Bipolar QA Flashcards
Three treatment drug classes for bipolar
1) Benzo
2) Antiphysoctics
3) Lithium or Valporic Acid
4) Asenapine (severe manic episodes)
Examples of short term use for treatment options
Benzodiazepines
Examples of Antipsychotics options
Quetiapine / Olanzapine / Risperidone / Haloperidol
Which medication is contraindicated in bipolar
Antidepressants
Why are benzo’s in bipolar only used for short term management
High risk of dependence
Bipolar Prophylaxis treatment options (4)
1) Lithium
2) Valproate
3) Olanzapine (only if pt responds to it in manic episode)
4) Carbamazepine (rapid – cyclin bipolar disorder unresponsive to other drugs)
When does the full prophylactic effect of lithium start
- 6 to 12 months)
What is lithium used for
Prophylaxis and treatment on mania , hypomania and depression in bipolar disorder , resistant depression and aggressive self-harm
What is the lithium range in patients?
- 4mmol/l to 1mmol (lower end of prophylactic treatment and for elderly pt)
- 8mmol/l to 1mmol (For acute manic episodes who are had previous relapse and have had subsyndromal symptoms)
Signs of toxicity REVNG
- Renal disturbances (polyuria / incontinence and hypernatremia)
- Extradyramydial symptoms (Tremor / Ataxia / Dysarthria / Myoclonus / Nystagmus and muscle weakness)
Visual disturbances: Blurred Vision - Nervous system disturbances: Confusion drowsiness incoordination restlessness and stupor
- GI side effects: Diarrhoea and Vomiting
Side effects of lithium (5)
- Thyroid disorder
- Renal Impairment
- Benign intracranial hypertension (pt should report headaches and visual disturbances)
- QT prolongation
- Lowers seizure threshold
Pt with lithium values > 2mmol/l (7)
- Renal failure
- Arrhythmias
- Sudden Death
- Coma
- Seizures
- BP changes
- Circulatory failure
Monitoring of lithium
- 12 hours post dose
- Every month
- Additional monitoring if significant illness or changes to diet or water intake
Counselling of lithium (8)
- Prescribe by brand
- Hyponatremia predisposes people to lithium toxicity
- Maintain constant and adequate salt and water intake
- Always carry lithium alert card
- Can cause drowsiness – avoid alcohol
- Lithium can interact with OTC medication (ibuprofen / soluble analgesics / antacids)
- Avoid abrupt withdrawal
- Sign and symptoms of toxicity
Interaction of lithium
- Prolong QT interval =
- Increase risk of seizures with medication such as SSRIs / Epilepsy / Ciprofloxacin
- Reduced renal excretion
- Hyponatremia predisposes people to lithium toxicity (
- Increase risk of extrapyramidal side effects drugs - antipsychotics
- Concomitant drugs that affect salt balance (OTC interactions soluble / effervescent analgesics (high salt) / sodium containing antacids.
- Increase risk of nephrotoxicity
