Module 3: Optimizing Use of Antipsychotic Medications

Module 3: Optimizing Use of Antipsychotic Medications


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Optimizing the use of antipsychotic medications, especially in older adults in PALTC, is a challenge. Providers need to determine an accurate diagnosis, weigh the harms and benefits of specific antipsychotics, learn how best to taper medications appropriately, and stay informed of current federal regulations around antipsychotic use. 

This 1-hour interactive module is part of the Drive to Deprescribe series and is designed to help providers, together with their interdisciplinary teams, develop systematic strategies for rational prescribing, deprescribing, or continuing the use of these medications safely and appropriately. Upon completion, participants can earn CMD Clinical Hours.

Learning Objectives
Upon completion of this module, participants should be able to:

  • Assess the appropriateness of antipsychotic use in PALTC settings.
  • Summarize relevant regulations related to antipsychotic use and explain their rationale.
  • Apply eligibility criteria for antipsychotic deprescribing in a patient case.

Acknowledgement
Funding to support the dissemination of this module was provided by Neurocrine Biosciences. All content was developed independently by PALTmed, without input or influence from the sponsor.

Jennifer A. Pruskowski, PharmD, MS, BCPS, BCGP

Assistant Professor and Director of Geriatric Pharmacy Research and Education

University of Pittsburgh

Dr. Pruskowski is an Assistant Professor at the University of Pittsburgh School of Pharmacy and the Director of Geriatric Pharmacy Research, Division of Geriatrics, in the School of Medicine, as well as the Associate Director for Education and Evaluation within the Pittsburgh Veteran Affairs Technology Enhancing Cognition and Health Geriatric Research Education and Clinical Center (TECH-GRECC).

Michael Cinque, PharmD, FAPhA

Michael Cinque PharmD, FAPhA, currently serves as the Senior Vice President of Clinical Strategic Partnerships at InnovAge and operates as a consultant in Medication Use Management through Michael Cinque Consulting. Prior experience includes a role as Senior Vice President of Pharmacy Management at Genesis and as President at Enclara Pharmacia, where notable achievements included driving the integration of Enclara Pharmacia with Hospice Pharmacia. Previously, Michael Cinque held positions such as Vice President of Operations at Hospice Pharmacia, overseeing a substantial payroll and managing extensive operations, and Chief Pharmaceutical Care Officer at excelleRx Hospice Pharmacia, where responsibilities included leading clinical operations. Academic credentials consist of a Bachelor of Science in Pharmacy from Temple University School of Pharmacy and a Doctor of Pharmacy degree from the University of Florida.

Steven Levenson MD, CMD

Steven Levenson, MD, CMD, was a medical director and physician in PALTC for 43 years. Dr. Levenson passed away on January 24, 2024, at his home in Maryland. He is widely recognized for his pioneering work in medical direction and efforts to improve long-term care and expand its body of knowledge. He has authored or co-authored more than 80 articles and four books, including Medical Direction in Long-term Care and the Subacute and Transitional Care Handbook. Over the past 30 years, he was involved extensively in activities to improve the implementation of the OBRA ‘87 regulations and guidance. Dr. Levenson is a Past President of the Post-Acute and Long-Term Care Medical Association, 2006-2007, and has contributed substantially to numerous PALTmed projects, programs, and publications for the past 35 years. 

Arif Nazir, MD AGSF FACP

CHIEF MEDICAL OFFICER

Signature HealthCARE

A specialist of internal medicine and geriatric care, Dr. Arif Nazir became Signature’s Chief Medical Officer in January 2016. Dr. Nazir brings more than 12 years of leadership experience from his previous role with the Optimistic Project. He has also received recognition for his work in implementing Indiana’s nursing home value-based purchasing system and his extraordinary work as a faculty member of Indiana University.

Dr. Nazir was drawn to Signature HealthCARE’s vision of revolutionizing care in the post-acute and long-term care settings. He continues to work on creating the consistent application of basic and foundational, evidence-based geriatric care, and he aims to partner with the best healthcare systems in Signature’s markets.

