Bipolar disorder and lithium Flashcards
(19 cards)
Acute mania management
- stop antidepressants
- offer antipsychotics (haloperidol, olanzapine, quetiapine or risperidone)
- if on lithium: check lithium is in range, then consider antipsychotic
What is bipolar disorder?
A long term mood disorder characterised by episodic depressed and elated moods, and increased activity (hypomania or mania).
What is a ‘manic episode’?
What is a hypomanic episode?
What is a depressive episode?
What is rapid cycling?
- Period during which there is abnormally and persistently elevated, expansive, or irritable mood, lasting 1 week
- A period of at least 2 weeks characterised by depressed mood
- experience of at least FOUR depressive, manic, hypomanic, or mixed episodes within a 12-month period.
bipolar depression phase management
fluoxetine + olanzapine, quetiapine, lamotrigine
long term management of bipolar disorder
1st = lithium
2nd = antipsychotic
3rd = valproate + antipsychotic or lithium
lithium toxicity serum concentration
> 2mmol/L
lithium monitoring levels
- maintenance therapy
- acute mania and relapse patients?
0.6-0.8mmol/L normally
0.8-1mol/L for relapses
How should lithium be prescribed? Why?
Always by brand name as preparations vary in bioavailability
How long after a dose should lithium levels be checked?
measure levels 12 hours after a dose
When should lithium levels be checked after a dose increase?
One week after dose change, 12 hours after dose
How often should lithium levels be monitored?
monitor weekly until stable, 3 monthly for 1st year, 6 monthly thereafter
lithium interactions
serotonin syndrome
- with SSRI’s
Increased toxicity risk
- diuretics
- NSAID’s
- metronidazole
- ACE/ARB’s
Avoid drugs causing QT prolongation, Hypokalaemia
Seizure threshold lowering
lithium side-effects
thyroid disorders- weight gain and fatigue
nephrotoxicity
lowered seizure threshold
benign intracranial hyperplasia
QT prolongation
Lithium monitoring
- Weight and BMI
- Thyroid function
- Us and Es
- kidney function with eGFR
- Calcium levels
- ECG if at risk/ has CVD
signs of lithium toxicity
renal impairment (polyuria and polydipsia)
extrapyramidal side-effects (tremor)
visual disturbances (blurred vision)
nervous system disorders (confusion)
GI disturbances
Two salts of lithium
carbonate (standard or MR TABLETS)
citrate (LIQUID)
General advice for those taking lithium
- To maintain their fluid intake, particularly after sweating
- Avoid dietary changes which alter salt intake- avoid low salt diet
- do not take OTC NSAIDs
- always maintain on the same brand
What should someone taking lithium always carry on them?
A lithium card
What should women of child bearing age who are prescribed lithium be advised to do?
Use reliable contraception
- due to possible increase in birth defects As it it teratogenic
