Term
| If an individual experiences one episode of mania, are they likely to have future episodes of mania/depression? |
|
Definition
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Term
| There is a high risk of relapse after 6 months after remission of |
|
Definition
|
|
Term
| What does prophylactic pharmacotherapy do to mania? |
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Definition
| Lowers frequency, number and severity of acute episodes |
|
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Term
| What are the primary goals of treatment for chronic bipolar disorder? |
|
Definition
1) Prevent recurrent acute depressive, manic, mixed, or hypomanic episode
2) Maximize patient functioning
3) Minimize/eliminate symptoms
4) minimize medication adverse effects
5) prevent suicide (#1)
6) Identify prodromal symptoms |
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Term
| Drugs for Bipolar I Disorder (keep it to monotherapy prophylaxis mood stabilizers) |
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Definition
1) Lithium (long term)
2) Valproate
3) Olanzapine |
|
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Term
| If patients do not respond adequately to one mood stabilizer, they may require a combination |
|
Definition
Add a second drug
Continue first drug until second drug shows improvement
taper off first drug or taper on depending if symptoms show or not |
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Term
|
Definition
Response with lithium- 34%
Response with placebo- 81%
Obviously, lithium doesn't completely eliminate relapse
3.2 pts./100 suicide with no lithium
0.37/100 patients with lithium |
|
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Term
| What are indications for lithium? |
|
Definition
1) Bipolar disorders
2) Major depression
3) Mania secondary to head injury
4) Mood disorders
5) Aggressive behavior
6) Impulse control- disorders
7) Self injurious behaviors |
|
|
Term
|
Definition
600-900 mg/day
Blood samples are drawn before AM dose |
|
|
Term
| What can affect lithium plasma concentrations? |
|
Definition
Disease
Age
Other drugs
Toxic effects are minimal
TI is about 20+ |
|
|
Term
|
Definition
Stomach upset
-nausea
-vomiting
-diarrhea
-stomach pain
Hand tremors
Fatigue, weakness, dazed
Increased thirst and frequent urination |
|
|
Term
| Late lithium side effects |
|
Definition
Severe hand tremors
Coarsening hand tremor
GI Symptoms
Nausea, vomiting, diarrhea
Confusion
Ataxia
Slurred speech |
|
|
Term
| Imminent toxicity with high serum lithium |
|
Definition
Vomiting and diarrhea
Sluggishness
Vertigo
Dysarthria |
|
|
Term
| Lithium toxicity with very high serum lithium |
|
Definition
|
|
Term
| Persistent lithium side effects |
|
Definition
Fine hand tremor (dose lithium at bed time)
Increased thirst and urination
Increased WBC count
Hypothyroidism (give them a thyroid supplement) |
|
|
Term
| What drugs will Lithium interact with? |
|
Definition
NSAIDs
Diuretics
Haloperidol
SSRIs
Calcium channel blockers
angiotension converting enzyme inhibitors |
|
|
Term
| What things do you look for before lithium usage? |
|
Definition
CBC
Chemistry profile
Thyroid function
Urinalysis
Fasting blood sugar
ECG
Vital signs
Serum pregnancy test |
|
|
Term
| How often should you monitor lithium? |
|
Definition
Every 6 months check chemistry profile, cbc, urinalysis, blood sugar
Annually- Thyroid function |
|
|
Term
| When would you want to obtain lithium plasma concentrations? |
|
Definition
When therapy doesn't work
Inadequate response
Worsening symptoms
You suspect toxicity
COmpliance
Complex drug regimens |
|
|
Term
|
Definition
Mixed mania
Rapid cycling
Absence of co-occurring personality disorders |
|
|
Term
| Adverse effects of valproate |
|
Definition
GI symptoms
Increased bleeding time
tremors
Dizziness
Drowsiness
Nystagmus
Tinnitus
Back pain
Abnormal gait |
|
|
Term
| Has lamotrigine been proven useful in treatment of mania? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Antidepressants, thyroid supplementation, omega 3 fatty acids, folic acid |
|
|
Term
| Non pharmacologic therapies |
|
Definition
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