Bipolar disorder/Mania Flashcards
(15 cards)
What are the treatment options for bipolar disorder?
acute vs long term
BACLV
benzodiazepines: acute
QOR antipsychotics - quetiapine, olanzapine, risperidone: acute
carbamazepine: long term
lithium: long term (takes 6-12 mths to see full effects), can be add on for acute
valproate (valproic acid or sodium valproate): long term, can be add on for acute
How long should patients be on medication for bipolar disorder?
continue long term treatment for at least 2 years from last manic attack or 5 years if there are risk factors for relapse
When are antidepressants CI in bipolar disorder?
rapid cycling bipolar disorder
recent history of hypomania, manic episode
rapid mood fluctuations
When is lithium CI?
dehydration: can cause lithium toxicity
low sodium diets: can cause lithium toxicity
untreated hypothyroidism
severe renal impairment
cardiac disease
addison’s disease
What are the symptoms of lithium toxicity?
REVNG, SICK and TREMOR
renal impairment: polydipsia, polyuria
EPSE: tremor, ataxia
visual disturbance: blurred vision
nervous system disturbance: confusion, drowsiness
GI effects: nausea, vomiting
if > 2mmol/L: renal failure, arrhythmias, BP change, coma, death
What are the side effects of lithium?
LITHIUMS
levels
increased urination: polyuria
thirst, tremor, teratogens
hypothyroidism: weight gain, fatigue
interactions: NSAIDs, ACEi, ARBs, diuretics, antacids
upset stomach: nausea and vomiting
muscle weakness
skin effects, acne/psoriasis
QT prolongation
benign intracranial hypertension: persistent headache, visual disturbance
lowers seizure threshold
What is the therapeutic range for lithium?
0.6–0.8 mmol/L: treatment and prophylaxis in lithium-naïve patients
0.4–0.6 mmol/L: treatment and prophylaxis of recurrent major depressive disorder, patients aged >65yrs
When should lithium samples be taken?
12 hours post dose: for twice-daily dosing, morning dose to be withheld until sample taken
What are the monitoring requirements for lithium?
TDM: 1 week after starting, 1 week after each dose change, weekly until stable, every 3 months for the first year then 6 monthly (3 mthly if at high risk: impaired renal or thyroid function)
Body-weight or BMI, renal and thyroid function, and urea and electrolytes: before and 6mthly
FBC: before
ECG: before if they have CVD or risk factors
What are the counselling points for lithium?
maintain constant and adequate salt and water intake: especially in infection, diarrhoea or vomiting due to risk of dehydration
carry alert card at all times
driving: can cause drowsiness
OTC: avoid NSAIDs, soluble analgesics, antacids
maintains same brand
Can lithium be used in pregnancy or breast-feeding?
avoid: risk of teratogenicity and toxicity in infants
if used then higher dose requirements in 2nd and 3rd trimester
What are the drug interactions that affect lithium levels?
increase vs decrease levels
increase lithium concentration: ACEi, ARBs, NSAIDs, diuretics, metronidazole, amiodarone, tetracyclines
decrease lithium concentration: sodium containing antacids, soluble/effervescent analgesics, urinary alkalising agents for cystitis, theophylline, osmotic and carbonic anhydrase inhibitors
What drugs cause neurotoxicity with lithium?
carbamazepine, antipsychotics, SSRI, triptans, CCB
drugs that cause QT prolongation
What are the main drug interactions for lithium?
increased risk of seizures: quinolones, SSRIs
QT prolongation: amiodarone, clarithromycin, antipsychotics, SSRIs (citalopram), diuretics, ondansetron
reduced renal excretion: ACREi, ARBs, NSAIDs
drugs that cause hyponatraemia: diuretics, antidepressants
EPSE: metoclopramide, PD
What drug interaction with lithium cause serotonin syndrome?
SSRIs, triptans, MAOIs, St Johns Wort, tramadol,
