Bipolar disorder Flashcards
what is bipolar disorder?
the extreme fluctuation between manic phases and depressive phase
what is the treatment for bipolar disorder? acute and prophylaxis
acute:
-benzodiazepines
-antipsychotics drugs (normally quetiapine, olanzapine or risperidone)
-add in lithium or sodium valporate
prophylaxis:
-carbamazepine,sodium valproate or lithium
what is the therapeutic range for lithium?
0.4-1mmol/L therapeutic range
0.8-1mmol/L in acute episode
how does the lithium levels checking work?
check levels 12hrs after dose
-weekly till stable then 3 monthly for 1st year and then 6 monthly after that
monitor 3 monthly when stable when high risk e.g. over 65 yrs
what is the main distinguishing signs of toxicity for lithium is what?
tremor
SICK AND TREMOR
What are the main signs of toxicity for theophylline?
FAST + SICK
what are the main signs of toxicity for digoxin?
SLOW + SICK
what are all the signs of toxicity for lithium?
REVNG- revenge
-renal impairment
-extrapyramidal side effects=tremors
-Visual disturbance=blurred vision
-nervous system disorder-confusion and restlessness
-gastrointestinal disorder=diarrhoea and vomiting
what are the normal side effects of lithium?
-thyroid disorder
-nephrotoxocity
-rhadomyolysis
-QT prolongation
-Benign intercranial hypertension
-1st trimester=teratogenic
what other drug can cause thyroid disorder?
-amiodarone
what are the interaction of lithium?
-if hyponatraemia can increase risk of toxicity
-salt imbalance
-serotonin imbalance
-extrapyramidal side effects
-QT prolongation
-renally cleared drugs (increase risk of toxicity
-reduce seizure threshold
-hypokalaemia
what other drug can cause extrapyramidal side effects?
-metoclopramide
-haloperidol
what pain killer should be avoided for lithium?
NSAIDS
