Bipolar disorder Flashcards
What drug classes are used in the treatment of bipolar D/O?
- Lithium
- Anticonvulsants
- Antipsychotics
- Benzos
What role do benzos have in bipolar tx?
Acute treatment of agitation, insomnia, or anxiety
What use does lithium have in bipolar disorder?
Treats acute mania, hypomania, mixed states, and bipolar/ unipolar depression
What PK information is important for lithium use?
- Rapidly absorbed PO route
- 100% excreted in urine, must monitor renal function test
Intro dosing of lithium?
Start BID-TID w/ titrations every few days until therapeutic level reached
Dosage changes in lithium use post- therapeutic level?
Change dosing schedule to once daily if no ADRs
What are contraindications to the use of lithium?
-Significant renal impairment
-Sodium depletion
Dehydration
-Significant CV disease
What drugs have DDIs with lithium?
- Diuretics
- ACEIs
- CCBs
- TCN & Metronidazole
- NSAIDs
What are acute ADRs of lithium?
- Nausea
- Weight gain
- Cognitive impairment
- Polyuria/polydipsia
- Loose stools
What are chronic ADRs of lithium use?
- Renal function
- Thyroid function
- Parathyroid function
- Rarely cardiac dysrhythmias
What tests must be performed at baseline before starting llithium use?
- Urinanalysis
- Bun/Cr
- Thyroid
- Pregnancy (if child bearing potential)
What is important in regards to lithium toxicity?
Narrow therapeutic window, correlate serum levels w/ timing of last dose since serum level may not correlate /w peak concentration
What signs/ sx are associated with lithium toxicity?
- GI: N/V/D
- Neurologic: confusion/agitation, ataxia; SEVERE- seizures, encephalopathy
- Cardiax (rare): arrythmias, bradycardia
If a patient is suspected to be experiencing lithium toxicity what do you do?
- Treat symptomatic patient even if serum concentrations low
- Treat high labs even if patient is asymptomatic
What is recommended treatment of lithium toxicity?
- Stop lithium, ABCs
- Supportive care/ hydration
- GI decontamination w/ whole bowel irrigation with PEG
