Week 2- prescribing tutorial- case 2 Flashcards
A 25 year old woman has had two previous episodes of depression which have responded well to anti-depressants. She now presents with a 2-week history of increased energy, racing thoughts, overactivity and reduced sleep. She appears grandiose at interview, has flight of ideas and speaks of having invented a machine that will make her millions.
What is her likely diagnosis?
Bipolar disorder
What factors in her history and presentation would influence the decision to commence him on a mood stabilizer
She has had periods of mania and periods of depression. Meaning she needs to be on long term mood stabilisers.
What would be the first line mood stabilizer to use? What is its mechanism of action?
Lithium- uncertain mode of action.
What would you tell her about common side-effects and signs of toxicity?
Common side effects include- dry mouth/funny taste, polyuria/polydipsia, hypothyroidism, fine tremor, long term reduced renal function, nephrogenic diabetes insipidus.
Signs of toxicity are diarrhoea, vomiting, coarse tremor, drowsiness, convulsions, coma.
What situation may lithium become toxic in?
In dehydration.
What investigations are routinely monitored during the course of the drug?
Serum lithium levels (especially within the first 12 hours)
U’s and E’s
thyroid function
Renal function
If this drug is not tolerated or is ineffective, what alternatives are there?
Anti-convulsants or anti-psychotics.
Don’t use sodium valproate in a girl of child bearing age.
The initial choice of drug is effective and provides a period of relative stability. 2 years later, she presents to say that she and her husband want to have a child.
What advice would you give her about whether to discontinue the drug or continue it through pregnancy
Congenital abnormalities can occur when the mother is taking lithium. Can also cause heart arrhythmias in the child. However if the mother was going to come off the drug then there is a 50% chance of relapse.
