CEimpact Podcast

Medications Used in Spectrum Disorders

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Medications play a crucial role in managing symptoms and enhancing the quality of life for individuals with autism spectrum disorders, yet their use requires careful consideration and specialized knowledge. Pharmacists are essential in navigating the nuances of these therapies, from dosing adjustments to monitoring for side effects and interactions. Join us to expand your expertise in supporting this unique patient population through informed, compassionate care.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Jena Quinn, PharmD
CEO
Perfecting Peds

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify commonly used medications for managing symptoms in autism spectrum disorders and their primary therapeutic effects.
2. Describe key considerations for dosing, side effects, and drug interactions in medications prescribed for autism spectrum disorders.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-319-H01-P
Initial release date: 12/30/2024
Expiration date: 12/30/2025
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm excited about our conversation today. Medications for autism spectrum disorder, also referred to as ASD, present unique challenges, from managing diverse symptoms to ensuring safety and efficacy in each patient. Understanding these complexities empowers pharmacists to provide informed, compassionate and individualized care, supporting both patients and their caregivers in navigating these treatment options. So today I'm so excited to have Jenna Quinn back with us as our guest expert for this episode. You'll maybe recall, if you're a longtime listener, that we've had Jenna on a couple times before and we're super excited that she's back with us to give us some insight into ASD medication. So welcome, jenna. Thanks for joining us again.

Speaker 2:

Hi Josh. Thank you so much for having me. It's always a pleasure and a fun time.

Speaker 1:

Yeah, awesome. Well, before we jump in, we do have some new listeners and they're not familiar with who you are or what you do at your practice site. Just tell us a little bit about yourself, your practice site and then maybe just I always like to ask why the speaker is passionate about today's subject. So just kind of give us a little bit of background.

Speaker 2:

Yeah, so my name is Jenna Quinn. As Josh said, I am the CEO and co-founder of Perfecting Peds. I've been a pediatric pharmacist for 13 years, practicing in various locations, which I'll talk about, and I am a mom of three crazy girls that keep me going every day and true to my mission. So our group of pharmacists basically, I've practiced at Children's Hospital of Philadelphia and Cooper for over a decade Children's Hospital of Philadelphia and Cooper for over a decade Doing so there was always this burning question of I feel like a Peds pharmacist.

Speaker 2:

We're so highly trained and skilled. We're really isolated to the acute care setting, but I would think we're more valuable in the ambulatory care setting, partnering with caregivers, partnering with patients and following them longitudinally. Just like you have your PCP, there should be a pharmacist that you're consulting longitudinally, similar to MTM. But we really kind of told ourselves as being comprehensive and holistic. So that's basically what our myself and our pharmacists do is. You know, we work with health plans. The health plans give us the high risk children, and a lot of those children are patients that have autism. Risk, which we'll talk about, is the drugs that we use to treat them, but then also the grayness that we see as far as a lack of true guidelines to help a provider really select the right drugs, because it's a very complex picture which we'll dissect and I think over the years, why this has become such an area of interest again is that there is no guideline. So my audacious goal is to eventually create those guidelines.

Speaker 2:

I gave myself five years and our staff. But because these parents, specifically with children with ASD, have been through the ringer for lack of a better word of the healthcare system. They have so many specialists which we'll talk about, so many healthcare providers that are on their care team that there's just an increased risk for miscommunication, inappropriate med optimization, not by any fault of anybody's, just that no one person's owning yeah and think they they've. I've very objectively been able to see that that they need a lot of help and that they from partnering there's just such a beautiful lifelong like. My first patient had autism and I still see that patient today because there's constantly things, changing rooms for optimization.

Speaker 2:

But then really which is another reason that I think pharmacists need to really own this medication regimen for this population is the polypharmacy that's massively present and obviously that flows into unnecessary AM care, er visits, et cetera.

Speaker 1:

Yeah, which just adds to healthcare costs. It adds to frustration for the caregiver. You know I wouldn't be surprised if there was a study done that a lot of these patients also are just lost to follow-up. You know like parents just get frustrated and they just don't even follow up anymore, you know, because maybe the answers aren't received or the medications don't seem to be working the way that they should because they're not being checked, and I fear that there's a lot of patients out there who have just thrown up their arms and kind of given up.

