Bipolar

Question 1

Lithium

Answer 1

IND: BPD
MOA: Unclear. Combo of glutamate uptake and release, serotonin blockade, and inhibition of GSK3B
BOX: Monitor lithium toxicity with therapeutic drug levels
CON: CV or renal dz, debilitation, dehydration/Na depletion. Use w/diuretics. Teratogenic; don’t use in pregnancy
ADR: Lots

Question 2

Lithium Toxicity

Answer 2

Narrow therapeutic range, requires close monitoring to ensure goodness
.6-1.2 mmol/L
Low grade s/s: weakness. tinnitus, N/D, poor concentration
More significant: Vomiting, slurred speech, confusion, lethargy
Severe: Seizure/coma, permanent neuro damage, death

Question 3

Lithium Drug Interactions

Answer 3

Diuretics: Promote Na loss and increase lithium toxicity because lithium excretion is reduced in hyponatremia
NSAIDS: Increase lithium levels up to 60%, increase reabsorption of lithium. NOT ASPIRIN THO
Anticholinergic drugs: Urinary hesitance and lithium induced polyuria

Question 4

Divalproex/Valproate/Valproic Acid

Answer 4

IND: BPD. Less effective than lithium at preventing suicide/treating BPD
MOA: Increases GABA
BOX: Hepatotoxicity, fetal abnormalities, Pancreatitis
CON: Hepatic dz, pregnancy, mitochondrial disorders
ADR: Alopecia, GI

Question 5

Carbamazepine

Answer 5

IND: BPD. Less effective at preventing depression
MOA: Limits influx of Na. Strong CYP inducer
BOX: SJS and TEN. Aplastic anemia and agranulocytosis
CON: Bone marrow depression, use with MAOIs
ADR: Dizzy/Drowsy

Question 6

Lamotrigine

Answer 6

IND: BPD, long term maintenance. Prescribed the most besides lithium, middle of the road
MOA: Inhibits glutamate release
BOX: SJS/TEN
CON:
ADR: Blood dyscrasias. Life threatening arrhythmias.

Question 7

Anti-psychotics

Answer 7

Help with generalized mania