-09-01",true,{"@type":66,"interactionType":67,"userInteractionCount":69},"InteractionCounter",{"@type":68},"ViewAction",6,{"@type":71,"mainEntity":72},"FAQPage",[73,79,83],{"name":74,"@type":75,"acceptedAnswer":76},"在给合并躯体疾病的患者使用精神科药物前需要重点考虑什么？","Question",{"text":77,"@type":78},"需要考虑针对特定医学问题与精神症状的用药证据、该精神疾病在合并躯体共病条件下的安全性证据，以及是否必须因药代/药效动力学改变而调整治疗方案。","Answer",{"name":80,"@type":75,"acceptedAnswer":81},"为什么在重症或器官功能受损的患者中要重点关注药物相互作用？",{"text":82,"@type":78},"很多药物相互作用通过CYP450系统的抑制或竞争发生，同时也可能涉及P-gp转运体与UGT相关代谢通路；此外蛋白结合改变会影响药物监测时“游离药物”与“总药物”的解读。",{"name":84,"@type":75,"acceptedAnswer":85},"药代动力学中的哪些环节最影响合并内科疾病患者的用药？",{"text":86,"@type":78},"吸收与生物利用度受胃肠功能、首过代谢、进食及CYP相关因素影响；分布受血清pH、血流、脂溶性与蛋白结合影响；代谢主要与肝脏和肠壁相关并涉及CYP与UGT等酶；排泄则与肾功能及透析清除能力相关。","https://schema.org",{"og:url":52,"og:type":89,"og:title":14,"og:site_name":59,"og:description":15},"article",{"robots":91,"canonical":52},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":94},[95,98,103,108,113,118,123,128,132],{"id":12,"doc_module":11,"doc_module_name":46,"category_name":13,"show_sort_weight":96,"slug":97},90,"presentations",{"id":99,"doc_module":11,"doc_module_name":46,"category_name":100,"show_sort_weight":101,"slug":102},12,"Resumes",80,"resumes",{"id":104,"doc_module":11,"doc_module_name":46,"category_name":105,"show_sort_weight":106,"slug":107},14,"Invoices",70,"invoices",{"id":109,"doc_module":11,"doc_module_name":46,"category_name":110,"show_sort_weight":111,"slug":112},15,"Posters",60,"posters",{"id":114,"doc_module":11,"doc_module_name":46,"category_name":115,"show_sort_weight":116,"slug":117},16,"Social Media",50,"social-media",{"id":119,"doc_module":11,"doc_module_name":46,"category_name":120,"show_sort_weight":121,"slug":122},17,"Forms",40,"forms",{"id":124,"doc_module":11,"doc_module_name":46,"category_name":125,"show_sort_weight":126,"slug":127},18,"Letters",30,"letters",{"id":29,"doc_module":11,"doc_module_name":46,"category_name":129,"show_sort_weight":130,"slug":131},"Paper Templates",5,"papers-templates",{"id":133,"doc_module":11,"doc_module_name":46,"category_name":134,"show_sort_weight":4,"slug":135},158,"General","general-158"]