Bipolar Flashcards
Whats the definition of bipolar disorder?
Extreme fluctuations between manic phases (overactive and excitability) and depressive phases
Whats the acute treatment of Bipolar?
Benzodiazepines
Antipsychotic drugs (Quetiapine, Olanzapine or Risperidone)
Add in LITHIUM or sodium valproate
Whats used as prophylaxis of bipolar disorder?
Carbamazepine, Sodium Valproate or lithium
Whats the therapeutic range of lithium?
0.4 - 1 mmol/l
Whats the blood range of lithium in an acute episode?
0.8-1 mmol/l
When do you measure the lithium dose?
12 hours after a dose
Weekly until stable then 3 monthly for one year then 6 monthly after that
What are the signs of lithium toxicity?
REVNG
Renal imapirment
Extrapyramidal side effects - tremors
Visual disturbances - blurred vision
Nervous system disorder- confusion and restlessness
Gastrointestinal disorder - diarrhoea and vomiting
SICK AND TREMOR
Whats the side effects of lithium?
Thyroid disorder
Nephrotoxicity
Rhabdomyolysis
QT prolongation
Benin Inter cranial hypertension e.g. headache symptoms
Teratogenic in 1st trimester
What patients should continue having 3 monthly monitoring?
65+
Renal and thyroid impairment
Poor symptom control
If last conc was 0.8mmol/L
What blood tests do they need to have when on lithium?
Before: Renal, ECG, TFT’s, Weight/BMI, U&E’s, FBC’s
3 monthly: weight/BMI, U&E’s, eGFR, TFT, Ca
Why does calcium need to be taken whilst on lithium?
Because the parathyroid gland regulates lithium.
What are interactions with lithium?
Hyponatraemia
Serotonin syndrome
Anticholinergics
QT prolongation
Renally cleared drugs
Ventricular arrhythmias
Neurotoxicity
Contraindications with lithium?
Dehydration
Decreased sodium
Addisons disease
Hypothyroidism
What does lithium increase?
Glucose
