Bi-Polar

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• One or more manic episodes AND depressive OR mixed episodes

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bipolar 1 disorder

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• One or more major depressive episodes accompanied by at least one hypomanic episode
• Patients never develop a full manic episode,

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bipolar II disorder

Front 3

• Form of bipolar disorder consisting of short periods of mild depression and short periods of hypomania
• Lasts from days to a few weeks, separated by periods of normal mood
• Never free of symptoms for more than 2 months at a time

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3. CYCLOTHYMIC DISORDER

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a. At least 4 episodes of a mood disturbance in the previous 12 months that meet criteria for major depressive, manic, mixed, or hypomanic episode.
b. Patient must have either partial or full remission for at least 2 months or a switch to an episode of opposite polarity. More common in women.

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4. RAPID CYCLING

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RF for bipolar disorder

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• (+) family history of bipolar disorder
• (+) family history of a mood disorder

Front 6

what is the initial dose of lithium for normal patients

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900-1800 mg/day divided

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what is the initial dose of lithium for elderly and renal impairment

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150-300 BID

Front 8

what is the target dose for lithium

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600-1800 mg/day and if its <1200mg you can give Q HS

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can only give Li to patients > ___ years old

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12

Front 10

Li levels for acute mania

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0.8 - 1.2

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Li levels for maintenace

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0.6 - 1.0

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Li levels for the elderly

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0.4 - 0.6

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when should Li levels be checked

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5 days after initiation/dose adjustment, weekly X 2 months, then q 3 months

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if TSH is >5 in Li therapy, what should you give

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levothyroxine 50 mcg daily

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drugs that can increase Li levels

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thiazide diuretics, NSAIDs, ACE-Is, antidepressants

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medicines that decrease Li levels

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pregnancy, caffeine, acetazolamide, theophylline, sodium bicarb

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drugs that increase the neurotoxicity of Li

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CBZ, diltiazem/verapamil, losartan, methyldopa, metronidazole, phenytoin, alcohol

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initial dose of valproate

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250 mg BID - TID, or 5 - 10 mg/kg/day divided use ABW

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target dose for valproate

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1000 - 3000mg daily divided w/ meals

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therapeutic valproate levels for acute and maintenance tx are

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50 - 150

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therapuetic levels for valproate in the elderly or medically ill are

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40 - 75

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drugs that are increased by VPA

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BDZ, phenobarbital, TCA, CBZ, ASA, Lamotrigine

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grugs that increase VPA concentrations

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fluoxetine, erythromycin, cimetidine, chlorpromazine

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what should you do when adding lamotrigine to VPA

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dose it 25 mg every other day and then titrate from there

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How should you dose lamotrigine in renal failure

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decrease dose by 50%

Front 26

can D/C lamotrigine w/o tappering?

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no

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RF for rash in lamotrigine

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VPA therapy, younger age, dose too high, rapid titration

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when is lamotrigine most effective?

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in bipolar depression

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initial dose for CBZ

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400-600 mg/day divided

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target dose for CBZ?

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800-1200 mg /day divided

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CBZ levels for acute mania

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4-15

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CBZ maintenance levels

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4-12

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DOC in cardiac disease/HF

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valproate

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DOC in renal impairment

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Valproate or CBZ

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DOC in hepatic impairment

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lithium

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DOC in pregnany

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lamotrigine, CBZ, atypical, or CCB