Bipolar

Question 1

AEDs or antiepileptic drugs are used to treat bipolar patients who _____

Answer 1

do not respond well to lithium or may not tolerate it
include
-rapid cycling pts (4+ episodes/yr)
-electoencephalographic abnormalities
-dysphoric mania (depressive thoughts and feelings during manic episodes)
-substance abuse not assoc. with mood episodes
-progression in the frequency and severity of symptoms
-no fam hx of bipolar disorder among first degree relations

Question 2

what are the 3 AED’s that have demonstrated efficacy for treating mood disorders;

Answer 2

carbamazephine (Tegretol)
divalproex (Depakote)
lamotrigine (lamictal)

Question 3

major adverse effects with Tegretol (antiepileptic or AED)

Answer 3

agranulocytosis and aplastic anemia are most serious.
monitor blood levels throughout 1st 8 weeks
maintain serum level 6-8mg/L
-sedation, diplopia, incoordination–excessive levels

Question 4

major adverse effects with Depakene (AED)

Answer 4

baseline liver fx tests!
hepatitis has been reported
WATCH FOR fever, chills, RUQ pain, dark urine, malaise, and jaundice
common SE: tremors, GI upset, weight gain, rarely alopecia

Question 5

major adverse effects with Lamictal (an AED)

Answer 5

LIFE THREATENING RASH reported in 3/1000 individuals (steven johnson syndrome)
use caution when renal, hepatic or cardiac fx is impaired
-dizziness, diplopia, h/a, ataxia and somnolence are among frequent SE

Question 6

what antipsychotics show mood stabilizing properties (for bipolar treatment)

Answer 6

olanzapine (zyprexa) better tolerated and prevents mania relapse more effectively thatn lithium
seroquel -treat anxiety sympt and acute mania in bipolar depression
-risperdal
-abilify
-and ziprasidone (geodon)

Question 7

first-line mood stabilizing agents used for lifetime maintenance therapy for bipolar patients

Answer 7

lithium and divalproex (Depakote)

Question 8

Lithium Carbonate is helpful in reducing

Answer 8

elation, grandiosity
flight of ideas
irritability
anxiety
(also helps control insomnia, psychomotor agitation, threatening behavior, distractibility, hypersexuality and paranoia)

Question 9

actual maintenance blood levels of Lithium should be_____

Answer 9

between 0.4 and 1.3

SHOULD NEVER EXCEED 1.5

Question 10

two major long term risks of lithium therapy are _____

Answer 10

hypothyroidism and impairment of kidney’s ability to concentrate urine–NEED THYROID AND RENAL FUNCTION TESTS

Question 11

expected SE of lithium

Answer 11

fine hand tremor, polyuria and mild thirst
mild nausea and general discomfort
weight gain

Question 12

stop taking lithium if you _____

Answer 12

have excessive diarrhea, vomiting, or sweating (ALL THESE SYMPTOMS LEAD TO DEHYDRATION–CAUSE LITHIUM TOXICITY) INFORM YOUR PHYSICIAN IF YOU HAVE THESE PROBLEMS