Bipolar 3 Flashcards
what is the level of mild lithium toxicity
1.5-20
what levels of lithium are considered severe toxicity, what are the symptoms of severe toxicity
3 or greater
coma or death
what are the contraindications with lithium
- renal disease
- CV disease
- history of leukemia
- first trimester of pregnancy
- hypersensitivity to lithium
how long does it take to see full effects of lithium
2 weeks
what should be done if a patient develops a rash or psoriasis on lithium
d/c lithium
what side effects of lithium require the dose to be lowered
CNS toxicity
GI problems
polyuria
what drugs increase the level of lithium
- NSAIDs
- ACE inhibitors
- fluoxetine
- thiazide diuretics
what drugs decrease the level of lithium
- caffeine
- acetazolamide
- loop diuretics
- bicarbonate
a decreased sodium level does what to lithium concentrations
increases lithium concentrations
what are the counseling points with lithium
- take with food if causes upset stomach
- keep salt and caffeine in diet consistant
- avoid becoming dehydrated
what is another first line treatment for acute manic episodes other than lithium
valproic acid
valproic acid is first line for what ?
acute mania or mixed episodes, rapid cycles and maintenance bipolar therapy (as effective as lithium in all of these)
when is Depakote not effective in treating bipolar disorder
it is not effective for depressive episodes
what is the initial dose of depakote
500-1000 mg/day divided in 2-4 doses (ie 250 mg TID)
what is the maximum dose of valproic acid
60/mg/kg/day
