Bipolar Disorder - Lithium Flashcards
What drug is used as a mainstay in the treatment of bipolar disorder?
Lithium is mainstay
What drugs are used as a secondary otion when lithium cannot be tolerated?
Anticonvulsants (carbazapam, valproate) and atypical antidepressants (risperidone, quetiapine).
Quicklly what are the various subtypes of bipolar disorder.
Type 1 BP disorder: very severe mood swings with manic episodes that are accompanied by psychosis. Type 2: less severe, hypomania, and cyclodysthmia: even milder.
What is rapid cycling?
More than 4 manic episodes a year!
How does Lithium work (purposed mechanisms)?
LIthiumis thought to 1) normalize increases Na+ and Ca+ intracellular concentrations, 2) inhibition of GSK 3 (required for cell survival and integrity), 3) activates ERK/MAPK which increases neuroplasticity.
Why most lithium evels be closely monitored?
Low therapeutic index!
What toxicities are involved with LIthium?
1) GI: N, V, D (dont give these patients antiemetics, 2) CNS: tremors, confusion, motor abnormalities, and seizures 3) Thyroid: decreased functions, 4) Renal: Li-induced diabetes insipidus due to ADH GPCR uncoupling, an 5) Cardiac: depresses SA node and T-wave amplitue.
Shouldlithium ever be given to a pregnant lady?
HECK NO.. Category D!
How is lithium metabolized?
Through the kidneys (urine).
What are the Contraindications with Lithium use?
Pregnant, people taking NSADIS/ACE-inhibitors (act to decrease GFR and increase Li+ concentration). Don’t give with diurectics. or if they have a history of seizure disorder.
