Pharmacology of Bipolar and Mania Flashcards
what diagnosis could be suspected if a depressed patinet doesnt respond well to medication
BAD - check for history of manic episodes
use of ADs in BAD
are sometimes used on top of mood stabilisers
they can cause switching to mania/hypomania or mood instability
is lithium a safe drug?
no, it has a very narrow therapeutic index
what tests must be done prior to intiation of lithium treatment
U and Es, TFT, ECG
what must be monitored whilst on lithium
lithium levels in blood 12 hours after dose
UandEs
TFT every 6 months
name some side effects of lithium
dry mouth, strange salty taste in mouth
fine tremor
hair loss
does lithium causes sedation or insomnia? and as a conseuqence when is it adminstered
sedation, taken at night
does lithium cause weight gain or loss
gain
what effect does lithium have on the thyroid
thyroid enlargement that is sometimes associated with hypothyroidism, check TFT before intitiation and every 6 months after
what does lithium do in the kidneys
- inhibits ADH - nephrogenic diabetes insipidus
- sodium retention due to increased aldosterone secretion
- renal tubular damage can occur with prolonged treatment
what are the 2 major symptoms of DI
polyuria and polydipsia
which drugs does lithium interact with
NSAIDs, ACEIs, ARBs, diuretics - any drug with the potential to reduce renal function can cause the accumulation of lithium
do thiazides or loop diuretics interact with lithium more
thiazides
signs of lithium toxicity
- Warning signs: GI upset, blurred vision, coarse tremor, ataxia, drowsiness
- Severe toxicity: confusion, loss of consciousness, seizures, coma, death
what must patient on lithium carry with them incase of toxicity
lithium card - remind of toxic symptoms and to inform healthcare professionals
what can precipitate lithium toxicity
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
management of lithium toxicity
stop lithium, IV fluids, monitor renal function, dialysis if required
what does an increase in salt intake cause
fall in lithium levels
which trimester is the baby most vulnerable to damage from drugs
1st - organs developing
which 3 classes of drugs are used in BAD
lithium, anticonvulsants and antisychotics
who should not receinve sodium valproate
do not give to women of child bearing age if you can avoid it, very teratogenic - causes neural tube defects
what tests should be done prior to initiation of sodium valproate
LFTs (can cause hepatoxicity) and platelet count
what is a serious side effect of lamotrigine
rash - must see doctor ASAP
can cause steven johnson syndrome
what precuation is taken when starting lamotrigine to avoid SJS
titrate up slowly over 6 weeks to reduce risk - see doctor ASAP if get rash!!!
how do antipsychotics work
main action is dopamine receptors 2 blockade, various other mechanisms too
how can antipsychotics be given if compliance is poor
depot IM injection
what type of symptoms can anti psychotics cause
extra pyramidal symptoms (acute dyskinesias, dystonic reactions, akinesia etc.)
what is there an increased risk of post partum withb BAD
puerperal psychosis
