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23 Cards in this Set
- Front
- Back
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What medications can cause mania?
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Alcohol
Drug Withdrawal Anti-depressants Dopamine augmenting agents Hallucinogens Marijuana Steroids Thyroid hormone Xanthine OTC Decongestants (ephedra, pseudoephedrine) St. Johns Wort |
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What medical conditions can cause mania?
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CNS Disorders
Infection Electrolyte/Metabolic abnormalities Endocrine disregulation |
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How do you design a pharmacotherapy plan for mania?
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Lithium or Valproic acid + Benzodiazepine (Lorazepam)
Add an atypical anti-psychotic if the patient is psychotic |
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What are some other alternatives to Lithium and Valproic Acid?
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Lamotrigine
Carbamazepine Oxcarbamazepine |
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Which anti-psychotic can you choose if the patient is psychotic?
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Olanzapine 10 mg QHS
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What is the dose, as well as the acute and maintenance serum levels for lithium?
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300 mg Tid
acute mania: 1.0-1.2 mEq/L maintenance : 0.6-1.2 mEq/L |
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What is the starting dose for Valproic acid? What is the serum therapeutic range?
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250 mg Tid
50-125 mcg/ml |
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What is the dose for Lorazepam?
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2-40 mg/day QHS
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As the patient becomes less psychotic, taper off the anti-psychotic. If the patient is in the depressed state, substitute the antipsychotic with an anti-depressant.
If the patient presented with leukopenia, what agent would you prefer? |
Lithium - side effect of leukocytosis
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What is the preferred mood stabilizer if the patient presents with manic and depressive behavior over the course of the day?
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Valproic acid/divalproex
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If you put the patient on lithium, what do you have to monitor?
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Hepatic function
Renal function CBC Thyroid ECG Lithium levels |
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If a patient presented with bipolar disorder, needed lithium and had comorbid hypertension, what would you be your agent of choice?
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Beta-blocker
Thiazide diuretics and ACE's/ARB's increase lithium levels |
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What is important to counsel a patient on if they are taking lithium?
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Drink extra fluids when you are sweating and do no go on a sodium restricted diet without consulting your doctor. (Na, Li compete for reabsorption in the proximal tubule. Decreased Na leads to increase Li reabsorption and increased Li levels.)
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In someone taking lithium, what otc painreliever would you recommend?
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Aspirin or Acetaminophen are okay
Advil is not okay (NSAIDs increase Lithium levels) |
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If a patient reports diarrhea, you would be concerned about dehydration and increased lithium levels. What would you tell the patient?
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Notify the physician to get Li levels
Drink extra fluids Hold any further lithium doses until a level is obtained |
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Early signs of lithium toxicity.
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Sluggish
Drowsy NVD Confusion Loss of control of body movements |
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If giving carbamazepine, what would you monitor for?
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CBC
Resolution of symptoms Hepatic Function Renal Function Electrolytes Carbamazepine levels Rash Pregnancy |
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What are individuals of asian descent screened for prior to carbamazepine therapy?
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HLA-B*1502 gene associated with TENS and SJS
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What would you recommend for contraception in a patient taking carbamazepine?
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Alternative method of contraception or higher dose of oral contraception
(Carbamazepine induces the P450 3A4 isozyme and reduces OC levels) Use EE 50 mcg and a 2nd method of contraception |
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What antibiotic would you want to avoid in a patient taking carbamazepine?
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Erythromycin - Inhibit 3A4 isozyme
Other drugs that inhibit 3A4: Azoles, Isoniazid CCBs, Fluoxetine, Fluvoxamine, Ritonavir |
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What drug would you prefer in pregnancy?
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Chlorpromazine
The other agents (lithium, valproic acid, carbamazepine cause defects in the 1st trimester) |
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If the patient is experiencing a server depressive episode, what regimen would you want to start?
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Lithium or Lamotrigine + an anti-depressant
or Lithium + Lamotrigine If psychosis is present, start an atypical anti-psychotic (Quetiapine is used in acute depressive episodes in bipolar disorder) |
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If a patient develops seizures, valproic acid could be the cause. Why is this?
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Valproic acid (divalproex) can cause elevated serum ammonia levels, which can present in a worst case scenario as seizures with foaming at the mouth. The patient can also present with excessive sedation, confusion and disorientation
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