Pharmacology of Bipolar and Mania

Question 1

what diagnosis could be suspected if a depressed patinet doesnt respond well to medication

Answer 1

BAD - check for history of manic episodes

Question 2

use of ADs in BAD

Answer 2

are sometimes used on top of mood stabilisers

they can cause switching to mania/hypomania or mood instability

Question 3

is lithium a safe drug?

Answer 3

no, it has a very narrow therapeutic index

Question 4

what tests must be done prior to intiation of lithium treatment

Answer 4

U and Es, TFT, ECG

Question 5

what must be monitored whilst on lithium

Answer 5

lithium levels in blood 12 hours after dose

UandEs

TFT every 6 months

Question 6

name some side effects of lithium

Answer 6

dry mouth, strange salty taste in mouth

fine tremor

hair loss

Question 7

does lithium causes sedation or insomnia? and as a conseuqence when is it adminstered

Answer 7

sedation, taken at night

Question 8

does lithium cause weight gain or loss

Answer 8

gain

Question 9

what effect does lithium have on the thyroid

Answer 9

thyroid enlargement that is sometimes associated with hypothyroidism, check TFT before intitiation and every 6 months after

Question 10

what does lithium do in the kidneys

Answer 10

• inhibits ADH - nephrogenic diabetes insipidus
• sodium retention due to increased aldosterone secretion
• renal tubular damage can occur with prolonged treatment

Question 11

what are the 2 major symptoms of DI

Answer 11

polyuria and polydipsia

Question 12

which drugs does lithium interact with

Answer 12

NSAIDs, ACEIs, ARBs, diuretics - any drug with the potential to reduce renal function can cause the accumulation of lithium

Question 13

do thiazides or loop diuretics interact with lithium more

Answer 13

thiazides

Question 14

signs of lithium toxicity

Answer 14

• Warning signs: GI upset, blurred vision, coarse tremor, ataxia, drowsiness
• Severe toxicity: confusion, loss of consciousness, seizures, coma, death

Question 15

what must patient on lithium carry with them incase of toxicity

Answer 15

lithium card - remind of toxic symptoms and to inform healthcare professionals

Question 16

what can precipitate lithium toxicity

Answer 16

dehydration (physical illness, lack of fluid intake, alcohol, hot weather, exercise, lots of caffeine), physical illness, lack of fluid intake, alcohol, hot weather, exercise) vomiting and diarrhoea

Question 17

management of lithium toxicity

Answer 17

stop lithium, IV fluids, monitor renal function, dialysis if required

Question 18

what does an increase in salt intake cause

Answer 18

fall in lithium levels

Question 19

which trimester is the baby most vulnerable to damage from drugs

Answer 19

1st - organs developing

Question 20

which 3 classes of drugs are used in BAD

Answer 20

lithium, anticonvulsants and antisychotics

Question 21

who should not receinve sodium valproate

Answer 21

do not give to women of child bearing age if you can avoid it, very teratogenic - causes neural tube defects

Question 22

what tests should be done prior to initiation of sodium valproate

Answer 22

LFTs (can cause hepatoxicity) and platelet count

Question 23

what is a serious side effect of lamotrigine

Answer 23

rash - must see doctor ASAP

can cause steven johnson syndrome

Question 24

what precuation is taken when starting lamotrigine to avoid SJS

Answer 24

titrate up slowly over 6 weeks to reduce risk - see doctor ASAP if get rash!!!

Question 25

how do antipsychotics work

Answer 25

main action is dopamine receptors 2 blockade, various other mechanisms too

Question 26

how can antipsychotics be given if compliance is poor

Answer 26

depot IM injection

Question 27

what type of symptoms can anti psychotics cause

Answer 27

extra pyramidal symptoms (acute dyskinesias, dystonic reactions, akinesia etc.)

Question 28

what is there an increased risk of post partum withb BAD

Answer 28

puerperal psychosis