Pharm - Bipolar Disorder

Question 1

How long does someone have to have increased mood/elevated activity for a mania diagnosis? What about hypomania?

Answer 1

At least 1 week: mania

At least 4 days: hypomania

Question 2

Which medication has anti-suicidal effects in bipolar disorder (and psychosis)?

Answer 2

Lithium

Question 3

How long does it take for lithium to help mania? Depression?

Answer 3

1-2 weeks: mania

6-8 weeks: depression

Question 4

What are the target therapeutic levels for lithium?

When is blood drawn?

Answer 4

0.8-1.2

Blood draw 12 hours after last evening dose, and 3 days after dosage changes.

Question 5

What class of medication might be added to deal with tremors associated with lithium?

Answer 5

A beta-blocker

Question 6

Is lithium okay in pregnancy?

Answer 6

It’s best to avoid it in the first trimester

Question 7

What tests should you have every 6-12 months while on lithium?

Answer 7

Renal function
Thyroid function
Urinalysis

Question 8

What effect can lithium have on the thyroid?

Answer 8

It can cause hypothyroidism. You might need levothyroxine.

Question 9

What low-level (below 1.5) lithium toxicity symptoms should patients watch out for?

Answer 9

NVD
Thirst and polyuria
Lethargy, slurred speech and muscle weakness
Fine tremor

Question 10

What mid-level (1.5-2) lithium toxicity symptoms should pts watch out for?

Answer 10

GI upset (NVD)
Worsening tremor (coarse)
Confusion and/or sedation
Poor coordination or hyperirritability of muscles

Question 11

What high-level (2-2.5) lithium toxicity symptoms should pts watch out for?

Answer 11

Ataxia, clonic movements or seizures
Blurred vision
Tinnitus
Hypotension and stupor OR giddiness
Polyuria
Coma, death

Question 12

Lithium toxicity above 2.5?

Answer 12

Oliguria, seizures, death.

Question 13

What should you tell a patient starting lithium therapy?

Answer 13

Eat enough salt - supplement if you are sweating excessively.

Watch your I/Os

If you’re a diabetic, monitor CBGs well.

Watch for toxicity sx

Question 14

Which antiepileptic drugs are often used in bipolar disorder?

Answer 14

Divalproex sodium (rapid cyclers, especially)

Carbamazepine (can add to lithium)

Lamotrigine (long-term maintenance and depression prevention).

Question 15

What are antipsychotic drugs typically used for in bipolar disorder?

Answer 15

Control of manic episodes (a bunch are indicated for this)

Some okay for depression (Quetiapine, lurasidone) (Olanzapine with fluoxetine).

Some okay for long-term management (Quetiapine above, plus Olanzapine, risperidal and abilify)

Question 16

What’s the role of antidepressants in bipolar disorder?

Answer 16

Should never be used as a monotherapy.

Might combine with other stabilizers.