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30 Cards in this Set

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