Barbara Resnick, PhD, CRNP

Barbara Resnick, PhD, CRNP, is a professor in the school of nursing at the University of Maryland and the Sonya Ziporkin Gershowitz Chair in Gerontology and combines clinical work as an advanced practice nurse in a CCRC with teaching and research. Her research is focused on optimizing function and physical activity among older adults.

Sabine von Preyss-Friedman, MD CMD FACP

CMO

Avalon Healthcare Inc, Caldera Care

Dr. Sabine von Preyss-Friedman is an Internist and Geriatric Medical Specialist who has practiced in Skilled Nursing Facilities (SNFs) since her fellowship at the University of Washington. She first became a certified Medical Director in 1992 and has since been passionately engaged in the Medical Direction of SNFs. In 2011, she was honored by AMDA/Society of Post-Acute and Long-Term Care Medicine (now PALTMed) as Medical Director of the Year.As a co-chair of AMDA's acclaimed D2D/Drive to deprescribe initiative she has won the John Gladstone award as well as AMDA's Choosing Wisely award. In addition to providing services as Medical Director for several facilities in the Seattle area, she is an Associate Clinical Professor Emerita at the University of Washington and serves as Chief Medical Officer of Avalon Healthcare and Caldera Care.
Dr. von Preyss-Friedman is deeply involved in quality improvement, developing standards, and outcome measures in SNFs, and successfully translating medical evidence into clinical care. Her mission is to support the best possible medical care for all patients.
Dr. von Preyss-Friedman currently is the president – elect of PALTMed/formerly AMDA and immediate past president of the WA Society for Post-Acute and Long-Term care Medicine.

Lea Watson, MD, MPH

Lea Watson, MD, MPH, is a geriatric psychiatrist and consultant to the long-term care workforce on issues of behavioral health, psychopharmacology and provider wellbeing.


Chad Worz, PharmD, BCGP, FASCP

Chad Worz, PharmD, BCGP, FASCP is Chief Executive of the American Society of Consultant Pharmacists (ASCP) in Alexandria, Virginia, the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. ASCP's senior care consultant pharmacist members manage and improve quality of life for geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and home- and community-based care. Dr. Worz received his Doctor of Pharmacy degree from the University of Cincinnati College of Pharmacy in Ohio, and he is a board-certified geriatric pharmacist. His career has focused on the medication management of older adults. Dr. Worz developed an innovative clinical practice in a long-term care setting in Ohio and directed the pharmacy practice of a regional, independent pharmacy serving 10,000 long-term care residents. Dr. Worz established a nation-wide, geriatric-based consulting company to educate and serve nursing facility residents, nursing facility administration, long-term care pharmacies, and the public through a comprehensive knowledge of medication use. He is a national thought leader, presenting on pharmacy- and medication-related topics, and he has served on a number of national boards related to pharmacy and medication utilization.

  • 1.0 CMD Clinical

Release Date: 6/9/2025 | Expiration Date: 6/9/2028


CMD Credit Hours: This activity has been pre-approved for up to 1.0 clinical hour(s) toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity. The CMD Program is administered by PALTmed. For further information, contact PALTmed at 410-992-3115 or at certification@paltmed.org.


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Since May 2021, the Post-Acute and Long-Term Care Medical Association (PALTmed) and the American Society of Consultant Pharmacists (ASCP) have collaborated through the Drive to Deprescribe initiative to provide tools and education that support optimizing medication use in long-term care. This module is part of that ongoing effort, designed to help healthcare leaders improve patient care while reducing polypharmacy. 

Explore Additional Modules
Start with any module that fits your current practice, or complete all of them for a comprehensive approach to deprescribing. New modules will continue to be added as the initiative grows:

Webinars and Tools
Access archived webinars, downloadable tools, and other practical resources by visiting the Drive to Deprescribe resource page

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