Bipolar

Card Set Information

Author:
capnhue
ID:
134052
Filename:
Bipolar
Updated:
2012-02-12 17:09:45
Tags:
Regis University
Folders:

Description:
Bipolar
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user capnhue on FreezingBlue Flashcards. What would you like to do?


  1. Lithium Drug-Drug interactions (increases Li levels)
    • ACE (200-300%)
    • ARB(200-300%)
    • thiazide diuretics (50%)
    • NSAIDs (20-30%)
    • COX2 inhibitor (20-30%)
    • salt restricted diet
  2. Drugs that interact w/ Lithium causing neurotoxicity (an adverse effect)
    • carbamazepine
    • diltiazem
    • losartan
    • methyldopa
    • metronidazole
    • penytoin
    • verapamil
  3. Enhance renal elimination of Lithium
    • caffine
    • theophylline
    • AVOID: do not use lithium is there are kidney issues
  4. Lamotrigine adverse effects
    • rash
    • steven johns syndrome (SJS)
    • aseptic meningitis (resolved by discontinuation of med)
  5. Lithium theraputic conc for steady state
    • maintenance: 0.6 - 1.2
    • acute manic: 0.8 - 1.5
    • Lithium toxicity: 1.5 mEq/L
    • Severe Lithium toxicity: 2.0 mEq/L
  6. Classifications of Bipolar Disease
  7. 5 types of mood disorders
    • Mania
    • Hypomania
    • Major Depressive
    • Mixed State (Depressive & Manic - most volatile)
    • Rapid Cycling (4 or more episodes in a year)
  8. Hypomania
    • duration is usually shorter than mania
    • "artistic" state of disorder
    • flight of ideas
    • clever thinking
    • increase in energy
    • If hospitalized: then automatically classify as manic and bipolar I
  9. Glycogen Synthase-kinase (GSK3)
    • involved in the regulation of circadian rhythm through phosphorylate of transcription factors
    • GSK3 regulates: PER, TIM, CLK transcription factors by changing phosphorylation states
  10. Lithium adverse effects
    • Initial side effects: GI distress (nausea, vomiting, dyspepsia, and diarrhea)
    • polydipsia (thirst)
    • polyuria (excessive piss)
    • nocturia (peeing at night)
  11. Lithium Toxicity
    • occur at blood lebels greater than 1.5
    • Severe toxicity: at levels greater than 2.0
    • Treat severe intoxiciation: Hold next dose of lithium, IV NS, manage electrolytes
    • If blood levels over 6.0: begin hemodialysis
  12. Carbamazepine & Oxcarbazepine
    • both efficacious for acute mania
    • side effects: nausea, sedation, rash, dizziness
    • Carbamazepine side effect: induces hepatic metabolism
    • Oxcarbamazepine side effects: hyponatremia
  13. Valporic Acid
    • mood stabilizer
    • superior to lithium pts w/ rapid cycling, mixed or dysphoric mania
    • loading dose: 20-30mg/kg or add a 0 to pts weight (lb)
  14. Lamotrigine
    • effective for bipolar depression and maintenance
    • NOT mania
  15. Atypical antipsychotics
    • Olanzapine, aripiprazole, ziprasidone: aprroved for maintenance
    • Acute treatment of mania: olanzapine, risperidone, quetiapine, siprasidone, aripiprazole, asenapine
  16. Manic/mixed episode treatments
    • atypical antipsychotic plus mood stabilizer
    • mood stabilizers: Lithium, VPA
    • Monotherapy: if not severe episode Li, VPA, or atypical can be used as monotherapy
    • In lieu of VPA or Li: can use Carbamazepine, Oxcarbazepine
  17. Depressie Episode treatements
    • lamotrigine
    • lithium
    • olanzapine-fluoxetine combo
    • Li has positive evidence against suicidal behavior (like clozapine)
    • Mood stabilizer not on board: do not use antidepressant w/o mood stabilizer b/c it can trigger manic episode
  18. Maintenance Treatment
    • Lamotrigine: more effective against depressive
    • Lithium: more effective against manic (suicide)
    • atypical: olanzapine, aripiprazole, ziprasidone
    • least risk for metabolic side effects: aripiprazole, ziprasidone
  19. Initial Lithium Dosing
    • based on weight
    • 100lb: 300mg BID
    • 150lb: 300mg TID or 450mg BID
    • 200lb: 600mg BID
  20. calculate steady state of Lithium
  21. Lithium's tremor treatment
    • propranolol
    • divide the dosing
  22. Valporic Acid adverse effects
    • upset stomach: treat by eating w/food or enteric coating
    • tremor: treat by dividing doses or propranolol
    • daytime sleepiness: take medication before bedtime
    • weight gain: counsel on diet & exercise
    • alopecia: vitamin E or seleium
  23. Dosing Schedule for Lamotrigine
  24. Pregnancy
    • Treat w/: haloperidol, respirodone
    • Lithium: category D (Ebstein's anomaly)
    • Valporic Acid: category D (spina bifida, low IQ, facial changes)
  25. Carbamazepine
    • target levels: 4-12 mcg/ml
    • initial dose: 200-600mg
    • acute mania: increase by 200mg/day up to 800-1000mg/day
    • minor side effects: fatigue, diplopia, blurred vision, ataxia
    • Major side effects: hepatic failure, agranulocytosis, aplastic anemia, thrombocytopenia

What would you like to do?

Home > Flashcards > Print Preview