Bipolar disorder

Question 1

What is first line management of bipolar disorder?

Answer 1

Lithium

Question 2

What is second line management of bipolar disorder?

Answer 2

Antipsychotics - quetiapine, lamotrigine, olanzapine, risperidone, haloperidol

Question 3

What is third line management of bipolar disorder?

Answer 3

Valproate + (antipsychotic or lithium)

Question 4

Name 7 lithium side effects

Answer 4

Thyroid disorder
Nephrotoxicity
Lowered seizure threshold
Rhabdomyolysis
Benign intracranial hypertension
QT prolongation
Teratogenic - avoid in 1st semester

Question 5

What 5 medications manage mania or hypomania phase?

Answer 5

Haloperidol, olanzapine, quetiapine and risperidone

Question 6

What 4 medications manage bipolar depression phase?

Answer 6

Fluoxetine + olanzapine, quetiapine, lamotrigine, olanzapine

Question 7

There are 7

What are signs of lithium overdose?

Answer 7

Sick and tremor
Diarrhoea
Vomiting
Blurred vision
Polyuria
Drowsiness
Confusion
Fine resting tremor

Question 8

What are the lithium monitoring targets for first time and relapse patients?

Answer 8

First time: 0.6-0.8mmol/L
Relapse: 0.8-1mmol/L

Question 9

When do you measure lithium levels?

Answer 9

12 hours after dose

Question 10

How frequent do you monitor lithium from start to when stable?

Answer 10

weekly until stable
3 monthly for 1st year
6 monthly thereafter

Question 11

What do you monitor before initiating lithium?

Answer 11

FBC, ECG, BMI, U&Es, eGFR, thyroid functions

Question 12

What do you monitor for the 6 monthly monitoring of lithium?

Answer 12

BMI, U+Es, eGFR, thyroid function

Question 13

What are some key lithium interactions?

Answer 13

Nephrotoxic/renally cleared drugs
Serotonin syndrome
QT prolongation
Hypokalaemia drugs - leading to torsade de points