6.3 Pharmacology for Bipolar Disorder

Question 1

Bipolar Disorder

Answer 1

• Cycles of depression and manic episodes manifested by grandiose thinking, rapid thoughts, hyperactivity and agitation.
• Medication controls the up and down rollercoaster via MOOD STABILIZERS

Question 2

Mood Stabilizers

Answer 2

• Prevention and treatment of manic episodes

Examples
- Lithium
- Anticonvulsants
- Anti-anxiety medications
- Antidepressants

Question 3

Lithium

Answer 3

• Alters sodium transport across cell membranes and adjusts signaling activity.
• Leads to serotonin blockage
• MAKES DEHYDRATION WORSE
• Not easily processed by elderly
• Onset is 5-7 days may take 1-3 weeks to work
• DO NOT USE IN PATIENTS WITH CARDIAC/RENAL DISEASE
• Continue to take even if not feeling well
• Do not skimp on dietary sodium
• Drink 6-8 glasses of water a day

Side Effects
- N/V
- Severe diarrhea
- Tinnitus
- Excessive urine output
- Increasing hand tremors (toxicity)
- Mental confusion
- Nephrotoxic
- Weight gain

Question 4

Lithium toxicity

Answer 4

1.5 - 2.0 mEq/L
- Blurred vision
- Ataxia (not in control of body movements)
- Tinnitus
- N/V and Diarrhea

2.0-2.5 mEq/L
- Excessive output of diluted urine
- Increasing tremors, reflexes, muscular irritability
- Slurred speech
- Kidney failure
- Psychomotor retardation
- Mental confusion
- Problems maintaining Calcium levels
- Psychosis

> 2.5 mEq/L
- Nystagmus
- Impaired consciousness
- Seizure/Coma
- Oliguria/Anuria
- Arrhythmias
- MI
- CVD
- Mental Confusion

Question 5

Lithium Lab Values

Answer 5

Therapeutic 1.0-1.5
Maintenance - 0.6-1.2

Question 6

Lithium Care

Answer 6

• Avoid pregnancy
• Monitor blood levels 1-2 times a week. Hold medication if levels are toxic and report it to physician
• Do not drive on lithium
• Drink 6-8 glasses of water and avoid caffeine.
• Maintain high sodium diet because lithium reacts to sodium depletion.

Question 7

Anticonvulsant Therapy

Answer 7

• Less toxic than lithium

Question 8

Lamotrigine/Lamictal

Answer 8

• Anticonvulsant mood stabilizer
• Associated with Steven Johnsons Syndrome (hypersensitivity reaction)

Side Effects
- Withdrawal seizures
- Blood dyscrasias
- Aseptic Meningitis

Question 9

Steven Johnson Syndrome

Answer 9

• Drug mediated immune adverse reaction.
• T-cell mediated attack on keratinocytes.
• Presents as fever, myalgias, and malaise
• Rapidly progressive disease

Total body redness, mucosal lesions.
- Mikulski syndrome (skin is thin so even just rubbing the skin will cause it to peel off

Question 10

Valproic Acid

Answer 10

• Depakote and Depakene
• Increases GABA and slows entrance of sodium and calcium which affects nerve transmission.
• HIGH POTENTIAL FOR DRUG INTERACTIONS AND LIVER DAMAGE
• DO NOT GIVE IN PREGNANCY

Question 11

Carbamazepine/Tegretol

Answer 11

• Low therapeutic index and multiple drug interactions
• Enhances GABA and decreases glutamate and blocks calcium influx
• DO NOT TAKE DURING PREGNANCY

Question 12

Topiramate, Trileptal, Gabapentin

Answer 12

• Anticonvulsants
• Can cause weight loss
• Watch out for hyponatremia

Question 13

Side Effects of Anticonvulsants

Answer 13

• N/V
• Weight gain
• Drowsiness
• Severe rash
• Prolonged bleeding
• Sore Throat
• Liver damage
• Decreased efficacy of oral contraceptives
• Risk of suicide
• Fever
• Malaise
• Dark urine
• Yellow skin or eyes

Question 14

Antipsychotics

Answer 14

• Caution when driving
• Use sunblock because skin is more susceptible to sunburn
• Smoking increases metabolism of these drugs