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PHA333 > WK 27 - Bipolar affective disorder in practice > Flashcards

WK 27 - Bipolar affective disorder in practice Flashcards

1
Q

What is bipolar affective disorder?

A

Abnormally elevated mood or irritability alternates w/ depressed mood

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2
Q

What is included in a physical check of someone w/ bipolar disorder?

A

Annually:

  • Weight or BMI
  • Diet
  • Nutritional status + level of activity
  • CV status (pulse + BP)
  • Metabolic status (fasting blood glucose, prolactin, lipid + liver function)
  • Lithium (renal, TFT + calcium)
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3
Q

What happens when a person is suspected bipolar disorder?

A

Refer to specialist mental health service team

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4
Q

Give examples of acute relapses

A
  • Mania
  • Depression
  • Rapid cycling
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5
Q

Outline the treatment for acute hypomania

A
  • Asses patient
  • W/draw antidepressants/stims
  • Initiate: haloperidol, olanzapine, quetiapine or risperidone
  • Poor toleration at max dose = add lithium or valproate
  • Already taking lithium: check plasma levels + add antipsychotics
  • ST: benzo (agitation)
  • Psychotherapy
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6
Q

What agents are not recommended for mania?

A
  • Antidepressants (induce mania)
  • Lamotrigine (bipolar depression)
  • Gabapentin + topiramate
  • Carbamazepine + antipsychotics metabolized by CYP3A4 (interaction)
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7
Q

Outline the treatment of bipolar depression

A
  • Psychological interventions
  • Antidepressant monotherapy = not recommended
  • Fluoxetine + olanzapine then atypical - no response then lamotrigine
  • Tricyclic + venlafaxine avoided
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8
Q

Outline the long term management of bipolar disorder

A

Prophylaxis indicated:
- 2/more acute episodes bipolar I

  • 1st line: lithium, valproate or olanzapine
  • 2nd line: lamotrigine or carbamazepine
  • Continue for 2 yrs
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9
Q

Outline the use of lithium when treating bipolar disorder

A
  • Prescribed by brand + name
  • 6 month trial
  • For: acute mania, prophylactic for mania + depression
  • 1st line: long term to treat relapse
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10
Q

What is needed monitoring every 6 months during lithium treatment?

A
  • Serum electrolytes
  • eGFR
  • Body-weight/BMI
  • Lipids
  • Thyroid function
  • Calcium levels
  • FBC (initiation) + ECG if cardiac risk factors
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11
Q

Outline the drug monitoring of lithium

A
  • Every 3-6 months
  • Initially weekly
  • Additional tests if concerns
  • Every 5-7 days after dose change
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12
Q

What is considered toxic lithium levels?

A

> 1.5mmol/L

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13
Q

Outline the side effects of lithium

A
  • Fine tremor
  • Sedation
  • QT prolongation
  • Polyuria, polydipsia
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14
Q

What are the long term side effects of lithium?

A
  • Weight change
  • Thyroid disorder
  • Hyperparathyroidism
  • Renal impairment
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15
Q

What are signs of lithium toxicity?

A

> 1.5mmol/L:

  • Lack of appetite
  • Blurred vision
  • Slurred speech

> 2mmol/L:

  • Muscle twitch
  • Convulsion
  • Unconsciousness
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16
Q

Outline the interactions of lithium

A

Anything that impacts renal + sodium levels:
- Diuretics

  • NSAIDs
  • ACE inhibitors
  • Antidepressants

Others:

  • Carbamazepine
  • Haloperidol
17
Q

Outline some patient advice when giving lithium

A
  • Carry card all times
  • Same brand
  • Tell before buying OTC
  • Adequate fluid
  • Avoid changes to diet that affect sodium
  • Regular blood tests
  • Reliable contraception
  • S/e: dry mouth, metallic, weight gain
  • Recognise toxicity: blurred vision, slurred words, confusion
18
Q

What are pharmacist points to remember when giving lithium?

A
  • Give at night
  • If twice daily dose. - morning dose taken after lithium level check
  • If admitted to hospital on lithium, check blood
  • Lithium book up to date
19
Q

What is valproate prescribed for?

A
  • Acute mania

- Prophylactic agent

20
Q

What are the different forms of valproate?

A
  • Sodium valproate
  • Valproic acid
  • Semi-sodium valproate
  • Semi-sodium + sodium val = metabolised to valproic acid
21
Q

What are the side effects of valproate?

A
  • Weight gain
  • GI irritation
  • Impaired liver function
  • Risk of suicidal thoughts
  • Teratogenic
22
Q

When initiating valproate, what needs to be measured?

A
  • Weight/BMI
  • FBC
  • Liver function test
23
Q

What are the interactions of valproate?

A
  • Less strongly protein bound drugs (warfarin) displace valproate = higher free levels = toxicity
  • Drugs that inhibit cytochrome P450 enzymes inc valproate
24
Q

What are atypical antipsychotics used for?

A

Acute mania

25
Q

What are the long term side effects of atypical antipsychotics?

A
  • Weight gain
  • Dyslipidemia
  • Hyperprolactinaemia
  • HT
  • Red seizure threshold
  • QT interval prolongation
  • VTE
26
Q

What is lamotrigine indicated for?

A

Prevention of depressive disorder in bipolar I - not acute manic or depressive episode

27
Q

What are the side effects of lamotrigine?

A
  • Skin rashes
  • Headache, nausea
  • Blood disorder
  • Risk of suicidal thoughts
28
Q

What are the interactions of lamotrigine?

A
  • Plasma conc red by: phenytoin, primidone, carb, oestrogen + progestogen
  • Plasma conc inc: valproate

PHA333 (35 decks)

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