Bipoladisorder Flashcards
Lithium and divalproex combined w/ an antipsychotic is more effective than mono therapy
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Divalproex
Depakote
Anticonvulsant that works for bipolar disorder
Divalproex with an antipsychotic is more effective than mono therapy
Lamotrigine
Lamictal
anticonvulsant can be used for bipolar
Carbamazepine
Equetro
Anticonvulsant that can be used for bipolar
Quetiapine
Seroquel XR
Olanzapine
Zyprexa
Olanzapine / fluoxetine
Symbyax
Risperidone
Risperdal
Ziprasidone
Geodon
Aripiprazole
Abilify
Lurasidone
Latuda
Asepnapine
Saphris
This medication comes as sublingual
SIDE effects for Valproic acid
VaLProic Acid
L-check LFT severe hepatotoxicity
P- Pancreatitis
A- alopecia, can increase Amonia
And THOROMBOCYTOPENIA ( can increase bleed )
Lamotrigine SE
Main is rash : SJ : D/C on first sign. Dont rechallenge
Lam ODT trigine : comes ODT
Carbamazepine
Recall Carbamazepines looks like TCA ( tricyclic antidpressent ) = thats why they have anticholinergic effects
Aplastic anemia,
Agranulocytosis ( CBC )
If patient is Asian ( Asian ancestry ) must recommend HLA-B*1502
If patient is bipolar and is depressive bipolar and comes in with Major depression, i never give a SSRI/SNRI or any antidepressant alone
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Bc it make some patients more manic
Combination of olanzapine and fluoxetine ( symbyax ) can be used. But never just an SSRI or SNRI alone.
Lithium
Indication
MOA
Levels
Really good for bipolar. DOC: Lithium But lots of SE’s
Levels need to be 0.6 to 1. If you above more toxicity
Positively charged element or ion. ( eg. Patient has severe diarrhea and loses a lot of electrolytes. You see positively charged sodium levels have dropped. What goes up ? Lithium levels go up. Lithium will often go in the opposite direction of sodium. Lithium toxicity.
Off label use depression.
MOA: exact is unknown. Increases Serotonin and NE. Dont want to give MAOIs.
Pregnancy category for lithium
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Lithium levels
Draw serum levels just before the next dose ( 12 hours post dose ) after 5 days of treatment
Acute levels 0.8 - 1.2 mEq/L
- maintenance: 0.6 - 1.0 mEq/L
Lithium’s effect usually begin in 1 week & full effect is seen by 2 to 3 weeks
LITHIUM is 100 percent through renal system. No liver metabolism at all. As patient ages renal goes down. So reduce dose in elderly. 300 mg day with levels of 0.4 to 0.6
Regular patient is 300-600 mg BID to TID starting
Effective range is 900 to 1800 mg /day ( 15-20 mg/kg )
Lithium side effects
GI: take with food. High w/citrate form due to direct effect on GI mucosa. Take with food. Divide doses
Fine international hand tremor. : reducing the dose and add a bb ( propranolol )
• nephrogenic diabetic insipidus : if patient on been for LT could see this se. This is due to effect on Collecting duct and affecting ADH. Resistance to ADH, resulting in polyuria and polydispsia —-> could lead to lithium toxicity
-if possible Lithium should be D/C’d
- if Li absolutely necessary add the K-sparing diuretic amiloride
Lithium maintenance dose
0.6 - 1.0 mEQ/L
Management of lithium toxicity
No antidote
Accuse toxicity: NVD. Give whole bowel irrigation w PEG. Never use charcoal. Does not absorb lithium.
Chronic toxicity : has used lithium chronically and therapeutic level is up. You can have major CNS effects. Could lead to seizures/coma/death.
- lithium is dialyzable : hemodialysis ( low molecular weight ).
If greater than 2.5 with s/sx seizures use hemodialysis. If > 5 use hemodialysis
What drugs can increase lithium?
Why
Thiazides and ACE , and NSAIDs ( sulidac and ASA do not appear to affect [ Li ] )
•Lithium goes in opposite direction of sodium. Thats why Thiazides and ACE increase lithium
•NSAIDs increase lithium bc NSAIDs work on kidneys and lithium work on kidneys and NSAIDs do not allow that lithium to be secreted.
• sodium restriction/ dehydration —> increase lithium toxicity
SSRI and lithium ddi
Additive. Li increase H-HT and so do SSRI —> risk of seratonin syndrome
what to monitor for Lithium?
•Serum Li ( 0.6 to 1)
•BUN and SCr: baseline then q 2-3 and once every 6 months then once a year.
• CBC : increase in wbc
•calcium: li can cause hypercalcemia. —> hyperparathyroidism could lead to osteoporosis
•sodium
TSH : can cause hypothyroidism ( rarely hyper )
EKG
Weight gain
Dystonia
Tardive Dyskinesia
Neuroleptic Malignant Syndrome
Akathisia
Drug induced parkinsons
Dy
If there is a deficit in central dopamine transmission it can result in
Overactive striatal acetylcholine release. That leads to dystonic reactions.
ODT antipsychotics
ORCA
Olanzapine
Risperidone
Clozapine
Aripiprazole
Available in oral liquid solution
Aripiprazole
Clozapine
Risperidone
This medication is administered by a healthcare professional by oral inhalation
Loxapine ( Adusuve ) for acute agitation
Rapid antipsychotic IM formulation
Haloperidol ( Haldol )
Ziprasidone ( Geodon )
Zyprexa ( olanzapine )
Decanoate formulations for antipsychotics
Haloperidol
Palipeidone
Olanzapine
Risperidone
Fluphenazine