Speaker 1:

So, yeah, I love that you have dug into this topic and have these lofty but achievable goals, and I love it because pharmacists need to be in this space for sure. We're the medication experts, so we need to be in this space. That's great. So for our listeners, Jenna, just kind of set the foundation again. I'm sure everyone has heard of autism or autism spectrum disorder. Those terms can be used interchangeably, but I just want to set the foundation just to make sure we're all on the same page as to what we're going to be talking about today. So if you could take just a couple of minutes, just let us know about kind of what that diagnosis means kind of how it comes about, and then maybe what are some of those symptoms that we're going to be looking to treat with medications?

Speaker 2:

Broadly. Autism spectrum disorder is a developmental disorder that affects many things. So it affects your communication, your behavior and your social interaction, which sometimes develop into things that are extreme in certain situations, like aggression and self-injurious behavior, and so we're going to talk about that aggression and self injurious behavior, and so we're gonna. We're gonna talk about that. It's referred to as a spectrum, obviously, because it's a wide range of symptoms and sensitivities affecting individuals in unique ways. So, for example, my oldest has extreme sensory disorder with, like, certain textures and stuff. I don't know if she would be a very mild case, but there's a wide range of the severities and the things that they find sensory overload that could affect this patient. And again, I feel like if you've seen a child with ASD, you've seen one, you know they're an NM1.

Speaker 1:

Right, yeah, they're.

Speaker 2:

no two are alike, really, because they could have a whole host of different things coming together, or one tiny thing, or 10 things, so yeah, yeah, and so I think just really hone that if you take away anything would be that that they're all unique and, again, because of how wide the spectrum is and the different ways they display their symptoms, you cannot do a one size fits all model for these children and young adults, and so some people require significant support in their daily lives, down to assisted living or where my mom actually works, which is a live-in facility for these patients, and then others can operate independently.

Speaker 2:

So the core characteristics of ASD are consistent of difficulty understanding or using verbal and nonverbal communication, which can also intuitively be the reason why they get frustrated. If you couldn't communicate your wants and needs like that would be extremely frustrating, and so that's something to remember as we're treating these patients. They usually and can have challenges in developing, maintaining and understanding relationships, and they have a reduced ability to engage in back and forth conversations. A lot of times they have repetitive behaviors or restricted interests, so that could be repetitive movements or repetitive speech, and they usually which is really cool when you find that area of interest that they have they usually have an intense focus or area of interest.

Speaker 2:

So for example, my husband's cousin, who I absolutely adore, like get him talking about trains, for example, and you could like. It's really fun when you find the thing that they get excited about and there's strict adherence to routines is a huge thing. So you really want to make sure that's something you're cognizant of. So a lot of the patients that we treat that have autism. I strategically ask our staff to have a CMM session during the transitions into the school year and out of the school year. There are really areas where sometimes we may need to make a medication adjustment, knowing that they are really like the routine, so they usually do really well in school or they really like the summer and they're resistant to the change, which I think. I mean I told you before we got on like I, I wasn't happy, I changed my Thanksgiving routine of years and so I think that's an innate thing that we all have.

Speaker 2:

But more magnified in this patient population, they do get a lot of times sensory overload. So a lot of things you'll see they actually look similar to this. But if you have a child that is on the spectrum a lot of times when they're in crowded places like we just went to disney around me and my kids. You'll see that they'll have headphones on to avoid that over stimulation that can get upset. Understandably, this can go for sounds and lights, or or even textures, as I had talked about before. Certain like I mean and I'm guilty of it too, I refuse to wear jeans like certain textures and down to like the, even the inside seams of things can be extremely irritating. I'm going to put myself in that category. I'm 36 year old. I'm 36 and will wear yoga pants all day, every day, like so again.

Speaker 1:

I feel like I'm similar in that I am a very texture person and my thing, my hangup. I'll let learners in on a little secret so they can better know me. Like you know, when you go to the pool and you put on, you have to like put on clothes while your body is still kind of wet.

Speaker 1:

Putting on dry clothes, I literally can't do it like it literally messes with my mind, like I have to be completely dry, um, and so yeah, I mean, and imagine like that being your everyday yeah, like we're not being able to communicate that that's your problem yeah, like I don't like, I don't like this, but I can't tell you.

Speaker 2:

You don't know why I'm acting aggressively or why.

Speaker 1:

I'm taking the pants off or why I'm throwing them across the room or whatever, because I can't even explain to you that I don't like the way they feel it's very frustrating.

