Episode #22: esketamine (Spravato) | Podcast Show Notes
esketamine (es KET a meen)
Below will be links for the full Podcast and the Drug Card for Spravato along with a brief summary of various points on Spravato.
QUESTIONS:
- T or F: Ketamine is the R-enantiomer of racemic esketamine?
- Select all that apply.
- A). Esketamine is a REMS drug
- B). Spravato is not a REMS drug
- C). Spravato is administered only by a licensed Pharmacist
- D). Esketamine is administered under healthcare provider supervision
- E). Only B and D
- In regards to monitoring blood pressure. As a healthcare provider what should you do? Select all that apply.
- A). Monitor blood pressure at approximately 40 minutes
- B). Monitor blood pressure only if patient had a high baseline
- C). Establish a baseline blood pressure
- D). Establish a baseline blood pressure only if patient is being treated for hypertension
- T or F: Spravato can be used a monotherapy for TRD and MDD
SUMMARY:
Esketamine is a REMS program drug that is currently brand only known as Spravato. It is a Non-Selective Non-Competitive NMDA Receptor Antagonist and typically administered in a healthcare setting that is enrolled in the REMS program. Spravato is used along with an antidepressant when treating patients with treatment-resistant depression or a major depressive disorder with acute suicidal ideation and behavior. It is not recommended for pediatric use and the efficacy in reducing and preventing suicide or suicidal behavior has not been proven. Spravato comes in a nasal spray in a 56 mg and 84 mg strength. In addition to the more common CYP pathways, Spravato is primarily metabolized via the CYP2B6 pathway. Esketamine is the S-enantiomer of racemic ketamine. Spravto should be administered by the patient under the supervision of a healthcare provider.
ANSWERS:
- B and C are correct. “A” incorrect because MDD is not an off label use. “D” is incorrect because trazodone is approved for use in children.
- 200-400 mg/day (split into two doses).
- Suicidal Thoughts and Behaviors.
- True. Medications that affect serotonin have been associated with an increase in bleed and bruise risk.
PDF of Drug Card: esketamine
