Bipolar Flashcards
What are the 5 different classes of meds that are used to treat bi-polar
- Lithium
- Valproic Acid
- Carbamazepine
- Second generation antipsychotics
- Lamotrigine
What is the first line for bipolar
Lithium
what is the goal level for lithium with acute mania
0.8 - 1.2 mEq/L for acute mania
What is the goal maintenance dose for lithium
0.6 -1 mEq and sometimes 0.4 -0.6 is often effective and better tolerate for elderly
When do you draw a level after starting or changing the dose
After 5 days of consistent dosing (maintenance dosing)
When do you draw levels for Lithium
12 hours after the HS dose before dose in the AM
What dose of lithium is better tolerated in elderly pts
0.4-0.6 mEq/L
How many days does it take for Lithium to onset?
6-10 days
Longer with treatment of depression
Main side effects and education for pt
Weight gain and hypothyroidism
With the average person when does toxicity happen with Lithium?
What about Elderly?
1.5 mEq/L
Elderly can be lower levels
Sometimes when starting Lithium, what s/s can happen?
What changes will help know if its toxic
N/V or tremors
After 2 weeks they can go away
If it reappears it could mean toxic and the tremors are course tremors
During Maintenance and stable how often do you measure labs?
How about unstable pts?
When does a steady state happen
Every 3-6 months
More often - every few days
5 days
What labs are also tested with lithium?
CBC EKG Pregnancy TSH BMP Renal function Lithium level
What are the risk factors of lithium toxicity?
Flu Dehydration V/Diarrhea >50 years old Heavy exercise Hot weather Fever
What do you education pts on lithium with water intake
Adequate sodium and fluid intake
