Are High Quality Webinars a Part of Your Professional Development?

I recently received a text message from a nurse at my Geriatric Clinic that informed me “Mrs. X, (90 y/o) is demanding a prescription for lorazepam (Ativan) for an intolerable flare of insomnia and anxiety”.  She had seen a clinic colleague 2 days prior, who had declined this request, but did prescribe an alternative medicine for her restless leg syndrome (RLS). Though my next day clinic schedule was already full, I texted back to add her to my schedule.  

Even though I have been a general internist for over 40 years and have acquired some expertise in Geriatrics, I’m always humbled by what I don’t know that could benefit my patients.  The above patient’s distress was another one of those “humble pie” experiences.   

Fortunately, I’m committed to life-long learning and have benefited greatly from attending and becoming a part of the work of AMDA, The Society of Post-Acute and Long-Term Care Medicine, CALTCM, and The Coalition for Compassionate Care of California.  

Later that very afternoon, I listened to an AMDA webinar on “Sleep Disorders in the Elderly” presented by Dr. Christopher Kitamura, a geropsychiatrist at Baycrest in Toronto.  On one of his slides on restless legs syndrome, he mentioned that antidepressants that increase serotonin levels may exacerbate this disorder. I was not aware of that association and immediately thought of my patient who was demanding lorazepam.  

I reviewed her chart just prior to her appointment and confirmed I had recently begun her on Lexapro 5 mg daily for depression and then had advanced the dose to 10 mg daily.  She described a sudden worsening of her RLS symptoms, insomnia, and anxiety that correlated with the addition of this medicine. She was frustrated that her ropinirole was no longer effective.  She was relieved to learn that her distress was likely easily reversible by stopping Lexapro, rather than adding lorazepam. The latter could have been a good example of the “Prescribing Cascade” so often experienced by our complex older patients.  In retrospect, I shouldn’t have been surprised by this relationship since serotonin syndrome can have a similar presentation.  

One of the values of AMDA webinars is the ability to submit questions real-time and expect an answer during the webinar or soon thereafter.  In this case, I asked if there was an antidepressant unlikely to exacerbate RLS and was informed that bupropion would be a good choice.

At CALTCM, we are committed to your professional development and see the value of interactive learning opportunities on timely subjects that are available wherever you are.  In 2020, we look forward to launching a monthly webinar program with hot topics such as disaster preparedness. With the threat of disasters becoming the “New Normal” in our state, these webinars should help you provide the right care in the right time.  

The AMDA Webinar library can be accessed at:

Here’s to lifelong learning and a Happy New Year!

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