Bipolar

Question 1

Bipolar Disorder is defined by fluctuations….

Answer 1

Extreme fluctuation between manic phases (overactive and excitability) and depressive (reclusive and lethargic)

Question 2

Acute - bipolar is treated using…(3)

Answer 2

Acute:
- Benzodiazepinesdes
- Antipsychotics (normally quetiapine,olanzapine and risperidone)
- Or Add lithium or sodium valproate

Question 3

Prophylaxis

Answer 3

-carbamazepine, sodium valproate or lithium

Question 4

Lithium therapeutic ranges and how often is the conc checked

Answer 4

Therapeutic range: 0.4-1mmol/L Lithium toxicity is the tremor!!!

Acute episodes(0.8-1mmol/l)

Weekly till stable, then monthly for 1 year, then 6 monthly after that

Question 5

Lithium can cause???- what 5??

Answer 5

Renal impairment - incontinence
Extrapyramidal side effects - tremors
Visual disturbances - blurred vision
Nervous system disorder - confusion and restlessness
Gastrointestinal disorder - diarrhoea and vomiting

SICK AND TREMOR!!!

Theophylline (sick and fast pals,tachycardia)
Digoxin (sick and Slow bradycardia etc)

Question 6

Interactions lithium:
(8)

Answer 6

• Hyponatraemia - increases risk of toxicity - diuretics needed
  
  • Salt imbalance
  • Serotonin syndrome
  • Extrapyramidal side effects drugs
  • Qt prolongation
  • Renally cleared drugs (increase risk of toxicity)
  • Reduced seizure threshold
  • Hypokalaemia