ADHD | BIPOLAR JUNE 24

Question 1

ADHD

Answer 1

It is a behavioral syndrome characterized by hyperactivity, impulsivity, and inattention, leading to social, educational, or occupational impairment.

Question 2

Aims of Treating ADHD

Answer 2

Reduce functional impairment and severity of symptoms, and improve the quality of life.

Question 3

1st Line Drugs for ADHD

Answer 3

Methylphenidate or lisdexamfetamine.

Question 4

Counseling Points for Methylphenidate

Answer 4

Affects driving; effects increased by alcohol.

Question 5

Alternative for Contraindications to Methylphenidate/Lisdexamfetamine

Answer 5

Atomoxetine or dexamphetamine; CBT considered if no response to medications.

Question 6

ADHD Treatment for Drug Misuse Patients

Answer 6

Atomoxetine may be used as first line.

Question 7

Side Effects of Atomoxetine

Answer 7

Agitation, irritability, suicidal thoughts, self-harming, unusual behavior changes in initial months or after dose change.

Question 8

Bipolar Disorder

Answer 8

A serious long-term condition characterized by periods of depression and mania/hypomania.

Question 9

Symptoms of Mania and Depression in Bipolar

Answer 9

Chart not provided.

Question 10

Drugs Used in Bipolar

Answer 10

Benzodiazepines, antipsychotics, carbamazepine, valproate, and lithium.

Question 11

Lithium in Bipolar

Answer 11

Used in both manic and depressive states; continue long-term treatment for at least two years from the last manic episode.

Question 12

Antidepressants in Bipolar

Answer 12

Avoid in patients with rapid cycling bipolar disorder, recent hypomania, or rapid mood fluctuations.

Question 13

Lithium Safety in Pregnancy/Breastfeeding

Answer 13

Avoid in breastfeeding; caution in pregnancy, especially in the first trimester.

Question 14

Contraindications for Lithium

Answer 14

Dehydration, low sodium diets, untreated hypothyroidism, significant renal impairment, cardiac disease, Addison’s disease.

Question 15

Side Effects of Lithium

Answer 15

Various, including GI disturbances, CNS effects, electrolyte imbalance, hypothyroidism, cardiomyopathy, arrhythmia, tremor, renal dysfunction, memory loss.

Question 16

Cautions for Lithium

Answer 16

Avoid abrupt withdrawal, diuretic treatment, drugs causing QT prolongation, epilepsy, elderly, current cardiac disease.

Question 17

Drug Interactions for Lithium

Answer 17

Not provided (to be added in a chart).

Question 18

Precautions Before Starting Lithium

Answer 18

Assess cardiac, thyroid, renal function, BMI, FBC, and electrolytes; ECG recommended in patients with cardiovascular risk.

Question 19

Warning Signs of Lithium Overdose

Answer 19

Levels, increased urination, thirst, tremor, hypothyroidism, interactions, upset stomach, muscle weakness, skin effects.

Question 20

Therapeutic Range for Lithium

Answer 20

0.4 mmol/L to 1 mmol/L (lower end for prophylactic treatment/elderly); 0.8 mmol/L to 1 mmol/L for acute manic episodes.

Question 21

Monitoring Requirements for Lithium

Answer 21

Blood samples every 12 hours after dose until stable, then routine monitoring every 3 months; renal, cardiac, TFT every 6 months.

Question 22

Patient Advice for Lithium

Answer 22

Report signs of toxicity, hypothyroidism, renal dysfunction, maintain fluid intake during infection, be cautious of OTC interactions, avoid alcohol, maintain a consistent sodium diet.

Question 23

Drugs Raising Lithium Concentrations

Answer 23

PPI, ACE inhibitors/ARB, NSAIDs, diuretics, metronidazole, amiodarone, tetracyclines.

Question 24

Drugs Decreasing Lithium Concentrations

Answer 24

Sodium-containing antacids, urinary alkalizing agents, theophylline, osmotic, and carbonic anhydrase inhibitor diuretics.

Question 25

Electrolyte Imbalance Predisposing to Lithium Toxicity

Answer 25

Hyponatremia.

Question 26

Drugs Increasing Neurotoxicity with Lithium

Answer 26

Carbamazepine, antipsychotics, SSRI, triptans, calcium channel blockers.