Bipolar drugs + ADHD - lecture 1

lithium

mood stabilizer

neuroprotective/neurotropic - decreases atrophy, increases neuronal growth

for acute maniac episodes, prophylaxis or bipolar disorder

0.4-1 TR

hemodialysis for greater than 2.5

• draw levels in AM

• inititation - 2-3 days

• established - 3-6 months

muscle weakness, fine hand tremors, polyuria, lethargy, slurred speech

• monitor kidney, thyroid, and Na levels

• adequate hydration

• improvement in 2-3 weeks

DO NOT GIVE - Diuretics, NSAIDS, ACE inhibitors, and anticholinergic meds

Divalproex Sodium (valporate)

mixtures of valporic acid and salts

approved for BPD and acute mania relapse

• lithium is better for suicide and initial mania though!

start at 250mg and work up to 1000-2000mg

trough plasma levels 50-120 mcg/mL

thrombocytopenia, pancreatitis, liver failure - pull CMP and CBC

• if AE occurs, contact provider.

Carbamazepine

reduces SYMPTOMS of maniac episodes - target trough is 4-12mcg/mL - neurological and hematological effects

Lamotrigine (Lamictal)

blocks sodium channels and decrease release of glutamate - prevention of RELAPSE into mania and depression - dizziness, double vision, HA, SJS

Amphetamine - dextroamphetamine(Adderall)​

PO CNS stimulant that causes the release of dopamine and NE

• weight loss, tachycardia, HTN, psychosis, restlessness

for ADD and narcolepsy

• take in the morning

• avoid other CNS stimulants and MAOIs

Modafanil (Provigil)

Non amphetamine stimulant

• narcolepsy, OSAHS, shift work sleep disorder 

HA, N/V, diarrhea, tachycardia, HTN 

monitor alertness, vitals, take 1 hour in AM before shift 

can cause breathing problems, decreases pulse ox, and lung dysfunction 

Methylphenidate (Ritalin) 

promotes NE and DA release, inhibits NE and DA reuptake - amphetamines

• for ADHD and narcolepsy

insomnia, reduced appetite, emotional liability, abuse liability 

• take in the AM 

• avoid other CNS stimulants and MAOIs