Speaker 2:

I think we have increased awareness of this and I don't have any stats, but you definitely see an uptrend of the diagnosis, and that goes with ADHD and all these childhood developmental disorders. I think we're starting to have a lot of therapies for them, which is amazing. You have ABA therapy, and so I think we're just increased awareness of it, which is a beautiful thing.

Speaker 1:

Yeah, just a general recognition that this exists. This is not just a child acting out. There are underlying reasons why there are concerns and so I think, like you said, just a broadening understanding that I don't want to say that it's more widely acceptable to be diagnosed now, but I think there, I think there's just yeah, there's awareness, there's more known about it and therefore there's, you know, there's something we can call it, we can actually address it and then try to treat it and manage it and whatever.

Speaker 2:

So, yeah, yeah, and certain things that can you know. It's not completely understood, but a combination of genetic and environmental factors. So if you have a history of autism, certain genetic conditions, there is an association between advanced parental age. So the parent's age at conception does play a role and can increase the risk, and then low birth weight or prematurity are all risk factors, jenna.

Speaker 1:

going back to the parental, is it one or the other, or could it be both? You know what?

Speaker 2:

I always thought it was the mother, but I'd be curious. Don't quote me on that.

Speaker 1:

Yeah.

Speaker 2:

But I think that is definitely a reason why we're seeing more of it. It's because nobody's in a rush to have kids anymore, which is, which isn't. It's not a bad thing, but it's just and I think we're obviously, like I said, advancing our screenings and genetic screenings and such, but that definitely is a objective thing that we're seeing that's correlating to just an increase in ASD.

Speaker 1:

Very interesting. Okay, great, that's a great kind of review overview, foundational level, so I think that's awesome. Jenna, you briefly touched on a few symptoms, but what are some of the symptoms as we progress throughout this episode? Like, what are some of the symptoms that we're going to be treating with meds?

Speaker 2:

Yeah. So obviously the diagnosis alone does not mean oh my God, your child has to be on meds the rest of her life, but really it's symptom control and comorbid conditions. So a lot of times we're going to see and again it's that it's a spectrum. Some patients don't have any self-injurious behavior but some patients have headbanging, for example, sometimes you'll see fecal smearing is another one that we commonly see. You'll see aggressive behavior to others. So as part of our ASD screening at Perfecting Peds, when we're talking to the patients and our caregivers is do you feel safe in the home? And we'll talk about this. But there are some emergency medications that we can give for that emergent behavioral response. And that's a very real conversation that we have to have and be prepared for, depending on the child and how they display their symptoms. As we talked about, it can be. There's a lot of comorbidities, such as anxiety, which you can imagine Again, if we all couldn't communicate effectively, we'd be anxious, adhd, depression, and so all these things kind of cloud the picture, but-.

Speaker 1:

Compound yeah.

Speaker 2:

Yeah, I've had some issues with. As far as treatment constipation, a lot of them have a lot of fecal holding. It's called encopresis.

Speaker 2:

It's a common thing that we discuss and help treat, because you can do that over the counter for pharmacist involvement. And then a lot of them have sleeping issues and so we'll talk about that. But a lot of them have difficulty winding down and a lot of times you can openly tell because the parent just looks exhausted. All these are really like I said, you've met one child with autism. You met one child with autism. So we're really digging in and doing what I call as a pharmacist review of systems. How are they sleeping? How are they eating? How are they behaving? Are you ever in danger? How are they? How are they stooling? All these things are going to paint a picture of where a pharmacist could possibly intervene.

Speaker 1:

Yeah, yeah, that's great. So you mentioned before there are no current guidelines. There's very little evidence-based practice guidelines or best practices for us to follow in this space for managing ASD. There are a few things that have some official approval. What are those that we know of for sure, medication-wise?

Speaker 2:

Yeah, so Risperidone and Abilify are the first two that come to mind, so they're your antipsychotics. Obviously, as you know, as pharmacists, it's really our job to manage and there's been some of these side effects because they're high risk meds, right, there's no way around it, and sometimes I've started these meds in as young as two years of age, especially if they're self-injurious. And so, with that being said, it really is our job and there's some heightened awareness around it, which is great, specifically with payers, because it's a HEDIS measure, so they get incentivized if they're managing these drugs right, and that's something that we help as an organization. But to us, okay, what should we be thinking of? First and foremost, making sure we start low and go slow on the dose. These are beautiful because, specifically with risperidone, a lot of patients get sleepy, so you can actually use that to your advantage, because a lot of them have sleep disorders, so you can give it at night.

