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Flashcards in Bipolar 3 Deck (20)
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1

what is the level of mild lithium toxicity

1.5-20

2

what levels of lithium are considered severe toxicity, what are the symptoms of severe toxicity

3 or greater
coma or death

3

what are the contraindications with lithium

1. renal disease
2. CV disease
3. history of leukemia
4. first trimester of pregnancy
4. hypersensitivity to lithium

4

how long does it take to see full effects of lithium

2 weeks

5

what should be done if a patient develops a rash or psoriasis on lithium

d/c lithium

6

what side effects of lithium require the dose to be lowered

CNS toxicity
GI problems
polyuria

7

what drugs increase the level of lithium

1. NSAIDs
2. ACE inhibitors
3. fluoxetine
4. thiazide diuretics

8

what drugs decrease the level of lithium

1. caffeine
2. acetazolamide
3. loop diuretics
4. bicarbonate

9

a decreased sodium level does what to lithium concentrations

increases lithium concentrations

10

what are the counseling points with lithium

1. take with food if causes upset stomach
2. keep salt and caffeine in diet consistant
3. avoid becoming dehydrated

11

what is another first line treatment for acute manic episodes other than lithium

valproic acid

12

valproic acid is first line for what ?

acute mania or mixed episodes, rapid cycles and maintenance bipolar therapy (as effective as lithium in all of these)

13

when is Depakote not effective in treating bipolar disorder

it is not effective for depressive episodes

14

what is the initial dose of depakote

500-1000 mg/day divided in 2-4 doses (ie 250 mg TID)

15

what is the maximum dose of valproic acid

60/mg/kg/day

16

what is the target serum concentration range of valproic acid

50-125 (often best effects at 100-125 but more AEs)

17

what increasese risk of free concentrations of valproic acid

hypoalbuminermia

18

what are some concentration dependent adverse effects of depakote

1. GI problems
2. sedation
3. unsteadiness
4. tremor
5. thrombocytopenia

19

what are some idiosyncratic adverse effects of valproic acid

1. acute hepatic faiure
2. acute pancreatitis
3. alopecia

20

what are some chronic adverse effects of valproic acid

1. weight gain
2. hyperammonia
3. menstrual cycle irregularities
4. polycystic ovarian-like syndrome