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10 Cards in this Set
- Front
- Back
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First Line Agents for Treating Mania |
Mood Stabilizers: Lithium, Valproate, Lamotrigine, Carbamazepine -medication that can treat mania or depression without inducing either Second Generation AP *lamotrigine not helpful in mania d/t long titration period to reach target dose |
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Lamotrigine |
Lamictal Tabs/ODT BBW: SJS/TEN ADR: somnolence, rash, vision changes, insomnia Dosing requires slow titration d/t risk of rash (increase every other week) - max 200 mg/day -if using VPA: decrease dose (max 100 mg/day) -if using CBZ, PHT,PHB,PRIM increase dose (max 400 mg/day) |
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Valproate |
Depakene, Stavzor, Depacon Therapeutic Range: 50-125 mcg/mL BBW: pancreatitis, hepatotoxicity, mitochondrial disease, teratogenicity ADR: nausea, alopecia (treat with MVI containing Zn and Se), weight gain, tremor, thrombocytopenia, blurred vision Pregnancy Category D (X - migraine prophylaxis) *supplement with calcium and vitamin D |
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Carbamazepine |
Equetro Therapeutic Range: 4-12 mcg/mL BBW: SJS/TEN - test for HLAB*1502 if asian; agranulocytosis ADR: somnolence, ataxia, rash, SIADH *potent CYP inducer and autinducer *supplement with calcium and vitamin D |
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Lithium |
Lithobid XR is given twice daily Proposed MOA: influences 5HT and NE reuptake; inhibits postsynaptic D2 receptors ADR: GI upset (take with food), cogwheel rigidity, fine hand tremor, weight gain, polyuria/polydipsia, hypothyroidism 100% renally cleared *serotonergic!! |
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Lithium Monitoring |
Therapeutic levels: (trough) -Maintenance: 0.6-1.2 mEq/L -Mania: 0.8-1.5 mEq/L >1.5 mEq/L: coarse hand tremor, N/V/D, confusion, ataxia >3 mEq/L: CNS depression, arrhythmia, seizure, coma |
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Lithium Drug Interactions: Increased Levels |
Sodium Depletion Thiazide diuretics ACE/ARB NSAIDs (aspirin and sulindac are safer options) Dehydration |
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Lithium Drug Interactions: Decreased Levels |
Increased salt intake Theophylline Caffeine |
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Lithium Drug Interactions: Increased neurotoxicity risk |
Verapamil Phenytoin Diltiazem Carbamazepine |
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Second Generation Antipsychotics Used in BPD |
Ziprasidone Asenaphine Risperidone Aripiprazole Quetiapine Olanzapine Lurasidone Symbyax - Fluoxetine/Olanzapine |