Speaker 2:

But we want to think about at least again the slew of things that we need to be monitoring for, which is the child's weight. Pediatric obesity is rampant, and an antipsychotic usually causes increased weight gain. Pressor minus prolactin, which can cause lactation of the breasts, which can be super embarrassing for patients in, obviously, the adolescent phase. We have to make sure we're watching their A1C because they are predisposed and have an increased risk of diabetes. So we want to make sure we're monitoring that at a regular cadence and then you have your lipid panel. So you know.

Speaker 2:

Add the combination that this med could make them morbidly obese. A lot of them usually have extreme dietary restrictions and not the healthiest diet, and that combination should make us hyper aware of trending their lipids. So all these medications are very effective, but monitoring these medications for the ADRs that we know are unfortunately pretty common, and then also making sure, as we talk about the other medications, you can add on the huge anticholinergic burden that we have coming from these medications is something that we should be constantly checking. Drug-drug interactions for side effects.

Speaker 1:

Just hearing you explain those things, jenna, I mean it's a very complex patient population because you just talked about basically potentially treating diabetes, heart disease, artery disease. I mean multiple, multiple things, which those in and of themselves are complex patients and we've got that added here. And, like you mentioned, communication barrier, as well as their peds I mean they're children usually that we're dealing with and so it just adds a whole lot of different layers. So, on that note, because our listeners are eagerly awaiting tips and tricks, what can they do? What can we do as pharmacists? Like, how can we plug in? Where can we be in this process? Yes, we know about the medications but like, what should we be looking for? What questions should we be asking? How can we really plug in to make sure these patients are benefiting from their medication regimen, from?

Speaker 2:

their medication regimen. Yeah, so, as we talked about, there are also not tight guidelines but additional medications that could help our clonidine. So they're alpha agonist and they're beautiful and actually they got their start as an antihypertensive medication. But what we found is that they have a slew of other magical things that we use, all the way down to new needle abstinence syndrome. We use it for sleep, we use it for ADHD and actually specifically has some literature and support in the ASD population.

Speaker 2:

Again, if you're comorbid with ADHD, it's a perfect drug to start, as opposed to going for a big gun like an antipsychotic, assuming that they don't have aggressive behavior. But that's another medication selection, I think, between antipsychotics, possible SSRIs, clonidine, guanfacine, all these things, especially in a child. That's this complex. Some things that we could do is, per drug, just honing in on what are we monitoring as far as side effects and how frequently are we monitoring it? I mean, if you're a community pharmacist, you could just ask them like, hey, can you take assuming it doesn't really make them angry can you take Danny's blood pressure? They're there once a month or whenever you're, especially if you're in a brick and mortar, you're at an advantage. But then, like I said, monitoring for those slew of side effects and knowing that we don't want to treat a med with the med, but sometimes with antipsychotics you can add metformin on to help with the weight gain and I don't see overall, a lot of PCPs owning that monitoring process and that's a huge place that we can come in and help.

Speaker 2:

And then, as far as over the counters, like I said, is your child extremely aggressive? There's can be PRNs that we use to help break that aggression One of them that has been. Again, there's not an ample amount of literature, but there's literature to support hydroxyzine actually being used for agitation in these patients and so we will ask if you feel in harm's way or they're having self-injurious behavior. We can add that as a breakthrough med. Again, the anticholinergic burden is there. So that's going to be kind of leading into my next thing, which is sleep. So they all sleep in constipation.

Speaker 2:

So constipation anytime you have any anticholinergic burden of a medication, we should instantly be ensuring that they are having regular stools. Overall, this patient population does tend to have very picky eating, like diet restrictions. Like we said, it's very heavy on textures, so they're usually pretty, very restrictive and pretty picky. So from that point of view, we want to do two things as a pharmacist making sure they're taking a multivitamin to supplement their vitamins and minerals, and then two, if they do have that constipation, equipping the parents with there's plethora of over the counters, but I usually start with Miralax.

Speaker 1:

Okay.

Speaker 2:

Obviously, if it's possible, increase your fruit and your veggies that's not always possible and then increase your water intake and I usually go to Miralax because, unless you're forcing a lot of water or the patient's taking a lot of water, fiber can actually constipate you.

