Bipolar Disorder

Lurasidone

Safest option for treating bipolar depression during pregnacy

0.6-1.2 mEq/L

Desired trough level for a patient taking lithium

A change in sodium level produces the opposite change in lithium level (decrease sodium causes increased lithium and vice versa)

How does salt impact lithium?

They can induce or worsen a manic episode when used alone

Why aren’t antidepressants used in bipolar disorder?

Inflated self-esteem, decreased need for sleep, more talkative than usual, having racing thoughts, easily distracted, an increase in goal-directed activities and engaging in high-risk behaviors (spending sprees, sexual interactions, gambling)

Qualifying symptoms for the diagnosis of mania

Additive risk of serotonin syndrome

Why should serotonergic drugs be used cautiously with lithium?

Thirst, weight gain or anorexia, a fine hand tremor, nausea

Lithium side effects

8 mEq

How much lithium ion is in 5 mL of lithium citrate syrup?

300 mg

How much lithium carbonate is 8 mEq of lithium ion?

BUN and SCr, TSH and FT4

Which labs should be monitored regularly during treatment with lithium?

Lithium and valproate

Preferred treatment for an episode of acute mania

Depakote

Brand name for valproate

Coarse hand tremor, ataxia, vomiting, arrhythmias

Symptoms associated with lithium toxicity

Valproic acid, carbamazepine and lithium

Bipolar disorder drugs known to cause birth defects

Lamotrigine

Safer option used in pregnancy for maintenance treatment or acute depressive episodes

They can increase lithium levels, which could cause toxicity (aspirin and sulindac are considered safer options)

How do NSAIDs impact lithium levels?

The presence of at least one manic episode distinguishes bipolar I from bipolar II. Mania only occurs in bipolar I, but hypomania and depressive episodes can occur in bipolar I and II

Bipolar I vs . Bipolar II

Can decrease the kidney’s ability to concentrate urine, leading to an increase in urination and thirst

Counseling point for chronic lithium treatment