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30 Cards in this Set
- Front
- Back
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Treat severe mania and mixed
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lithium and valproate with antipsychotics
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Less severe bipolar
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lith or valproate
or antipsycho |
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bipolar not controlled in 10-14 days
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add another 1st line or increase the dose
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Labs to do before lithium
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BUN, Creat, thyroid, preg, ECG, electrolytes, glucose, CBC with diff, urine specific gravity
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Labs with valproate
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LFT, AST ALT, ALK PHOS, CBC and preg
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lithium not used with what patients?
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renal or hypothyroid
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increase lithium levels with what meds and situations and cause toxicity?
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NSAIDs, thiazide diuretics, ACE inhibitors, low Na+ intake, sweating, dehydration, renal disease
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things that decrease lith levels
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caffiene and theophylline
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tx for lithium induced tremors
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decrease cafeine intake and Propranolol
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What are you looking for with ECG and lithium?
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ST changes
T wave flattening arrythmias conduction disturb |
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How often to do lith levels and when
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3-4 days after dose changes
q 3-6 months 8-12 hours after last dose |
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anticonvulsant SE
wt gain lower with what 2 |
lower with lamotrigine and topiramate
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anticonvulsant SE
tremors tx with |
beta blocker; propranolol
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anticonvulsant SE
thrombocytopenia agranulocytosis |
all
carbemazepine |
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valproate first line tx of
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acute mania
euphoric mania mixed states |
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valproate not used with who
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liver disease
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valproate less effective with
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depression with bipolar and maintenance
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valproate side effects
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wt gain
alopecia, n/, diarrhea, thrombocytopenia, spinabifida, increase LFT, polycystic ovarian |
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things that increase valproate levels
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Magnesium
Aluminum antacids/ASA Phenobarb |
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carbamazepine used 2nd line for
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acute mania
good for rapid cyclers |
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carbamazepine SE
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aplastic anemia, liver problems, thrombocytopenia, Steven Johnson rash, hypnatremia, agranulocytosis
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labs with carbamazepine
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CBC with diff q2wks for 3 months then q3mo
teg level q2wks x2months then q3mo |
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lith level
carbamazepine level valproate level |
.6-1.2
6-12 50-125 |
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lamotrigine use and SE
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bipolar maintenance and bipolar depression
Steven Johnson rash, insomnia, H/A |
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topiramate use and SE
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not first line tx
adjunct wt loss, short term memory loss, cognitive slowing, parathesis |
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topiramate not used with who
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chronic nephrolithiasis
gluacoma |
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oxycarbazepine (trileptal)
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hyponatremia and interferes with BCP
Do Na+ level q3mo |
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acute mania tx with
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olanzapine, risperidone, quetiapine, ziprazidone, aripirtazole
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mixed
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aripirtazole, olanzapine, risperidone, ziprazidone
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resistant bipolar
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clozapine
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