Cynthia Farrar - Academia.edu (original) (raw)
Papers by Cynthia Farrar
The Journal of Clinical Psychiatry, 2002
Sir: We report on the case of a male patient who developed extreme elevations in triglyceride lev... more Sir: We report on the case of a male patient who developed extreme elevations in triglyceride levels after the initiation of olanzapine, but has subsequently been maintained on olanzapine through aggressive treatment with agents to combat this adverse effect. Case report. Mr. A, a 42-year-old African American man, was diagnosed with schizophrenia, paranoid type (DSM-IV). Mr. A's history of psychiatric hospitalizations dates back to the age of 19. However, before that, he had a long history of illicit substance abuse, using marijuana at the age of 12 and alcohol regularly at the age of 14. Despite this, he obtained a high school diploma and took several hours of college-level coursework. Over the years, Mr. A has presented with a number of psychiatric symptoms such as poor grooming and hygiene, auditory and visual hallucinations, paranoid ideations, and irritable, threatening, assaultive behavior. He has been diagnosed with a number of schizophrenia subtypes since 1980, but has been managed with either thioridazine or haloperidol decanoate. A long history of medication noncompliance has led to numerous decompensations and hospital readmissions. At the time of this admission to our facility, Mr. A weighed 190 lb (86 kg) and had a body mass index (BMI) of 31. Upon admission, Mr. A was on treatment with the following medications: lovastatin, 40 mg p.o. q.d., for hypertriglyceridemia; divalproex sodium, 500 mg p.o. q.a.m. and 750 mg p.o. q.h.s., for mood stabilization; thioridazine, 100 mg p.o. q.a.m. and 300 mg p.o. q.h.s., for psychosis; and propranolol, 10 mg p.o. t.i.d., for migraine headache prophylaxis. Due to formulary differences between our institution and the transferring institution, lovastatin was replaced by pravastatin, 20 mg p.o. q.d. At the time of admission, Mr. A was diagnosed with DSM-IV schizophrenia, paranoid type, and polysubstance dependence. In addition, he was diagnosed with hypertension and hyperlipidemia. Mr. A's admission lipid panel had the following results: total cholesterol = 227 mg/dL, triglycerides = 313 mg/dL, highdensity lipoprotein (HDL) = 42 mg/dL, and low-density lipoprotein (LDL) = 122 mg/dL. Additionally, his fasting blood glucose was 82 mg/dL, his serum creatinine was 1.2 mg/dL, and his aspartate aminotransferase (AST) was 22 U/L. As a result, pravastatin was discontinued 7 days after admission, and gemfibrozil, 600 mg p.o. b.i.d., was initiated in an effort to specifically lower triglycerides. In addition, Mr. A was placed on a Heart Healthy Diet. Serum valproic acid levels 2 and 3 months after transfer to our facility were 54 mg/L and 62 mg/L, respectively. Thirteen weeks after initiation of gemfibrozil, repeat laboratory measures showed that Mr. A's total cholesterol was unchanged while his triglycerides were greatly improved at 134 mg/dL, his HDL was 38 mg/dL, and his LDL was increased at 162 mg/dL. During this time period, a gradual titration off of
Pharmacotherapy, 2002
Seizure activity is a known complication associated with multiple sclerosis; however, it may also... more Seizure activity is a known complication associated with multiple sclerosis; however, it may also result from side effects of the treatments for the disease. A 21-year-old man with Tourette's syndrome, pedophilia, Asperger's syndrome, and multiple sclerosis experienced seizures after receiving therapy with interferon beta-1a. Adjustments in his drug regimen led to the discovery of pseudoparkinsonism and other extrapyramidal symptoms. This case report illustrates how pharmacodynamic properties of drugs can complicate the treatment of neurologic disorders. Clinicians must be aware of the delicate balance between the signs and symptoms of disease states and the effects of drugs.
The Journal of Clinical Psychiatry, 2002
Sir: We report on the case of a male patient who developed extreme elevations in triglyceride lev... more Sir: We report on the case of a male patient who developed extreme elevations in triglyceride levels after the initiation of olanzapine, but has subsequently been maintained on olanzapine through aggressive treatment with agents to combat this adverse effect. Case report. Mr. A, a 42-year-old African American man, was diagnosed with schizophrenia, paranoid type (DSM-IV). Mr. A's history of psychiatric hospitalizations dates back to the age of 19. However, before that, he had a long history of illicit substance abuse, using marijuana at the age of 12 and alcohol regularly at the age of 14. Despite this, he obtained a high school diploma and took several hours of college-level coursework. Over the years, Mr. A has presented with a number of psychiatric symptoms such as poor grooming and hygiene, auditory and visual hallucinations, paranoid ideations, and irritable, threatening, assaultive behavior. He has been diagnosed with a number of schizophrenia subtypes since 1980, but has been managed with either thioridazine or haloperidol decanoate. A long history of medication noncompliance has led to numerous decompensations and hospital readmissions. At the time of this admission to our facility, Mr. A weighed 190 lb (86 kg) and had a body mass index (BMI) of 31. Upon admission, Mr. A was on treatment with the following medications: lovastatin, 40 mg p.o. q.d., for hypertriglyceridemia; divalproex sodium, 500 mg p.o. q.a.m. and 750 mg p.o. q.h.s., for mood stabilization; thioridazine, 100 mg p.o. q.a.m. and 300 mg p.o. q.h.s., for psychosis; and propranolol, 10 mg p.o. t.i.d., for migraine headache prophylaxis. Due to formulary differences between our institution and the transferring institution, lovastatin was replaced by pravastatin, 20 mg p.o. q.d. At the time of admission, Mr. A was diagnosed with DSM-IV schizophrenia, paranoid type, and polysubstance dependence. In addition, he was diagnosed with hypertension and hyperlipidemia. Mr. A's admission lipid panel had the following results: total cholesterol = 227 mg/dL, triglycerides = 313 mg/dL, highdensity lipoprotein (HDL) = 42 mg/dL, and low-density lipoprotein (LDL) = 122 mg/dL. Additionally, his fasting blood glucose was 82 mg/dL, his serum creatinine was 1.2 mg/dL, and his aspartate aminotransferase (AST) was 22 U/L. As a result, pravastatin was discontinued 7 days after admission, and gemfibrozil, 600 mg p.o. b.i.d., was initiated in an effort to specifically lower triglycerides. In addition, Mr. A was placed on a Heart Healthy Diet. Serum valproic acid levels 2 and 3 months after transfer to our facility were 54 mg/L and 62 mg/L, respectively. Thirteen weeks after initiation of gemfibrozil, repeat laboratory measures showed that Mr. A's total cholesterol was unchanged while his triglycerides were greatly improved at 134 mg/dL, his HDL was 38 mg/dL, and his LDL was increased at 162 mg/dL. During this time period, a gradual titration off of
Pharmacotherapy, 2002
Seizure activity is a known complication associated with multiple sclerosis; however, it may also... more Seizure activity is a known complication associated with multiple sclerosis; however, it may also result from side effects of the treatments for the disease. A 21-year-old man with Tourette's syndrome, pedophilia, Asperger's syndrome, and multiple sclerosis experienced seizures after receiving therapy with interferon beta-1a. Adjustments in his drug regimen led to the discovery of pseudoparkinsonism and other extrapyramidal symptoms. This case report illustrates how pharmacodynamic properties of drugs can complicate the treatment of neurologic disorders. Clinicians must be aware of the delicate balance between the signs and symptoms of disease states and the effects of drugs.