C E N T E N N I A L M E N T A L H E A L T H C E N T E R , I N C May 17, 2013
WoW: Inducers and Inhibitors: An enzyme inducer increases the enzymatic
metabolism of a drug (it induces the enzyme); An enzyme inhibitor decreases
the enzymatic metabolism of a drug (it inhibits the enzyme). These are
examples of drug-drug interactions, such as Depakote inhibiting the
metabolism of Lamictal so much that you must halve the dose of Lamictal
when mixed with Depakote. Another—more everyday—enzyme inhibitor is
grapefruit juice, 10 oz. of which wil inhibit the metabolism of many drugs for as
much as 3 days. On the other hand, Tegretol is an enzyme inducer that, when
added to, say, Lamictal, wil cut its blood level in half by increasing the
enzymatic activity that metabolizes it—meaning you must double the dose of
Lamictal in order to achieve a desired effect.
In practice, an enzyme inhibitor can increase the likelihood of
medication side effects. An enzyme inducer can suddenly render a drug
ineffective because it’s metabolized quicker. Therefore, sometimes it’s useful
to question clients regarding their day-to-day habits, because a simple
change in, say, their breakfast beverage, might affect their treatment progress
Paul D. Freda, M.D. Medical Director
Ft Morgan Office Asst. MHP in Central Region
Pathways to Wellness: Random Acts of Kindness:
Al we have to do to change our own lives is pass it on.
11. Put sticky notes with positive messages (e.g., "You look gorgeous!") on a restroom mirror. 12. In low-income families, a baby can spend a day or longer in the same diaper, and Laundromats often don't
al ow cloth diapers to be washed in machines. Help out a mom and a baby by donating diapers (find a
13. Send a thank-you note to the brave officers at your local police station. (Given how we carry on about
parking tickets, it's important to acknowledge the daily risks taken by the men and women on the force.)
14. Share the wealth: Ask the grocery clerk to apply your unused coupons to another customer's items. 15. Arrange to pay anonymously for a soldier's breakfast when you see him or her dining alone. 16. Slip a $20 gas card or public-transportation pass into someone's shopping bag. 17. Rekindle your Girl Scout spirit: Pick up trash at a park or a playground. 18. Donate your old professional clothes to an organization, like Dress for Success , that
helps women jump-start their careers — and up their confidence.
19. Carry someone's groceries. 20. It's hot out! Offer your mail carrier a glass of iced tea or a $5 Starbucks gift card.
Clinical Coordinator Report – May, 2013
Steve Gilbertson – Substance Use Disorder (SUD) Clinical Coordinator
Special Connections: services for pregnant substance users We are continuing our efforts with systems integration with primary care with a target towards pregnant substance users (Special Connections). Due to our region being in two RCCO’s, I attended a Regional Convening on Maternal Substance Use in Colorado Springs both to connect with that RCCO and to engage in planning for the Regional Convening to be held in Ft. Morgan on May 9. Our outreach to our communities with a focus on Morgan and Logan Counties has resulted in an increase in the number of pregnant substance using moms who have entered our programs. Sarah Walgenbach is performing valiantly as our Specialized Women’s Services/ Special Connections Team Lead and is having a significant positive impact in the growth of these programs. We have appointed an Intensive Case Manager to work with Special Connections clients from intake through their program in order to wrap them with all available services and opportunities in our communities. This is going very well and there is a positive impact on how quickly we can help someone enter services. We are participating in the Regional Convening on May 9th in Ft. Morgan.
Specialized Women’s Services (SWS) SWS is targeted towards Women with Dependent Children and Special Connections is a subset of this. We are continuing to implement our SWS grant and have begun an incentive program for clients who meet the eligibility criteria as a part of this grant. We are receiving technical assistance for the Central East Addiction Technology Transfer Center (ATTC) in the implementation of Motivational Incentives beginning in Ft Morgan and also starting in our other regions. These Motivational Incentives are targeted towards attendance in group services and provision of monitoring services as scheduled with appropriate negative results. Funding has also been moved within this grant to make physical healthcare available for mothers and their children if needed, and to make Medication Assisted Therapy more available to this population. We are expecting continued growth in this program.
Medication Assisted Therapy (MAT) MAT is the category of medication based treatment for substance use disorders. This includes medication for alcohol dependence and medication for opiate addiction including common pain management medications. I have begun a series of meetings with Reckitt Benckiser, the manufacturer of Suboxone sublingual strip medication (the most common and safest form of Suboxone) to get Dr. Freda enrolled in their database referral system and to be able to tie our clients into their patient assistance programs. We have seen significantly more people enroll into this program than anticipated which evidences the state data showing a greater than expected incidence of opiate addiction in NE Colorado. We continue to work out our internal clinical pathways as we go and have developed a set of intake instruments to aid clinicians in determining if a client is appropriate for Suboxone as a medical intervention for opiate addiction. We continue to search out resources to help with the cost of medications and are finding ways to help those who have no insurance.
Peer Review As an advocate of Peer Review for many years, I am happy to report that this was begun just this week in the East Region for SUD and Integrated Dual Disorder Treatment through a hands on staff training in use of our Quality Improvement instrument. Clinicians who provide SUD or Dual Diagnosis services will begin in the month of May by performing a QI Chart Review on one of their own charts and then in June will begin performing QI on each other’s charts. Benefits include:: 1) familiarity with all of the facets of good charting; 2) an opportunity to learn from each other, someone may have a way of doing a particular task that is better and more efficient than someone else 3) opportunity to be directly involved in improving our record keeping at a peer level. As a part of Peer Review I have begun traveling to each region and am setting a schedule for face-to-face meetings with clinical staff in addition to clinical supervision currently performed using VidCon technology.
SIKKERHETSDATABLAD Aniosterase SV 1. IDENTIFIKASJON AV KJEMIKALIET OG ANSVARLIG FIRMA 1.1 Produktidentifikator Kjemikaliets navn 1.2 Relevante identifiserte anvendelser for stoffet eller blandingen, samt anvendelser som frarådes AnvendelseEnzymatisk rengjøringsmiddel for flater og utstyr. Ingen spesifikke. Ikke bland produktet med andre kjemikalier uten å ha konferert med produsent