Speaker 1:

Right, make issues. Yeah, yeah, yeah. I'm hearing this, some of these suggestions, and I'm thinking of all the ways that the pharmacist is needed in this situation. Because if it's as simple as saying, oh, take a multivitamin to make sure you're supplementing with nutrients, well, sure, which one, which one? And what if they have texture issues? Okay, so now we have to look at they don't like to chew it because it's gritty in their mouth. Or is there a gummy that we can? You know that will work? Or is there a liquid? Or is you know?

Speaker 1:

I mean, so that is where the pharmacist can really plug in and be sure that they are using their expertise and their knowledge and asking the right, open-ended questions to get at what is our ultimate goal and then choosing a medication that fits right for the patient. So yeah, those are great. So, as you know, anybody could say, oh, they're constipated, give them something over the counter. But the pharmacist is the one that's going to ask the right questions.

Speaker 2:

Yeah, how much do you weigh? What are we diluting into what is their favorite thing to drink? Sometimes, because they are sensitive to textures, they may feel the sand and the grit. So what are we going to do if that happens? So all those things and those very detailed questions is something that is really hyper and more important because of their texture sensitivities, and those are all real things that we work with our parents every day on.

Speaker 1:

And also just knowing, as a pharmacist, brushing up on what medications can go in, what can be opened up and go in applesauce, what can be diluted in something, what can you make a flurry out of, like those are the types of things to be really aware of. What could you crush? What can you not crush? You know that kind of stuff so that we're helping to come up with solutions when we hit one of those texture barriers, or this is only available in this form and they won't do that or whatever.

Speaker 2:

So yeah, and also Josh. I do want to add that a lot of patients with ASD do have sleeping issues. So again to that same point, melatonin. They usually respond pretty well and that's a common medication that we'll use just to help them shut down at night. And so again, just I hope you have. There was a previous episode called Food is Medicine.

Speaker 1:

And we had one of actually Jenna's colleagues on for that call as our guest expert and she gave a little sleep cocktail teaser and so if that interests you at all, go back and listen to that episode. If you haven't already, or if you did and you forgot, go back and listen to it again. I can't remember. Or if you did and you forgot, go back and listen to it again. I can't remember the specifics, but I want to say it had something to do with cherries tart cherry juice yeah, yeah, yeah, tart cherry juice.

Speaker 1:

Um, she gave some other stuff with uh, like tapioca pudding I think she loves chia pudding for constipation.

Speaker 2:

Mary's taught me all these things, so she's a weird unicorn that she is not only a pharmacist, but a nutritionist, and so exactly we have the luxury of tapping her in a lot of cases to be like, oh my god, help me helping my nutritionist for for this child and again, she's great because she is, uh, an extreme focus in neurology but a lot of autistic patients as well working with. How can we creatively get these into this child?

Speaker 1:

Yeah, into the system. So if you're interested and this is really piquing your interest then please go back and listen to that episode. A lot of good talks in there too. That, I think, can be some good treatment options for patients, especially patients who have difficult issues that we need to work through and find solutions for.

Speaker 1:

So well, jenna, I feel like our time just rushed past us and I didn't get to half the things that I wanted to get to, because we could talk for hours on the subject. Well, maybe you have to do an ASD medications part two at some point, but is there anything that we wanted to talk about that you definitely want to be sure that we squeeze in before our time's up. Is there anything you want to use the last few minutes for? I know we had talked about some of the opportunities for pharmacists how we can be there asking the right questions, supporting with adherence of medications and then also collaborating with other healthcare providers. You know we haven't really mentioned medications and then also collaborating with other healthcare providers. You know we haven't really mentioned that, but that should be an obvious, so important it's important to advocate for our patients, especially when we know that this medication is not working.

Speaker 1:

We need to get them off of this. Or the dose is wrong or we've noticed that they have a creeping A1C. We need to start something to try to counteract that.

Speaker 2:

It's really important that we're collaborative in that sense as well with our other providers and making sure that they're getting the right care Right, Because you have a slew of developmental specialists, aba, psychiatrists, neurologists usually on their team, and so just making sure everyone's on the same page as far as the medication regimen can be extremely impactful, and then making sure everyone's on the same page as far as the medication regimen can be extremely impactful, and then making sure all the medications play right is also a very easy way that a pharmacist can jump in as we talked about.

