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RxPrep

Bipolar disorder

QuestionAnswer
First-line for acute mania? Antipsychotic OR lithium OR valproate
Preferred for severe mania? Antipsychotic + lithium or valproate
First-line for bipolar depression? Antipsychotic (quetiapine mainly)
Alternatives for bipolar depression? Lithium, valproate, lamotrigine
Maintenance therapy includes? Lithium, antiseizure drugs, SGAs
Can antidepressants be used alone in bipolar? NO, SSRIs/SNRIs/wellbutrin can cause mania + serotonin syndrome risk
Therapeutic lithium range? 0.6–1.2 mEq/L
Acute mania lithium target? Up to 1.5 mEq/L initially
Lithium toxicity level? >1.5 toxicity >2.5 severe toxicity
Lithium main ADRs? N/D, tremors, polyuria, weight gain, hypothyroid, hypercalcemia, arrhythmias
Lithium toxicity symptoms? Early: GI upset, tremors Moderate: ataxia, more tremors Severe toxicity: CNS depression, arrhythmias, seizires, coma
Lithium labs to monitor? Lithium level, renal function, thyroid function
Electrolytes to monitor on lithium? Calcium*, potassium, sodium
Drugs that increase lithium levels? ACE inhibitors, ARBs, thiazides, NSAIDs
NSAIDs that are safer with lithium? Aspirin and sulindac
What decreases lithium levels? Caffeine, theophylline, ↑ salt intake
What condition increases lithium levels? Dehydration
Lithium has an increased risk of neurotoxicity with what other drugs? Carbamazepine, phenytoin, and verapamil/diltiazem
Main counseling points for lithium? Consistent salt intake, maintain hydration, take with food
Can lithium be used in pregnancy? NO, congenital cardiac defects
Best bipolar meds for pregnancy? *Lurasidone (best one) Other SGAs are generally good too
Which SGAs are used for bipolar? Aripiprazole, olanzapine, quetiapine, risperidone, lurasidone, ziprasidone
What is the first line option for acute depressive episodes? Olanzipine + fluoxetine* (do not use while on lithium)
Dose lithium need renal dosing? Yes, toxicity risk in renal impairment
Can antidepressants ever be used in bipolar? Yes, but not with lithium, and must give with a mood stabilizer (SGA).
Created by: cdaughtry
 

 



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