Medications for Bipolar Disorders

Question 0

Mood stabilizers:

Medications

Answer 0

1. Lithium Carbonate, Lithane, Lithobid

Question 1

Medications for Bipolar Disorder:

Answer 1

1. Mood Stabilizers

2. Anti-epileptic medications

Question 2

Mood stabilizers:

Action

Answer 2

1. Lithium produces neuro chemical changes in the brain, including serotonin receptor blockade.
2. There is evidence that lithium decreases neuronal atrophy and or increases neuronal growth.
3. Lithium helps control episodes of acute mania, helps prevent the return of mania or depression, and decreases the incidence of suicide.

Question 3

Mood stabilizers:

Adverse effects

Answer 3

1. GI distress
2. Find hand tremors
3. Polyuria, mild thirst
4. Weight gain
5. RENAL TOXICITY (short term treatment)
6. Goiter and hypothyroidism

Question 4

Mood stabilizers:

Medication Interactions

Answer 4

1. Diuretics- Na is excreted-> decreased Na-> decreased lithium excretion-> lithium toxicity.
2. NSAIDS-> increase renal absorption of lithium-> toxicity
   
   • use Aspirin as a mild analgesic
3. Anticholinergics

Question 5

Lithium Levels:

monitoring

Answer 5

1. Monitor levels every 2-3 days until stable, then every 1-3 months
2. Obtain levels in the morning, usually 12 hrs. after last dose

Question 6

Lithium Levels:

During initial treatment of a manic episode

Answer 6

levels should be between 0.8-1.4

Question 7

Lithium Levels:

Maintenance level range

Answer 7

between 0.4-1.0

Question 8

Lithium Levels:

Toxicity

Answer 8

Plasma levels greater than 1.5 can result in toxicity

• Older adults more at risk, more monitoring
• may need hemodialysis
• Effects being 7-14 days
• TAKE WITH FOOD- GI stress
• INCREASE FLUID AND SODIUM INTAKE

Question 9

Anti-Epileptic Drugs:

Medications

Answer 9

1. Valproic Acid (Depakote)

2. Tegretol

Question 10

Anti-Epileptic Drugs:

Action

Answer 10

1. Slowing the entrance of sodium and calcium back into the neuron, thus extending the time it takes for the nerve to return to its active state
2. Potentiating the inhibitory effects of gamma butyric acid (GABA)
3. Inhibiting glutamic acid (glutamate) which in turn suppresses CNS excitation

Question 11

Anti-Epileptic Drugs:

Adverse Effects

Answer 11

Tegretol- Nystagmus, double vision, Vertigo, Staggering gate, Teratogenesis, Hypo-osmolarity.
Depakote- Hepatotoxicity (jaundice, n/v, fatigue, abd pain, anorexia), pancreatitis, thrombocytopenia, teratogenesis

Question 12

Anti-Epileptic Drugs:

Med/food interactions

Answer 12

Tegretol- Oral contraceptives, warfarin (coumadin), grapefruit juice, phenytonin, phenobarbital
Depakote- Phenytonin, phenobarbital.