Drugs to Treat Bipolar Disorder Flashcards
(53 cards)
Lithium Clinical Use
First-line treatment
Acute mania, bipolar depression, maintenance treatment
Reduces risk of suicide (BP I, BP II, major depression)
How long does it take for Lithium to reach full therapeutic effect?
2-3 weeks
Lithium MOA
Unclear
- 2nd messenger enzymes
- effects neurotransmitters and release
- effects on electrolytes and ion transport (similar to Na)
Lithium protein binding
NONE!
How is lithium excreted?
Entirely renal excretion
Effect of Carbonic Anhydrase Inhibitors (ex. Acetazolamide) on Li?
Inhibit the proximal convoluted tubule from reabsorbing bicarbonate- Na and Li accompany bicarbonate, overall less Na and Li are absorbed, Li LEVEL GOES DOWN
Effect of osmotic diuretics (ex. Mannitol) on Li?
Increase tubular fluid osmolality at proximal convoluted tubule. Leads to an increase in the excretion of water and Na/Li, Li LEVEL GOES DOWN
Effect of loop diuretics (ex. Furosemide) on Li
Inhibit Na/K/Cl transport system in the thick ascending loop of Henle. uncertain effect on Li
Effect of Thiazide diuretic on Li
Inhibit Na/Cl reabsorbtion in the distal convoluted tubule, compensatory increase in reabsorbtion of Na and Li at the proximal convoluted tubule, Li LEVEL GOES UP
Effect of K sparing diuretics on Li
Act on collecting duct, decrease Na and Li reabsorption, Li LEVEL GOES UP
Effect of ACE Inhibitors on Li
Inhibits angiotensin II production, increase in Na and Li reabsorption in collecting duct, Li LEVEL GOES UP
Effect of Angiotensin II inhibitors on Li
Inhibits angiotensin II production, increase in Na and Li reabsorption in collecting duct, Li LEVEL GOES UP
Other things that can decrease the Li level
Aminophylline
Theophylline
Caffeine
Pregnancy
Other things that cause no change in Li level
Amiloride
Acetaminophen
Aspirin
Sulindac
Other things that cause increased Li level
NSAIDS COX-2 inhibitors Dehydration Na Depletion Renal Impairment Advanced Age
Li Common Side Effects
hypothyroidism Nausea Diarrhea Fine Tremor Decreased concentration Sedation Weight gain
Li Rare Side Effects
Increased parathyroid
Li Serious Side Effects
Nephrogenic Diabetic Insipidus
Mild renal insufficiency
End stage renal disease
Li toxicity
Before starting Li check:
TSH Renal Function ECG (if patient >50 y/o) Weight (BMI) Pregnancy test
After starting Li, check:
Lithium level
When stable on Li, check___ every 6-12 months:
TSH
Renal function
Weight (BMI)
Li level
What is Depakote and what is the advantage to using over Valproic Acid?
Valproic acid & Sodium Valproate > pill that is enterically coated, decreased GI symptoms
Depakote MOA
Unknown, blockage of voltage dependent Na channels
Depakote protein binding
HIGHLY (90%) protein bound
