Term
What is first line for acute mania?
What combinations can also be first line?
When should a combination be used? |
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Definition
Lithium, Divalproex, SGAs are first line for acute mania.
Lithium + SGA, or Divalproex + SGA can also be used first line.
If mania is severe |
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Term
What is the regular dose of lithium therapy for acute mania?
Serum level?
Maintenance dose?
Serum level? |
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Definition
Acute: Lithium 900mg-2100 mg
serum level: 1-1.2 mmol/L
Maintenance dose 600mg-1800mg
serum level 0.6-1 mmol/L |
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Term
What is the regular dose of divalproex therapy for acute mania?
Serum level?
Maintenance dose?
Serum level? |
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Definition
Acute: Lithium 750mg-2000mg
serum level: 350-800 umol/L
Maintenance dose 750mg-2000mg
serum level 350-690 umol/L |
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Term
| How should SGA + Lithium or SGA + divalproex be initiated ? How about the dose of SGAs ? |
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Definition
| Allow SGA therapy to begin 1-3 days before initiation of divalproex or Lithium. Dose of the SGA should be lower than that of monotherapy. |
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Term
| When should the dose of mood stabilizers be increased? When should a second agent be added? |
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Definition
| If the patient experiences a minor breakthrough while on a mood stabilizer check serum levels and increase dose as necessary. A second agent should be added if the patient has a major breakthrough while on a mood stabilizer. |
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Term
DEPRESSIVE episodes associated with bipolar disorder
How should therapy begin in an unmedicated patient?
How about severe depression? How long should antidepressants be used?
If the patient was taking divalproex and lamotrigine is initiated, how should the dose be adjusted when using this combination? Why?
In all cases for Bipolar disorder, how long should the trial period last ? |
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Definition
Start with lamotrigine, quetiapine or lithium.
In severe depression you can use two of these agents simultaneously. Or use antidepressants for 3-4 months.
Reduce the normal dose of lamotrigine by 1/2, because divalproex doubles serum levels of lamotrigine
Trial period should be 2-4 weeks |
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Term
Maintenance therapy for bipolar disorder
How long should maintenance therapy last after 1 episode?
How long should maintenance therapy last after episodes?
Severe/multiple episodes ?
Over what period of time should therapy be discontinued? |
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Definition
Maintenance therapy for bipolar disorder
1 episode: 6 months--> 1 year maintenance
Severe/multiple episodes --> INDEFINITE prophylaxis.
Therapy should be discontinued over a period of 1-3 months. |
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Term
Lithium Carbonate
Side effects:
Monitoring parameters:
Interactions: |
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Definition
Lithium Carbonate
Side effects - electrolyte disturbances, alopecia, acne
Monitoring parameters: Monitor 24 hour urine and CrCl,and monitor thyroid and renal function after 6 months.
Interactions: Anything renally cleared, including caffeine, salt, thiazides etc. |
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Term
Divalproex
Side effects:
Interactions: |
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Definition
Divalproex
Side effects: *Weight gain, teratogenic, hepatotoxic, polycystic ovary syndrome, thromobocytopenia, hyperammonemia
Lamotrigine (reduce lamotrigine dose 1/2), carbemazepine, benzodiazepines |
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Term
Lamotrigine
Side effects:
Interactions:
Special point with divalproex |
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Definition
Lamotrigine
Side effects: Rash, SJS (rare)
Interactions: not a lot. DIVALPROEX
Reduce lamotrigine dose by 1/2 when using with divalproex. |
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