CHAPTER 4: CNS: Bipolar and Lithium Flashcards
How long after the last manic episode should treatment with bipolar continue? (2)
- 2 years
2. Up to 5 years if risk of relapse
What can be used for the treatment of co-existing depression?
An anti-depressant
Antidepressants should be avoided in which patients? (3)
- Rapid-cycling bipolar
- Recent episode of hypomania
- Rapid mood fluctuations
Which drugs may be useful in the initial stages of treatment for behavioural disturbance or aggression but should not be used long-term due to risk of dependence?
Benzodiazepines
Which antipsychotics are used to treat acute episodes of mania? (3)
- Olanzapine
- Risperidone
- Quetiapine
If response to antipsychotic drugs is inadequate, which drugs can be added? (2)
- Lithium
2. Valproate
When discontinuing antipsychotics, over how long should the dose be gradually reduced if the patient is continuing with antimanic drugs?
4 weeks
When discontinuing antipsychotics, over how long should the dose be gradually reduced if the patient is NOT continuing with antimanic drugs?
3 months
As well as valproate, which other anti-epileptic can be used under specialist supervision for the treatment of bi-polar unresponsive to other drugs?
Carbamazepine
What is valproate used for in bipolar? (2)
- To treat manic episodes
2. As prophylaxis
What are the indications for lithium? (5)
Prophylaxis and treatment of:
- Mania
- Hypomania
- Depression
- Recurrent unipolar depression
- Aggressive or self-harming behaviour
How long after initiation of therapy can the full prophylactic effect of lithium take to occur?
6-12 months
Like sodium valproate, which MHRA warnings is VALPROIC ACID associated with?
Abnormal pregnancy outcomes, must not be used in females of childbearing potential
To which organ is valproate toxic, espeically in the first 6 months of treatment?
Liver
As well as the liver, which organ can valproate affect causing side effects of severe abdominal pain?
Pancreatitis
Which disorders has long-term treatment with Lithium been associated with? (2)
- Thyroid
2. Cognitive and memory
How often should thyroid function be monitored in patients taking lithium?
Every 6 months
What are the signs of lithium toxicity? (8)
- Vomiting
- Diarrhoea
- Visual disturbance
- Polyuria
5, Muscle weakness - Confusion and drowsiness
- Abnormal reflexes
- Hypernatreamia
How long after the dose should lithium levels be taken?
12 hours
What is the desired serum-lithium range?
0.4-1mmol/L
Routine lithium levels should be taken weekly after initiation until concentrations are stable then how long thereafter?
Every 6 months
What is the risk of stopping lithium abruptly?
Risk of relapse - no evidence of rebound or withdrawal psychosis
As well as thyroid function, what else should be monitored in patients taking lithium? (2)
- Renal function
2. Cardiac function
Which signs should patients be counselled to report?
- Lithium toxicity
- Renal dysfunction
- Hypothyroidism
- Intracanial hypertension
What could be signs of benign intracranial hypertension?
- Headache
2. Visual disturbance
What should be given to all patients on initiation of treatment with lithium?
Lithium treatment pack
Which drugs can interaction with lithium and precipitate renal dysfunction (3)
- ACE inhibitors
- Diuretics
- NSAIDs
Are lithium citrate and lithium carbonate dose equivalent?
NO citrate 509mg = carbonate 200mg
Which lithium salt is the one that comes in liquid form?
Lithium citrate