Speaker 2:

the one thing that I've seen experientially in practice but I don't see a lot of literature on is just I've had a lot of ASD. Patients have paradoxical effects from benzodiazepine, and I think it's one of those drugs that you know. One of the ways that we can also help too which sounds so silly is that our organization partners up or just make sure we're aware of who's in network as far as pediatric dentists goes, and we work with pediatric dentists to get these child's the right sedation medications, because a lot of autistic patients need to be sedated in order to tolerate a cleaning, and so that's one of the weird things.

Speaker 1:

I'm almost there on that one.

Speaker 2:

I know, yeah, weird things I'm almost there on that one. I tell you what it's one of my favorite things to do.

Speaker 1:

Same same. No, that's a whole nother interesting realm, it's. You know, that's a place where the pharmacist can intervene as well and making sure that, again, we know that oral care ties to a whole host of other things. Later down the road it can tie to heart issues, I mean. So there are things that those should be important to us as well. I guess that's what I'm saying From the pediatric perspective. We shouldn't just be like I don't care if they get their teeth cleaned or not, like those are things that we should really be caring for that patient in a holistic way. So that's great, that's such an interesting.

Speaker 1:

I would have never even gone there or thought of that. So to summarize a little bit some of the practical strategies that we've offered for pharmacists, and you jump in, please. But what I heard was asking questions, and we all know open-ended questions are the best. So you're going to try to pose those questions to where they're not just yes or no answer possibilities.

Speaker 1:

You're really trying to open the door, communicate with your caregivers or your patients if they're in a communicative form, and we're going to be asking those questions and we're really going to be focusing on how's your diet, how are your bowel movements, your stools? We're going to be focused on what sort of side effects are you experiencing with the medications, just to see if there's any reason to maybe go down in a dose or titrate upward or whatnot. We're going to be monitoring some of those things that complications can arise later, whether it be from a complication of a medication. So we're looking at our lipid panel, we're looking at A1C, we're obviously watching weight and that's kind of where the diet comes in as well. So a lot of different ways that pharmacists can really kind of plug in for these patients.

Speaker 2:

Yes, a ton, and these patients and caregivers sometimes are frustrated because they're just medications are being thrown at them and this could be a totally different conversation we could have, but there's definitely some, there's definitely validity and using PGXx as well, which we could do it totally um, pharmacogenomics is what jen is referring to.

Speaker 1:

There is pgx and, and, yeah, and we have um a couple of episodes on that already, so that's another topic that you're welcome to dig back through the archives on. Uh, we have some courses in the course catalog on pharmacogenomics as well, if that piques your interest. So, yeah, just a, just a lot of I mean yeah, you're exactly right. This could go down a whole different path if we kind of get to that tailoring therapy to the patient. So well, fascinating stuff, jenna. As I always do when wrapping up for our episode, I like to circle back to the title of the episode, which is Game Changers. So summarize what you think the game changer here. What do our learners need to walk away from today?

Speaker 2:

I think, as you stated, this important part and really indispensable part of a pharmacist as being part of these children's care as an institution or an organization, we're approaching health payers to say, hey, how can Perfecting Peds help? And it's amazing that we aren't owning this drug monitoring process when it really should be us, because not to toad our own horn but we do it best. And so I think continuing to push us into a direction where we're more and more clinical because we have the education and skill set, and then, if possible, in the same vein of talking about increasing our clinical practices, would be to ensure that, if there's any way to start gaining more studies or evidence behind what is helping this very niche group of patients that are near and dear to my heart, I think documenting trends in medications that are working, medications that are, and broadening the medication scope of just two meds to hopefully more meds, would be my big game changer and kind of my challenge to any pharmacist listening as well.

Speaker 1:

Yeah. So again, we've had other discussions and courses on document, document, document. It's one of the most important things and so, like Jenna said, if you're seeing something, if you've had success with someone, document it, keep track of it, monitor it and share it, because others want to know what's working. And again, patients are very unique in the spectrum disorder and so it's important that we kind of have all the tools in our arsenal that we possibly can. This has been so great, jenna, thank you so much again for taking time. Like you said, the game changer is just kind of push out of your comfort zone as a pharmacist and really get in this space, because you're the expert, you're the one with the clinical knowledge, and really just kind of get in there to help these patients and advocate for them. So that's great. Well, jenna, thanks so much again. It's always a pleasure.

Speaker 2:

Thank you for having me.

Speaker 1:

Of course, if you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom. And, as always, have a great week and keep learning. Thank you.