Pushback from other clinicians with benzo tapers
Last year a local independent psychiatrist retired who was heavy handed when it comes to poly pharmacy and controlled substances. I inherited a patient on 12 mg of Klonopin. Made it very clear at initial appointment my plan would be taper and she was free to seek a second opinion. She wanted to move forward. Without getting into specifics it came to my attention that another provider she sees was telling her to advocate for herself and push back on my taper plan. I have been tapering slowly... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 7, 2024 Category: Universities & Medical Training Authors: Attending1985 Tags: Psychiatry Source Type: forums

Benzos vs benztropine for EPS in the elderly
So I got an outpatient consult recently for med recs on an 65ish year old lady with well-documented late-onset schizophrenia (onset around 52-53) who has been on Invega LAI for years and done very well with it. Patient and daughter are adamant about staying on it, as apparently previous periods without meds were disastrous. She's also been taking benztropine 1 mg BID for EPS (appears to be parkinsonism and akathisia) and clonazepam 1 mg daily for anxiety. When clonazepam was previously... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 25, 2022 Category: Universities & Medical Training Authors: Stagg737 Tags: Psychiatry Source Type: forums

Dear SDN, I test in < 2 days. Please come give me your take on whether I should postpone.
The relevant numbers:​ 70 days out, UWSA2: 173 29ish days out, New Free 120: 57% 21 days out, UWSA1: 190 (took once before in 2020) 14 days out, NBME29: 59%, score report says I have a 75% chance of passing! 6 days out, NBME26: 55%, 52% chance of passing. devastated. Boyfriend wishfully discounts this performance because I hadn't taken my clonazepam. UW average hovering around 56% right now, including questions I've seen before since I haven't reset it since... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - July 30, 2022 Category: Universities & Medical Training Authors: glutamate Tags: USMLE and COMLEX Step I Source Type: forums

How would you help this type of patient?
I have a patient who is in his early 60s who has chronic severe PTSD and I think likely either borderline traits or borderline personality disorder. This patient doesn't have any suicidal ideation. No mania or psychosis. No depressive episode. The patient refuses to take medication for PTSD, and mistakenly says another physician has told him SSRIs will harm his heart and wont' accept education to the contrary. He won't even listen to that same physician. He will only take clonazepam 1mg PO... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 8, 2021 Category: Universities & Medical Training Authors: wolfvgang22 Tags: Psychiatry Source Type: forums

New patients evals/transfers with adderall prescription.
For those getting patients for evaluation that have chronic prescriptions for benzodiazepines, stimulants etc. How do you handle it? I've started working at a location where most referrals are prescribes Klonopin and Adderall (which I believe is basically malpractice). Also, most of these patients are not gainfully employed or going to school, what would the purpose of the stimulant be? Added bonus is that they have multiple different providers in prescription monitoring review. Maybe... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - June 25, 2021 Category: Universities & Medical Training Authors: freditoj Tags: Psychiatry Source Type: forums

PCP changing medication dosage
Patient was referred by PCP and was seen once. Patient was on Xanax and changed to klonopin for panic attacks with an agreement to stop cannabis, advised to obtain complete sobriety from cannabis otherwise no benzo will be prescribed while monitoring drug screen. Patient was seen by PCP who increased dosage of benzo and provided one refill on top of it while knowing my plan on initial consult and patient admitting to continuous use of cannabis as before. I have strictly warned patient on... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 9, 2020 Category: Universities & Medical Training Authors: nrmp Tags: Psychiatry Source Type: forums

Controlled substances and concurrent cannabis use
I recently had a new patient who came to me on a number of medications, plus a couple of controlled substances (Adderall and Klonopin). He also admitted to being a regular user of marijuana. I explained my policy on the prescribing of controlled substances and had him sign an agreement stating that he would not use illicit substances such as marijuana, and he agreed to it. The marijuana use continued, however, and after a couple of months a recent drug screen came back positive for THC so... Controlled substances and concurrent cannabis use (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2019 Category: Universities & Medical Training Authors: SpongeBob DoctorPants Tags: Psychiatry Source Type: forums

Holy trinity-would you put your name on this?
Not a pharmacist, but I’ve been a tech for the past five years while completing my undergrad, and I’m starting med school this July. While home for the summer, I was filling at my local (chain) store. At work today, I received a script for Vicodin 10. After looking at their recent fills, I noticed they were also getting morphine IR 30, klonopin 0.5, and soma 350 for the past several months. I pointed it out to my pic, and she said to just continue to fill as is. Forces notes stated... Holy trinity-would you put your name on this? (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2019 Category: Universities & Medical Training Authors: pharmchica15 Tags: Pharmacy Source Type: forums

