bipolar d/o

Question 1

Medications you should get blood levels for

Answer 1

Lithium, carbamazepine, valproic acid, clozapine

Question 2

Test to get before initiating lithium and test to get throughout course

Answer 2

Initially: EKG, BMP, CBC, TFTs, UCG

Monitoring test: lithium levels, creatinine, TFTs

Question 3

Lithium therapeutic range, toxic and lethal levels

Answer 3

Therapeutic range: 0.6-1.2
toxic: greater than 1.5
Lethal: greater than 2

Question 4

Lithium side effects

Answer 4

Tremor, nephrogenic DI, G.I. disturbance, weight gain, sedation, hypothyroidism, thyroid enlargement, EKG changes, leukocytosis
Toxic levels of lithium because AMS, course tremors, convulsions, delirium, coma, death

Question 5

Lithium answered of action

Answer 5

5 to 7 days

Question 6

Carbamazepine is especially useful in treating? Mechanism of action?

Answer 6

Useful in treating mania with mixed features and rapid cycling bipolar, less effective for depressive
Ask by blocking sodium channels inhibiting action potential’s

Question 7

Carbamazepine onset of action, what tests to obtain before initiating treatment and during treatment?

Answer 7

5 to 7 days, CBC, LFTs

Question 8

Carbamazepine side effects

Answer 8

Most common core G.I., CNS: drowsiness, ataxia, sedation, confusion
SJS, leukopenia, hyponatremia, a plastic anemia, Thrombocytopenia, agranulocytosis, elevated LFTs,

Question 9

Carbamazepine toxicity

Answer 9

Confusion, stupor, motor restlessness, ataxia, Tremor, nystagmus, twitching, vomiting

Question 10

Factors that increase lithium levels

Answer 10

NSAIDS, aspirin plus/minus, Thiazide, dehydration, salt deprivation, sweating, impaired renal function

Question 11

Unique carbamazepine interaction

Answer 11

*Significant drug interactions with cytochrome P4 50 induction, even autoinduction

Question 12

Use of valproic acid in what types of bipolar

Answer 12

Acute mania, mania with mixed features, rapid cycling