Blaszczyk Amie Taggart, McGinnis Kelley A, Michaels Heidi N, Nguyen Tony N
Geriatrics, Texas Tech University Health Sciences Center-Dallas/Fort Worth, Dallas, Texas, USA.
Consult Pharm. 2015 May;30(5):287-90. doi: 10.4140/TCP.n.2015.287.
The mandate of the Centers for Medicare & Medicaid Services to decrease the use of antipsychotics in long-term care facilities requires creative solutions. Low-dose quetiapine is used for a multitude of behavioral disorders and sleep problems in the nursing facility population. Yet, at doses of 25 mg per day or less, it doesn't have strong affinity (if any) for the dopamine-2 (D2) receptor, but it does maintain affinity for the histamine-1 and alpha-1 receptors. This begs the question: If it's not antagonizing the D2 receptor, could the use of something with similar receptor-affinity produce the same result, allowing discontinuation of the antipsychotic altogether? Using knowledge of receptor affinities and the pharmacologic action of low-dose quetiapine, consultant pharmacists may have one additional tool in their armamentarium of fighting inappropriate antipsychotic use.
医疗保险和医疗补助服务中心要求减少长期护理机构中抗精神病药物的使用，这需要创造性的解决方案。低剂量喹硫平被用于护理机构人群中的多种行为障碍和睡眠问题。然而，在每天25毫克或更低剂量时，它对多巴胺2（D2）受体没有很强的亲和力（如果有的话），但它确实对组胺1和α1受体保持亲和力。这就引出了一个问题：如果它不拮抗D2受体，那么使用具有相似受体亲和力的药物是否能产生相同的效果，从而完全停用抗精神病药物呢？利用受体亲和力知识和低剂量喹硫平的药理作用，咨询药师在对抗不适当使用抗精神病药物的武器库中可能又多了一种工具。