Drug Testing when prescribing controlled substances
This is something I wanted to look more into, so I decided to start here. Is there specific protocol for tox screens, how often, etc. I only ask because I see different things going on in the community. At community mental health clinics that take medicaid - I see people wanting tox screens monthly when prescribing a controlled substance At clinics that take private insurance - I see people getting Klonopin, Adderall, etc without ever being tox'ed, or rarely. I'm not accusing one... Drug Testing when prescribing controlled substances (Source: Student Doctor Network)
Source: Student Doctor Network - April 11, 2018 Category: Universities & Medical Training Authors: Psychobabbling Source Type: forums

Random Psychiatry venting
My patient's GF: (at appt with pt) "Doctor, I too have bipolar disorder. My psychiatrist has me on Zoloft and Klonopin". Me: "Oh, anything else? Her: "Nope, those two meds are what works for my bipolar disorder." Me: "Uh....alrighty then, I will leave that to your psychiatrist". (Source: Student Doctor Network)
Source: Student Doctor Network - April 10, 2018 Category: Universities & Medical Training Authors: Messerschmitts Source Type: forums

Tapering off Benzo's?
Do you guys have any general strategies you use? I'm getting patients who have been on Xanax their whole lives and I have made it clear to them that I will no longer be continuing the medication as they are also receiving Opioids. A few of the patients have already complained and left the clinic as their PCP's would be more than willing to refill their medications. However, I have been trying to dose them on an equivalent version of Klonopin and taper 25-50% every 2 weeks. Am I being too... Tapering off Benzo's? (Source: Student Doctor Network)
Source: Student Doctor Network - January 25, 2018 Category: Universities & Medical Training Authors: ryerica22 Source Type: forums

Mistake -customer complained to board of pharmacy
i made a mistake ( typed and verified half of a tablet on clonazepam 0.5 mg...and it should of been typed as 0.5mg, so as a result pt was taking 0.25 mg of clonazepam ) Pt complained to board of pharmacy ... Now they want me to give them an explanation ... What is the best way to do it? (Source: Student Doctor Network)
Source: Student Doctor Network - December 26, 2017 Category: Universities & Medical Training Authors: jmail Source Type: forums

Methadone Rx
Hi everyone, There's a patient who has been filling methadone (~12 tabs/day= 120 mg) and klonopin at the pharmacy for almost 3 years. Upon review of the state's PDMP report, that's 369 mgEq/day. Per the dr's office the diagnosis code is M54.5 for chronic low back pain. I am relatively new to the pharmacy, and am not feeling comfortable filling the script. Under what circumstances, if any, would you fill the Rx? What if I don't fill it and the patient ends up going through withdrawal...? Any... Methadone Rx (Source: Student Doctor Network)
Source: Student Doctor Network - November 13, 2017 Category: Universities & Medical Training Authors: mimi06bg Source Type: forums

Would you fill these rxs?
Hi everyone, Would you question/fill these rxs? Scenario 1: Only medications on file are ambien cr 12.5 mg (#90), norco 10 mg (#180) and soma 350 mg (#120). They are all written by the same doctor. Scenario 2: Is prescribed soma 250mg and oxycodone 15 mg (#120) from the same doctor, who is a visiting physician (i.e sees patients at their homes.) Scenario 3: Fills methadone 10 mg (#320)- prn dosing and klonopin 1 mg monthly. They're both written by the same doctor, an internist. (Source: Student Doctor Network)
Source: Student Doctor Network - July 25, 2017 Category: Universities & Medical Training Authors: mimi06bg Source Type: forums

Use of multiple benzos with stimulants
Hi all, I'm wondering if you could offer any insight about a patient who came into my pharmacy today with scripts for Ritalin 30 mg qid xanax 0.5 bid and klonopin 2mg bid. I really don't pretend to be a psych expert so i called the office and got a response of "just fill it". I didn't end up filling it but I guess my questions are where do you guys typically draw the line on titrating stimulant doses, what's the rationale behind prescribing stimulants with benzodiazepines, and what's the... Use of multiple benzos with stimulants (Source: Student Doctor Network)
Source: Student Doctor Network - April 5, 2017 Category: Universities & Medical Training Authors: Claydoe Source Type: forums