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22 Cards in this Set
- Front
- Back
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two general types of treatment for bipolar
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mood stabilizers and anticonvulsants
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only two fda approved tx for bipolar
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lithium (mood stabilizer) and lamotrigine (anticonvulsant)
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other off label anticonvulsants used to tx bipolar
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valproic acid, carbamazepine
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is lithium usually given by itself?
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no, usually w/ other meds such as SSRIs, MAOIs, antipsychotics
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what other mental dz has a high comorbidity with bipolar
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ETOH abuse
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what causes problems with lithium compliance?
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-side effects
-"flat line" personality -pts feel better so stop taking it |
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what is the primary cause of the "merry go round" syndrome that always accompanies bipolar dz?
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the fact that the meds. have a long half life so pts stop taking it.
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kinetics of lithium:
________absorption |
absorption is SLOW into the CNS (kinetics similar to the sodium ion)
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half life of lithium
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24 hrs
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lithium % bound
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none! is not bound to plasma proteins
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how is lithium excreted?
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95% unchanged in urine. (80% of filtered Lithium is reabsorbed by the proximal tubules)
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lithium is ineffective in what % of pts?
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30%
(so it IS effective for 70%) |
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M of A Lithium:
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-inhibits nerve metabolism (overall dampening)
-alters reuptake and decreases release of: 5HT NE DA -directly affects neuronal inositol levels |
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Why does Lithium have so many side effects?
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has a very low therapeutic index
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Lithium SE:
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-GI problems (N/V/D)
-sedation -polyuria -dry mouth -wt gain -insomnia |
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what does lithium TOXICITY look like?
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-vomiting
-profuse diarrhea -coarse tremor ataxia -coma -convulsions -arrhythmias (toxic effects of Na) |
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difference b/t lithium SE and lithium toxicity?
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severity of symptoms (b/c many are similar)
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what two "medical conditions" can lithium administration mimic?
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-thyroid enlargement
-increasing circulating leukocytes (resolved after d/c med) |
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most problematic lithium drug interaction
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diuretics (can cause increased or decreased Li levels)
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what diuretics can increase lithium excretion (decrease blood levels)
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the drugs that work at the proximal tubule/glomerulus
1. Mannitol 2. Acetazolamide (Diamox) |
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what diuretics can decrease lithium absorption (increase blood levels)?
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1. Loop diuretics (lasix, bumex)
2. Thiazides |
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what other class of drugs can increase plasma levels of lithium due to diminished clearance?
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NSAIDS
1. indomethacin 2. naproxin 3. ibuprofen |
