Bipolar Flashcards
acute treatment
-immediate treatment in response to current mood episode
maintenace treatment
-preventative treatments after stabilization of cute mood episode
mood stabilizers
-anticonvulsants
-atypical antipsychotic
-lithium
First line mono therapy for acute mania
-second gen antipsychotic(quetiapine preferred)
-lithium
-valproate
second line for acute mania
switch to another SGA, lithium or valproate
3rd line for acute mania
-use first line agents in combo therapy
-SGA + lithium or valproate
-lithium + valproate
SGAs to avoid in acute mania
-lurasidone
-lumateperone
-brecpiprazole
First line mono therapy for acute bipolar depression
-SGA: quetiapine or lurasidone
2nd line treatment for acute bipolar depression
-switch to another SGA, or lithium + lamotrigine
3rd line combo treatments for acute bipolar depression
-SGA+ lithium or lamotrigine
-lithium + lamotrigine
-adjunct antidepressant: not as a monotherapy
medications for mixed episodes
-SGA
rapid cycling
-use antipsychotics or valproate
-avoid antidepressants and lithium
high risk of suicide
- consider lithium, ECT
psychosis
-antipsychotics, ECT
Anxiety
antiphsychotic, valproate
Pregnancy
-antipsychotic, lamotrigine, ECT
-avoid lithium and valproate
True or False: mania symptoms take longer to resolve than bipolar depression with medication.
False.
Mania: 3-4 weeks
Bipolar: 6-8 weeks
True or false: lithium is associated with reduced suicide rates
true
onset of lithium
-5-10 days for actute mania
-6-8 weeks for acute depression
Lithium dosing
-When first starting, split dosing 2-3 times a day to avoid side effects
-titrate every 5-7 days based on lithium levels
Lithium drug levels
0.8-1 mEq/L is normal
-draw trough 12 hours post dose
-levels should be checked within 5-7 days of initiation or dose change(steady state)
Lithium ADEs
-polyuria and polydipsia
-hypothyroidism
-hypercalcemia
-reduced kidney function
-N/V
-Diarrhea
-fine hand tremor
-Somnolence
-ataxia
-cognitive impairment
-weight gain
-sexual side effects
Lithium interactions
-100% renally eliminated so it is susceptible to interactions
-kidney impairment
-sodium depletion
-dehydration
-cardio disease
-volume depletion
Lithium drug interactions
-thiazide diuretics: hydrochlorothiazide
-NSAIDs
-ACE-I: linsinopril
-ARBs: lorasrtan
Lithium toxcitity mild-mod
-develops over several days
-drowsiness
-confusion
-course hand tremor
-ataxia
-dysarthria/slurred speech
-reappearance of GI symptoms
Lithium toxicity mod-severe
-gradual or sudden onset
-muscle tremor
seizure
coma
-hyperreflexia
-cardio collapse
-death
-requires hospitilization
lithium in pregnancy
-avoid in 1st trimester of pregnancy due to cardiac malformations
-may require higher lithium dose during pregnancy
-dose reduction following delivery
Lithium monitoring
-check at baseline then annually
-renal function
-thyroid function
-CBC
-electrolytes
-pregnancy tests
-BMA
-ECG is CVD risk factors presents
