Drugs For Bipolar Disorders Flashcards
Lithium
Moa: unknown, inhibits dopamine release, enhanced serotonin release & decrease formation of intracellular second messenger
Indication: prevention of manic and depressive episodes in BMD, tx in acute Mania,schizoaffective & chronic schizophrenia … others: augmentation of tx resistant depression
Precaution
Hyponatremia
Hypothyroidism
Psoriasis
Tx with drugs that increase serotonin toxicity
Increases risk of congenital heart defects, neonatal neurotoxicity & hypothyroidism
Adr
Metallic taste, nausea, diarrhoea, epigastric discomfort,wt gain, hypercalcaemia
Dose:750-1g od in divided doses
Prophylaxis:250mg-1g od in divided doses
Conc monitoring
Measure after 5-7 days after starting tx. Monitor during illness such as gastroenteritis, manic, depressive,changes in wt,diet,temp, pregnancy,meds eg. Diuretics
Range
Acute Mania :0.5-1.2mmol/l
Prophylaxis:0.4-1mmol/l
Counseling
1. Regular blood taking
2. Monitor signs and sx of lithium toxicity such as extreme thirst, frequent urination, excessive sweating,low fluid intake
3. Take with food avoid taking with hot drinks. Maintain a normal diet with regular salt & fluid intake.
4. Avoid sodium bicarbonate found in indigestion meds like ural, salvital, citracescent as it makes lithium less effective
5. Onset of action maybe delayed for 6-10days, consider adding a bdz or antipsychotic
6. Check wt,,serum calcium,PTH hormone at baseline,3-6 Mo monthly and annually
7. Di not stop lithium tx,taper gradually over at least 4 weeks to avoid relapse
