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RUSMpsychopharm9

Drugs for bipolar disorder and mania

QuestionAnswer
Lithium is DOC for (several disorders) DOC for recurring and relapsing mania, hypomania, bipolar type 1, recurrent endogenous depression that is resistant to other antidepressants, aggressive or self mutilating behavior, and prophylaxis of schizoaffective d/o (in combo with antipsychotic
Pure mania is treated with neuroleptics
What is the difference between bipolar I and bipolar II Bipolar I: Manic episodes and periods of depression. May include psychotic symptoms. Bipolar II: hypomanic episodes and periods of depression. No psychotic symptoms
What effects will be seen in lithium prescribed to a normal, healthy pt no discernible effects
What ion does lithium displace in the body Lithium
What are the components of a pre-lithium workup serum creatinine/BUN (renally excreted) , urine specific gravity (Li causes kidneys to stop responding to ADH... polyuria), electrolytes, ECG(Li can worsen severe cardiac disease), CBC + diff, T4&TSH (Li may cause hypothyroidism, pregnancy (teratogenic)
What drug is given concurrently with initiation of lithium to get the patient through a manic crisis during initial period of waiting for Li to take effect? Chlorpramazine (CPZ). D/C when Li kicks in (5-7 days)
What are two major long term side effects asso with Li therapy, what are the mechanisms? Li inhibits cAMP and IP second messenger systems by inhibition of adenyl cyclase. This results in nephrogenic diabetes insipidus (due to blockage of ADH sensitive adenylcyclase) and hypothyroidism (due to blockage of TSH sensitive adenylcyclase)
First sign of lithium toxicity? abdominal pain, albuminuria
CI of Li therapy Cardio problems
What drugs are C/Id for pts on lithium Ace inhibitors (Na depletion due to lack of aldosterone mediated Na/K exchange, and subsequent loss of Na), NSAIDS, thiazides
What drug reduces Li clearance Thiazides
What effect to NSAIDS have on Li Decreased clearance(renal) ---> elevated Li levels
What type of bipolar pts do not respond to Li rapid cyclers. Use valproate, carbamazapime, or Li + carbamazapine or neuroleptic
Created by: rkirchoff
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