Bipolar Disorder

Question 1

Mood stabilizers: Lithium, divalproex sodium, and

carbamazepine

Answer 1

§ Relieve symptoms during manic and depressive episodes
§ Prevent recurrence of manic and depressive episodes
§ Do not worsen symptoms of mania or depression; do not accelerate the rate of cycling

Question 2

Lithium [Lithonate, Lithotabs]

Answer 2

Chemistry
§ Simple inorganic ion
§ Found naturally in animal tissues
§ Therapeutic uses § BPD
§ Other uses
§ Alcoholism
§ Bulimia
§ Schizophrenia
§ Glucocorticoid-induced psychosis

Mechanism of action § Neurotrophic
§ Neuroprotective

§ Excretion
§ Short half-life
§ Excreted by the kidneys
§ Sodium levels: Lithium excretion reduced when sodium level is low
§ Plasma levels
§ 0.8 to 1.4 mEq/L

Adverse effects
§ Excessive lithium levels
§ Greater than 1.5 mEq/L
§ Monitor levels every 2 to 3 days at initiation of therapy and
then every 3 to 6 months
§ Therapeutic lithium levels § Gastrointestinal effects
§ Tremors
§ Polyuria
§ Renal toxicity
§ Goiter and hypothyroidism § Teratogenesis

Drug interactions § Diuretics
§ Nonsteroidal antiinflammatory drugs § Anticholinergic drugs
§ Preparations, dosage, and administration § Lithium carbonate
§ Lithium citrate
§ Dosage is highly individualized

Question 3

Antiepileptic Drugs

Answer 3

Divalproex sodium [Valproate]
§ Carbamazepine
§ Reduces symptoms
§ Protects against recurrence of mania and depression § Target trough plasma level: 4 to 12 mcg/mL
§ Lamotrigine
§ Indicated for long-term maintenance
§ Can be used alone or in combination with other drugs

Question 4

Antipsychotic Drugs

Answer 4

Used to acutely control symptoms during manic episodes
§ Used long term to help stabilize mood
§ Benefit patients with or without psychotic
symptoms
§ Can be combined with mood stabilizer
§ Five antipsychotics approved for use
§ Olanzapine [Zyprexa], quetiapine [Seroquel], risperidone [Risperdal], aripiprazole [Abilify], and ziprasidone [Geodon]