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BNF > CHAPTER 4: CNS: Bipolar and Lithium > Flashcards

CHAPTER 4: CNS: Bipolar and Lithium Flashcards

1
Q

How long after the last manic episode should treatment with bipolar continue? (2)

A
  1. 2 years

2. Up to 5 years if risk of relapse

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2
Q

What can be used for the treatment of co-existing depression?

A

An anti-depressant

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3
Q

Antidepressants should be avoided in which patients? (3)

A
  1. Rapid-cycling bipolar
  2. Recent episode of hypomania
  3. Rapid mood fluctuations
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4
Q

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?

A

Benzodiazepines

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5
Q

Which antipsychotics are used to treat acute episodes of mania? (3)

A
  1. Olanzapine
  2. Risperidone
  3. Quetiapine
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6
Q

If response to antipsychotic drugs is inadequate, which drugs can be added? (2)

A
  1. Lithium

2. Valproate

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7
Q

When discontinuing antipsychotics, over how long should the dose be gradually reduced if the patient is continuing with antimanic drugs?

A

4 weeks

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8
Q

When discontinuing antipsychotics, over how long should the dose be gradually reduced if the patient is NOT continuing with antimanic drugs?

A

3 months

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9
Q

As well as valproate, which other anti-epileptic can be used under specialist supervision for the treatment of bi-polar unresponsive to other drugs?

A

Carbamazepine

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10
Q

What is valproate used for in bipolar? (2)

A
  1. To treat manic episodes

2. As prophylaxis

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11
Q

What are the indications for lithium? (5)

A

Prophylaxis and treatment of:

  1. Mania
  2. Hypomania
  3. Depression
  4. Recurrent unipolar depression
  5. Aggressive or self-harming behaviour
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12
Q

How long after initiation of therapy can the full prophylactic effect of lithium take to occur?

A

6-12 months

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13
Q

Like sodium valproate, which MHRA warnings is VALPROIC ACID associated with?

A

Abnormal pregnancy outcomes, must not be used in females of childbearing potential

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14
Q

To which organ is valproate toxic, espeically in the first 6 months of treatment?

A

Liver

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15
Q

As well as the liver, which organ can valproate affect causing side effects of severe abdominal pain?

A

Pancreatitis

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16
Q

Which disorders has long-term treatment with Lithium been associated with? (2)

A
  1. Thyroid

2. Cognitive and memory

17
Q

How often should thyroid function be monitored in patients taking lithium?

A

Every 6 months

18
Q

What are the signs of lithium toxicity? (8)

A
  1. Vomiting
  2. Diarrhoea
  3. Visual disturbance
  4. Polyuria
    5, Muscle weakness
  5. Confusion and drowsiness
  6. Abnormal reflexes
  7. Hypernatreamia
19
Q

How long after the dose should lithium levels be taken?

A

12 hours

20
Q

What is the desired serum-lithium range?

A

0.4-1mmol/L

21
Q

Routine lithium levels should be taken weekly after initiation until concentrations are stable then how long thereafter?

A

Every 6 months

22
Q

What is the risk of stopping lithium abruptly?

A

Risk of relapse - no evidence of rebound or withdrawal psychosis

23
Q

As well as thyroid function, what else should be monitored in patients taking lithium? (2)

A
  1. Renal function

2. Cardiac function

24
Q

Which signs should patients be counselled to report?

A
  1. Lithium toxicity
  2. Renal dysfunction
  3. Hypothyroidism
  4. Intracanial hypertension
25
Q

What could be signs of benign intracranial hypertension?

A
  1. Headache

2. Visual disturbance

26
Q

What should be given to all patients on initiation of treatment with lithium?

A

Lithium treatment pack

27
Q

Which drugs can interaction with lithium and precipitate renal dysfunction (3)

A
  1. ACE inhibitors
  2. Diuretics
  3. NSAIDs
28
Q

Are lithium citrate and lithium carbonate dose equivalent?

A

NO citrate 509mg = carbonate 200mg

29
Q

Which lithium salt is the one that comes in liquid form?

A

Lithium citrate

BNF (28 decks)

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