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19 Cards in this Set
- Front
- Back
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what characterizes bipolar I disorder? what characterizes bipolar II disorder? what characterizes cyclothmia? define hypomania |
at least one manic episode, and probably had an episode of depression at least one episode of hypomania and at least one episode of major depression middle ground hypomania and less transient depression, modd disturbances for 2 years less severe mania, persistent disinhibition, does not require hospitalization |
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when does bipolar usually appear in life? what other conditions do patients with bipolar usually have? what plays a big role in determining suseptibillity to bipolar? |
20 years old substance abuse, anxiety disorder, impulse control genetic |
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what is lithium used for? what is the purpose of maineance therapy? who can benefit from this the most? |
acute treatment of mania and depression (most efficacious antimanic) prevent relapse suicidal patients |
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what is the therpeutic range of lithium? when do you draw the dose? what level do you want for elderly? for depressive episodes? for manic episodes? |
0.6-1 mEq/L, narrow therapeutic index after 8-12 hours after administration 0.8 1.2 |
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what is a common side effect from Li? how can you correct these? |
Gi upset, tremor, polyuria, hypothyroidism gi- take with food, use SR, give in smaller doses tremor-low dose propanolol, or above polyuria- hctz, amiloride hypo- use levo |
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what are the sypmtoms of severe Li toxicity? what predisposes you to this? how do you treat Li tox? |
severe gi upset, deterioration in motor coordination, impaired cognition, severe symptoms fluid and Na loss, drug interaction that increase Li d/c lithium, iv fluids, hemodialysis (li may still be in cns even if cleared from blood) |
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what are common drug interactions with Li? what do all these interactions do? what should you do if you give a thiazide with li? |
thiazides, nsaids, aceis/arbs, loops increase Li concentration reduce Li dose by 50% |
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what are the counseling points for lithium? |
maintain consistent Na and h20 increase h20 in hot weather/excercising maintain consistent excercise scheudle talk to provide before using otc pain medications (interaction with lithium) |
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what comorbid disease is divalproex sodium and valproic acid good for? what is the therapeutic range for bipolar disorder? when do you draw levels? |
substance abuse, migraines 50-125 ug/mL 24 hours after, at the trough |
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what are the common side effects of dvp and valproic acid? how do you treat these? |
gi distress, tremor, drowsiness as above drowsiness- take at bedtime, use ER |
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is carbamazepine used first line? what drug causes a serious interaction? what is that reaction? what should you do if a patient is to be given carbazepine and lamotrigine? what is an important factor to consider when counseling for carb? |
usually not first line, consider it if patients fail lithium clozapine, agranolycytosis double the dose of carb adherence, because autoinduction affects dose |
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is oxcarb fda apporved for bipolar disorder? important drug interaction with this one? what are benzos used for? |
no increase clearnance of oral contraceptive inpatient manic episodes |
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should you only give SGAs if the patient is psychotic? what antipyschotics work for bipolar mania? for bipolar depression? what drug combo is most efficacious for treating a manic episode? |
no it doesnt matter, give regardless of pyschosis aripiprazole, asenapine, rispericdone quetiapine, lurasidone combo of mood stabiliaer and antiphsychotic |
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what age is lithium approved for? SGAs? what should be given before any bipolar treatment? |
10 12 pregnancy test |
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what medications are good for pregnancy? when should you start bipolar treatment if the patients is doing ECT? when do you get lifetime maintence treatment for bipolar? |
ECT, SGAs, lamotrigine if you have the time, clopazine if they can handle the side effects give meds after ECT treatment at least 2 manic episodes or 1 severe manic episode and/or faimly history |
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when can you discontinue bipolar treatment? |
patients with only one episode of mania and no family history, taper one med at a time, reduce dose by 25 percent every week |
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what can bipolar physically do the brain? does lithuim affect this? what areas of the brain does lithium affect? what is the MOA of Li? where does Li act? |
cause, atrophy and autophagy... increases volume of brain structures prefrontal cortex, hippocampus, amygdala reduces dopamine and glutamate and increases GABA at receptros and inside of neurons |
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do healthy people get any benefit from taking Li? what does Li inhibit in the cell? what disease state is sometimes causes by bipolar? |
no cAMP formation hypothyroidism |
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how does Li cause hypothyroidism? what happens after you take Li for a long time in regard to the thyroid? |
prevents iodination, induces antithyroid antibody, prevents secrtion of thyroid hormone into blood hypothyroidsim improves and patient may not require hormone supplemenation anymore |
