Bipolar Disorder and Mania Flashcards
What does the treatment of bipolar disorder and mania usually consist of?
The control of acute attacks and the long-term treatment of the disorder.
For how long does the long-term treatment of bipolar disorder occur for?
At least two years from the last manic episode or up to five years if the patient has risk factors for relapse.
Use of which drugs may be helpful in the initial management of agitation in bipolar disorder?
Benzodiazepines however long-term use is not recommended due to risk of dependence.
Which drugs can be used to treat acute episodes of mania or hypomania?
Atypical antipsychotic drugs (olanzapine, quetiapine, risperidone), lithium or valproate as alternatives. Carbamazepine can be used in patients who do not respond to lithium.
What is the therapeutic range for lithium?
0.4 to 1 mmol/L (0.8 to 1 mmol/L for acute episodes of mania and relapse patients).
What warning signs associated with lithium use are a cause for referral and further investigation?
Toxicity, increasing GI disturbances, visual disturbances, CNS disturbances, fine tremor increasing to course tremor, muscle weakness, signs and symptoms of hypothyroidism, signs and symptoms of renal dysfunction, signs and symptoms of benign intracranial hypertension.
What serum concentration of lithium is associated with lithium toxicity?
Over 2 mmol/L.
What are the symptoms of lithium toxicity?
Seizures, coma, renal failure, arrhythmias, blood pressure changes, circulatory failure, death.
What gastrointestinal disturbances are occasionally seen with lithium use?
Vomiting and diarrhoea.
What visual disturbances are occasionally seen with lithium use?
Blurred vision.
What CNS disturbances are occasionally seen with lithium use?
Drowsiness, unsteadiness, confusion.
What are the signs and symptoms of hypothyroidism, occasionally seen with lithium use?
Unexplained fatigue, weight gain, hair loss.
What are the signs and symptoms of renal dysfunction, occasionally seen with lithium use?
Polyuria and polydipsia.
What are the signs and symptoms of benign intracranial hypertension, occasionally seen with lithium use?
Persistent headache and visual disturbances.
When a patient is taking lithium, when should their serum lithium levels be assessed?
Weekly, then every three months once the dose becomes stable.
When a patient is taking lithium, when should their renal function be assessed?
Every 6 months.
When a patient is taking lithium, when should their cardiac function be assessed?
Every 6 months.
When a patient is taking lithium, when should their thyroid function be assessed?
Every 6 months.
Is it possible for lithium to have an effect on one’s ability to drive or perform skilled tasks?
Yes
There is an increased risk of toxicity when lithium is used with which other drugs?
ACE inhibitors, angiotensin-2 receptor antagonists, loop diuretics, thiazides and related diuretics, NSAIDSs, potassium-sparing diuretics, aldosterone antagonists, metronidazole, SSRIs, tricyclics.
There is an increased risk of ventricular arrhythmias when lithium is used with which other drug?
Amiodarone.
There is an increased risk of neurotoxicity when lithium is used with which other drugs?
Methyldopa, phenytoin, carbamazepine, diltiazem, verapamil.
There is an increased risk of extrapyramidal side effects when lithium is used with which other drugs?
Clozapine, haloperidol, sulpiride, phenothiazines, risperidone, flupentixol, zuclopenthixol.
What conditions have been associated with long term lithium use?
Thyroid disorders and mild cognitive and memory impairment.
Do carbonate and citrate salts of lithium have the same or different dose equivalents?
Different.
What precaution is required when changing a patient from one preparation of lithium to another?
The same as initiation, close monitoring of serum lithium levels weekly until stabilisation.
Should patients on lithium be maintained on the same brand?
Yes.
What should be given to patients upon initiation with lithium?
A lithium treatment pack.
Depletion of which electrolyte can worsen the effects of lithium toxicity? How should this be managed?
Sodium. Adequate salt and water intake should be maintained, especially during illness or hot weather.
