bipolar disorder Flashcards
What is bipolar disorder?
A condition with cycles of recurrent mood fluctuations between mania and depression.
What are the mood episodes in bipolar disorder?
Euphoric mania, hypomania, depression, mixed episode.
Why do many patients stop taking their medication?
They enjoy the euphoric manic phase but then crash into a depressive episode.
How is bipolar disorder treated?
A combination of two or three medications: Mood stabilizers, antiepileptics, antipsychotics, antidepressants, anxiolytics.
Why does lithium require monitoring?
It has a low therapeutic index.
When should lithium levels be checked?
In the morning, right before the next dose.
What is the therapeutic range for lithium?
0.6 – 1.2 mEq/L.
What are common side effects of lithium?
GI distress (N/V/D, abdominal pain), fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, hypothyroidism, bradydysrhythmias, hypotension, electrolyte imbalances.
What is used to manage lithium-induced hand tremors?
Propranolol.
How can polyuria be managed in lithium therapy?
Drink fluids and possibly use a potassium-sparing diuretic.
What lab values should be monitored for lithium patients?
GFR, creatinine, creatinine clearance, I&O (renal function).
What medication might be needed for lithium-induced hypothyroidism?
Levothyroxine.
< 1.5 mEq/L (Common Toxicity)
N/V/D, thirst, polyuria, muscle weakness, fine hand tremor, slurred speech, lethargy.
1.5 – 2.0 mEq/L (Early Toxicity)
GI distress, mental confusion, poor coordination, coarse tremors, sedation.
2.0 – 2.5 mEq/L (Advanced Toxicity)
Extreme polyuria (dilute urine), tinnitus, involuntary extremity movements, blurred vision, ataxia, seizures, severe hypotension → coma → respiratory complications & death.
> 2.5 mEq/L (Severe Toxicity)
Oliguria, seizures, rapid progression → coma → death.
How should lithium be taken?
In 2–3 doses per day.
What should patients maintain?
Fluid and sodium intake.
Why should dehydration be avoided?
It increases lithium levels, leading to toxicity.
What medications interact with lithium?
Diuretics, NSAIDs, anticholinergics.
Is lithium safe in pregnancy/lactation?
NO – Avoid in pregnancy & lactation.
Valproic Acid adverse effects
GI distress (N/V, indigestion), hepatotoxicity, pancreatitis, thrombocytopenia, teratogenesis, weight gain.
Lamotrigine adverse effects
Double/blurred vision, dizziness, headache, nausea/vomiting, skin rash, risk of cleft lip/palate in 1st trimester.
When should carbamazepine be given?
At bedtime (reduces CNS effects).
What should be monitored for carbamazepine?
Plasma levels (4–12 mcg/mL), signs of infection (due to blood dyscrasias), liver function.
Who should NOT take carbamazepine?
Pregnant patients, those with bone marrow suppression or bleeding disorders.
What drugs does carbamazepine interact with?
Decreases effects of: Oral contraceptives, warfarin. Increases carbamazepine levels:Grapefruit juice, phenytoin, phenobarbital.
What is the valproic acid level to be monitored?
Valproic acid levels (50–125 mcg/mL).
Who should NOT take valproic acid?
Pregnant or breastfeeding women.
What drugs increase valproic acid levels?
Phenytoin, phenobarbital.
What is the major teratogenic effect of lamotrigine?
Cleft lip/palate in the 1st trimester.
What are common side effects of lamotrigine?
Double/blurred vision, dizziness, headache, nausea/vomiting, skin rash.
What drugs lower lamotrigine levels?
Carbamazepine, phenytoin, phenobarbital, estrogen.
What drug increases lamotrigine levels?
Valproic Acid.
How does lamotrigine affect oral contraceptives?
It decreases the effectiveness of progestin-only oral contraceptives.
What are the central nervous system (CNS) side effects of carbamazepine?
Nystagmus, double vision, vertigo, staggering gait, headache.
What blood-related side effects can carbamazepine cause?
Blood dyscrasias, including leukopenia, anemia, and thrombocytopenia.
What is the pregnancy-related risk of carbamazepine?
Teratogenic effects.
How can carbamazepine affect fluid balance?
It can cause hypo-osmolality, leading to fluid overload.
What are the signs of bleeding complications with carbamazepine use?
Bruising and increased risk of bleeding.
What are the signs of hepatotoxicity from carbamazepine and valproic acid?
Anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice.
