Bipolar Disorder

What leads to Lithium toxicity? Reduced renal fxn and decreased intake of NaCl.
Lithium is renally cleared, It cannot be used in impaired renal clearance. NaCL
intake must remain constants. Kidney cannot distinguish between Na and Li; if NaCl
is increased, the kidney excrete more lithium and the serum level decreases. And
the opposite, if the salt intake is decreased, the kidneys retain more lithium and the
concentration will increase.
Lithium Counseling= do not become preg while taking this medicine, can harm the
baby, contact provider and quit med, med can cause a light tremor in the hands; if
the patient notices the tremor looks works (much more noticeable), it can mean the
level of drug in the body is too high and the user should healthcare provider right
away, eat the same amount of salt each day, blood needs to be checked
occasionaly while taking this medicine.
FDA drug approved for schizophrenia and various states of bipolar- asenapine
sublingual tablets (Saphris), Quetipine (Seroquel), aripiprazole (Abilify)
Antipsychotics have various indications and are used bipolar , or for mania, or for
mixed episodes, either alone or with other agents in combination. It would have
been a good guess that the older agents that cause significant ADRs would not get
this approval; thioridazine due to QT prolongation, and haloperidol due to
movement disorders.
Patient with Parkinsons disease and taking quetiapine: what is the benefit of
quetiapine? Little risk of movement disorders. Quetiapine(compared to other atypic
antipsychotics) has low risk for EPS and is often used for psychosis in Parkinsons
disease
Lithium toxicity at level 3.2 (in elderly person that developed acute renal tox):
Severe CNS depression, arrythmmia, seizure, coma, and death. The patient started
lithium when they were younger. In general, Lithium is a DO NOT USE drug in
elderly due to risk of toxicity associated with declining renal function. Normal
Lithium Level 0.6-1.2 mEq/L. In treating an acutely manic patient, the clinician may
go slightly above this level for a short-time period, and then lower the dose to stay
within this range. Check 12 hours post-dose. Test every 3 months and any
intercurrent illness. Lithium is serotonergic
Mood stabilizers- Carbamazepine, Lamotrigine, Lithium, Valproic acid and
derivatives
Lithium, carbamazepine and valproic acid_ Preg D have to determine if the benefits
outweigh the risks. Lamictal and Seroquel are both increasing used in bipolar and
are Preg. C. Valproic formulations are Preg. Cat. X for migraine prophylaxis. 500 mg
to 1500 mg/day. Depakote 750 to 1500 mg day. Propanol 80-240 mg into 3 to 4
doeses per day
Valproic acid can cause damage to the pancrease, if pt becomes nauseated, with a
loss of appetite and pain around the abdomen(stomach area), the pt needs to be
seen by healthcare probider right away, should avoid becoming pregnant, damage
to live, if tired, loss of appetite, if the users stool becomes light in color (or skin
become yellowish) the pt should PCP right away. DOES NOT cause agranulocytosis.
S/E causes upset stomach and is easier to tolerate with food.
100% renally cleared *excreted* but has important DI with drugs that affect renal
clearance. Salt intake direct inverse of lithum; salt intake increases, the lithum
exection increases and lithium decrease. Maintain a constant salt intake.
Avoid Preg. On lithium. If you feel nauseated, or have diarrhea , loose and watery
stool. And if the patients feels confused with slurring speech, or have troble walking,
it could mean the amount of medicine in th e boody is too high, see a healthcare
provider right away
This medicine can make the user fell thirst, and pts may need to use the bathroom
more often. In order to prevent becoming dehydrated users should drink water ofter
and take water bottle with them when they go out. Lithium causes stomach upset
and is TAKEN WITH FOOD. OTHERWISE IT would be different to tolerate.
Lithium Toxicity-Characteristics-Ataxia(drunk like uncoordinated walk) coarse hand
tremor, diarrhea.
Ataxia present other drugs toxicity- alcohol, many anticonvulsants, many CNS
depressants, and lithum. Occasionally you will be seen as drunk on alchocol you are
actualy toxic on script. Increase Serum Cr indicates renal impairment, which causes
toxic levels. Polyuria is a common SE and cogwheel rigidity occurs with chronic use;
these are not symptoms of toxicity.
Depakene-Valproic acid-comes in 250 mg capsules and 250 mg/5ml 16 oz oral
solution The recommended initial dose is 15 mg/kg/day, increasing
at one week intervals by 5 to 10 mg/kg/day until seizures are controlled or side
effects preclude further increases. The maximum recommended dosage is 60
mg/kg/day. If the total daily dose exceeds 250 mg, it should be given in divided
doses.
Bioplar can aggrevate or cause trouble at work due to poor performance, higher risk
of suicide, risky sexual behaviors, excessive gambling. NOT ticks and other vocal
outbursts they may be present as a comorbid disorder but not associated with
bipolar disorder.
Lamictal (Lamotrigine)- When starting medication slowly increase the dose; that is
why is comes in dosing packet. Tell pharmacist if taking any supplements or OTC
meds, if rash develops quickly and becomes serious, see healthcare provider right
away if cannot see healthcare provider right way go to ER., lamicital can cause you
to feel somewhat dizzy and tired. Dose is titrated to decrease risk of rash. No
antidote. Supportive emergency care
S/E of divalproex sodium= thrombocytopenia, GI upset, significant Weight Gain,
alopecia (prevented w/ selenium and zinc supplements), sedation, tremor.
PT comes in with lithium toxicity which lab do you look at: thyroid; TSH and FT4;
Lithium can cause hypothyroidism; patients on lithium therapy need to have their
thyroid function monitored. A low FT4 and high TSH would indicated hypothyroism.
BP I most sever version. Pts having manic episode or experiencing psychosis,
hospitalization may frequently be required. BP II disorder is characterized by
hypomania episodes which are less sever where the patient can still fx and does not
require hospitalization. Mania worse in I than II. Depressive symptoms worse in BPII
than I. BPI is more common than II. BP II is more common in women.
Valproic acid terrible in preg worst during 1 st trimester. Neural tube defects,
permanent cog. Damage, Lurasidone is 2nd gen antipsyoctic used for bipolar(BP II
depression) Preg cat B treat pregnancy DOC with bipolar, Lithium can cause heart
dmage to the newborn, along with cog. Fxn
Asenapine (Saphris)- can make the mouth numb and no food or drink should be tak
for 10 min after dose/ comes in a sublingual formaulation which must be dissolved
under the tongue and cause mouth numbness.
Which antiphychotics can raise prolactin levels? Risperdal (risperidone) and
paliperidone (Invega) are associated with increase in prolactin levels. Paliperidone
does not have the indication for bipolar but my be used off-label for this condition.
Symbyax-olanzapine (Zyprexa) and fluoxetine (Prozac)