Bipolar Affective Disorder

Question 1

Name 4 drugs used for Bipolar Affective Disorders

Answer 1

Lithium
Valproate
Lamotrigine
SGAs

Question 2

Adverse effects: Lithium

Answer 2

GI, QT prolongation, polyuria, tremor, sedation, weight changes
Toxicity: N + V + D, excessive thirst, drowsy, blurred vision, convulsions

Question 3

Mechanism of Action: Lithium

Answer 3

Promotes GABAergic neurotransmission

Question 4

Interactions: Lithium

Answer 4

Avoid NSAIDs
Diuretics, ACEIs
Antidepressants
Carbamazepine
Haloperidol

Question 5

Indications and Forms of Valproate:

Answer 5

Acute mania, prophylactic agent

Sodium, valproaic acid, semi-sodium

Question 6

Adverse effects: Valproate

Answer 6

Weight gain, GI, blood disorders, fatigue, n, sedation, tetatogenic

Question 7

Mechanism of action: Valproate

Answer 7

Block NA+ channels, inhibit GABA transaminase, suppress glutamate action, blocks Ca++ channels

Question 8

Interactions: Valproate

Answer 8

Highly protein bound

Liver metabolised

Question 9

Indication: Lamotrigine

Answer 9

Depressive episodes

Monitor

Question 10

Adverse Effects: Lamotrigine

Answer 10

Skin rashes – may need to be withdrawn

Headache, dizziness, N, drowsiness, insomnia

Question 11

Mechanism of Action: Lamotrigine

Answer 11

Block Na+ channels, inhibit excitatory amino acid release (glutamate and aspartate)

Question 12

Interactions: Lamotrigine

Answer 12

Plasma conc reduced by: phenytoin, carbamazepine, oestrogens, progestogens, valproate, primidone

Question 13

Indications: SGAs

Answer 13

Acute mania

Usually olanzapine or quetiapine