Bipolar Disorder Pharmaceutical Care Flashcards
What is bipolar?
Episodic depressed + elated moods
What are the important complications?
Suicide
Deliberate self-harm
What should you do if you suspect someone has bipolar?
Referred to specialist
Mental health assessment
Risk assessment
Hospital admission IF danger to themselves
What is secondary care of bipolar?
Treating an acute episode + establish long term management plan
What is the treatment for acute phase of mania?
Therapeutic trial of oral antipsychotic
If not tolerated choose a different one
If not effective = add lithium or sodium valproate
What are the oral antipsychotic considered?
Haloperidol
Olanzapine
Quetiapine
Risperidone
What happens 4 weeks after the acute episode?
Discuss long term management plan
= prevent relapses
What is the long term treatment plan?
Continue their current treatment for mania
OR start long term treatment with lithium
Valproate may be added if lithium NOT effective
Olanzapine may be added if lithium NOT tolerated
What will secondary care do?
Monitor physical health, mental health + effects of antipsychotic for at least first 12 months
How do you prescribe lithium?
By brand = vary widely in bioavailability
What are the initial adverse effects of lithium?
Nausea, diarrhoea, vertigo, muscle weakness + “dazed” feeling
What are the long term adverse effects of lithium?
Hypothyroidism
Hyperthyroidism
Nephrotoxicity
Renal tumours
What is the problem with lithium?
Lots of interactions
How is lithium monitored?
Levels are normally measured one week after starting treatment
One week after each dose change + weekly till levels are stable
Then usually every 3 months
What is the problem with valproate?
Should NOT be prescribed to females
= physical birth defects + developmental disorders in children exposed in utero
