CNS - BIPOLAR DISORDER/MANIA

Question 1

What are the 2 types of episodes you can have?

Answer 1

• Mania - high and overactive

- Depression = low and lethargic

Question 2

What is the general treatment for adults with mania or hypomania?

Answer 2

• If pt is already taking an antidepressant, stop it and give an antipsychotic
• haloperidol, olanzapine, quetipaine, risperidone

Question 3

What could you use for acute episodes of mania and hypomania?

Answer 3

benzos

Question 4

What could be used for the prophylaxis of bipolar disorder?

Answer 4

• Lithium, Valproate, Olanzapine, Carbamazepine

- should continue 2 years after last episode

Question 5

What is lithium used for?

Answer 5

prophylaxis and treatment of mania, hypomania, and depression in bipolar disorder

Question 6

Lithium has a narrow therapeutic index, what are the ranges?

Answer 6

• 0.4mmol/L - 1mmol/L - lower end for prophylaxis and for elderly
• 0.8mmol/L - 1mmol/L - for acute manic episodes, pts who have previously relapsed or have other symptoms

Question 7

What would you need to monitor in lithium?

Answer 7

Blood samples taken 12 hours post dose and levels monitored every 3 months

Question 8

When would additional monitoring for lithium be needed?

Answer 8

• If there is significant illness
• significant changes to diet
• change in water intake

Question 9

What are the symptoms of lithium toxicity?

Answer 9

REVeNGe

• Renal disturbances - e.g. polyuria, polydipsia
• Extrapyramidal symptoms - e.g. tremor, ataxia
• Visual disturbances
• Nervous system disturbance - e.g. confusion
• GI effects - e.g. n&v

Question 10

What are the general side effects of lithium?

Answer 10

• Thyroid disorders
• Renal impairment
• Benign intracranial hypertension - pts should report persistent headaches and visual dist
• QT prolongation
• Lowers seizure threshold

Question 11

Which OTC products should you be cautious of when taking lithium?

Answer 11

• ibuprofen
• soluble analgesics e.g. effervescent paracetamol
• antacids

Question 12

What interacts with lithium?

Answer 12

• Quinolones, SSRIs - increase risk of seizures
• Drugs that prolong QT - increase risk of arrhythmias. Loop and thiazide cause hypokal which increases risk of prolonged QT
• Drugs that induce hyponatraemia - predisposes to Li toxicity
• Antipsychotics, metoclopramide, parkinsons disease = risk of extrapyramidal symptoms
• Drugs that affect salt balance = soluble analgesics, sodium containing antacids
• Neurotoxic drugs = phenytoin, carbamazepine, antipsychotics, amitriptyline
• Sumatriptan, SSRI, granisteron, MAOIs, amphetamine, SJW, Tramadol = increase risk of serotonin syndrome