ADHD | BIPOLAR JUNE 24 Flashcards
ADHD
It is a behavioral syndrome characterized by hyperactivity, impulsivity, and inattention, leading to social, educational, or occupational impairment.
Aims of Treating ADHD
Reduce functional impairment and severity of symptoms, and improve the quality of life.
1st Line Drugs for ADHD
Methylphenidate or lisdexamfetamine.
Counseling Points for Methylphenidate
Affects driving; effects increased by alcohol.
Alternative for Contraindications to Methylphenidate/Lisdexamfetamine
Atomoxetine or dexamphetamine; CBT considered if no response to medications.
ADHD Treatment for Drug Misuse Patients
Atomoxetine may be used as first line.
Side Effects of Atomoxetine
Agitation, irritability, suicidal thoughts, self-harming, unusual behavior changes in initial months or after dose change.
Bipolar Disorder
A serious long-term condition characterized by periods of depression and mania/hypomania.
Symptoms of Mania and Depression in Bipolar
Chart not provided.
Drugs Used in Bipolar
Benzodiazepines, antipsychotics, carbamazepine, valproate, and lithium.
Lithium in Bipolar
Used in both manic and depressive states; continue long-term treatment for at least two years from the last manic episode.
Antidepressants in Bipolar
Avoid in patients with rapid cycling bipolar disorder, recent hypomania, or rapid mood fluctuations.
Lithium Safety in Pregnancy/Breastfeeding
Avoid in breastfeeding; caution in pregnancy, especially in the first trimester.
Contraindications for Lithium
Dehydration, low sodium diets, untreated hypothyroidism, significant renal impairment, cardiac disease, Addison’s disease.
Side Effects of Lithium
Various, including GI disturbances, CNS effects, electrolyte imbalance, hypothyroidism, cardiomyopathy, arrhythmia, tremor, renal dysfunction, memory loss.
Cautions for Lithium
Avoid abrupt withdrawal, diuretic treatment, drugs causing QT prolongation, epilepsy, elderly, current cardiac disease.
Drug Interactions for Lithium
Not provided (to be added in a chart).
Precautions Before Starting Lithium
Assess cardiac, thyroid, renal function, BMI, FBC, and electrolytes; ECG recommended in patients with cardiovascular risk.
Warning Signs of Lithium Overdose
Levels, increased urination, thirst, tremor, hypothyroidism, interactions, upset stomach, muscle weakness, skin effects.
Therapeutic Range for Lithium
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.
Monitoring Requirements for Lithium
Blood samples every 12 hours after dose until stable, then routine monitoring every 3 months; renal, cardiac, TFT every 6 months.
Patient Advice for Lithium
Report signs of toxicity, hypothyroidism, renal dysfunction, maintain fluid intake during infection, be cautious of OTC interactions, avoid alcohol, maintain a consistent sodium diet.
Drugs Raising Lithium Concentrations
PPI, ACE inhibitors/ARB, NSAIDs, diuretics, metronidazole, amiodarone, tetracyclines.
Drugs Decreasing Lithium Concentrations
Sodium-containing antacids, urinary alkalizing agents, theophylline, osmotic, and carbonic anhydrase inhibitor diuretics.
