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37 Cards in this Set
- Front
- Back
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DOC and alternatives for acute mania
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DOC::Lithium and divalproex sodium
Alternatives::atypical antipsychotics and carbamazapine |
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DOC and alternative for euphoric mania
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DOC::lithium
Alternative::divalproex |
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DOC and alternative for dysphoric mania
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DOC::divalproex
Alternative::lithium |
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DOC and alternatives for mood disorder maintenance therapy
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DOC::lithium
Alternative::lamotrigine and AAPs |
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DOC for cycling bipolar disorder
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divalproex
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DOC and alternative agents for bipolar depression
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DOC::lithium
Alternative::olanzapine/fluoxetine |
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TI for lithium
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narrow therapeutic index so it requires monitoring
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which tests are required prior to prescribing lithium?
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1.serum creatine-excreted renally
2.electrolytes-hyponatremia and dehydration lead to increased renal absorption and subsequent toxicity 3.TSH-causes hypothyroidism 4.weight-causes weight gain 5.pregnancy test-potentialteratogen |
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thyroid and renal function tests should be done every ______when monitoring during lithium tx
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6-12 months
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side effects with therapeutic doses of lithium
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-GI distress, polyuria adn polydipsia, and fine tremor in the hands
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side effects with chronic use of lithium
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nephrogenic DI, hypothyroidism, weight gain, and edema
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what is the concern if a pt develops nephrogenic DI during lithium therapy?
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-dehydration will cause lithium retention and toxicity
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Symptoms of lithium toxicity::
1. moderate 2. higher levels |
1.coarse tremors, muscle twitches, slurred speech, unsteady gait, ataxia
2.seizures, stupor, coma,CV collapse |
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what can you do to tx the fine hand tremor from lithium use?
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-lower the dosage
-reduce caffeine intake avoid tricyclic antidepressants andsympathomimetics -consider BB such as propranolol |
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tx for hypothyroidism secondary to lithium therapy
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-discontinue lithium or tx with levothyroxine
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what can be done about the polyuria and polydipsia associated with lithium use?
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-may be related to serum levels, so reduce dosage or frequency of administration
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what can be done about the weight gain associated with lithium therapy?
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-avoid polyuria and polydipsia
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DI of lithium and sodium intake
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-increased sodium intake decreases renal absorption of lithium, while reduced sodium intake elevates lithium serum levels
-pts on sodium restricted diet are at risk for lithium toxicity |
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DI of lithium and thiazide diuretics and NSAIDs
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-serum lithium concentrations are increased due to sodium depletion
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DI of lithium and ACEIs
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-ACEIs cause volume depletion and lower GFR, which reduces lithium excretion
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Both __________ and _________ may cause neurotoxicity with normal lithium levels
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carbamazapine and antipsychotics
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what is the major contraindication of lithium use?
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serious renal disease
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BID admin of lithium _______peak levels and _______ trough levels which can lead to __________
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1. lowers
2. raises 3. polyuria |
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common adverse effects of divalproex sodium
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GI disturbances and sedation
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what are some ways to avoid or lessen the GI disturbances associated with divalproex sodium?
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-give with food
-start with low doses -use delayed release, enteric coated form |
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long term effects of divalproex sodium
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tremor and thrombocytopenia
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a rareADR of divalproex sodium is___________ so must monitor_________
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1. hepatotoxicity
2. LFTs (should also get CBC) |
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divalproex sodium is the preferred initial therapy for ___________
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rapid cycling
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efficacy of divalproex sodium is equivalent to lithium in ______onset and ______manias
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1. faster
2. acute |
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other ADR of divalproex sodium
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-ataxia, alopecia, weight gain, transient liver enzyme elevations, thrombocytopenia
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extended release form of ______________is indicated for acute manic or mixed episodes associated with bipolar disorder
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carbamazepine
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most common side effects of carbamazepine
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-sedation, dizziness, rash, GI distrubances
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hematologic ADR associated with carbamazepine use
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leukopenia
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carbamazepine induces _________so besure to monitor labs for _______
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1. SIADH
2. hyponatremia |
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metabolism of carbamazepine
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-induces P450 and autoinduces its own metabolism
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____________can occur with combination of carbamazepine and lithium, causing symptoms of ___________
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1. neurotoxicity
2. confusion, weakness, coarse temor, lethargy, hyperreflexia, ataxia |
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what are the ADR of Olanzapine when used to tx bipolar disorder?
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-dizziness, weight gain, orthostatic hypotension
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