Summer E1 Neuro Bipolar

Question 1

Bipolar

Mood Stabilizing Drugs (5)

Answer 1

Lithium (#1 DOC)

Divalproex (Na+ + Valproic Acid)

Carbamazepine

Oxcarbazepine

Lamotrigine

Question 2

Lithium Toxicity

• Acute v Chronic Sx
• Tx

Answer 2

Narrow TI - monitor kidney fx

Sx: LETHAL

• acute (suicide):* n/v
• chronic:* kidney damage,

arrhythmia, deterioration in motor coordination, seizure, coma

Tx: d/c, gastric lavage, diuresis, monitor serum lithium levels, fluids/supportive care

Question 3

More Lithium AE

Answer 3

Lithium Toxicity !

Thyroid - goiter, transient ↑TSH - 30% + Levothyroxine

GI upset - take w food, SR/adjust dosing schedule

Tremor 50% - SR/adj dosing schedule, + low dose BB/Propranalol

• Polydipsia, Polyuria*
• Wt gain, Alopecia, worsened psoriasis, Poor concentration, rash, metallic taste, imp glucose reg, benign leukocytosis,*
• flattening of t-wave on ECG*

Question 4

Lamotrigine AE

Answer 4

• Maculopapular Rash*
• .. can progress.. SJS*,

(esp in combo w Divalproex or other metabolic enzyme inhibiting drug)

Dizziness, drowsiness, headache, blurred vision, nausea

*But, NO significant effect on wt :)

**TITRATE SLOWLY (every 1-2 wks, retitrate if missed doses)

Question 5

Which Bipolar Meds ok in

Pregnancy & Postpartum?

Answer 5

Lamotrigine

Oxcarbazepine

*Tricky risk (teratogens) v benefit

Question 6

Bipolar Meds

Pediatric tx issue

Answer 6

More sensitive to AEs