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Copy of Copy of Untitled Prezi

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mira abd el wahed

on 28 July 2013

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Transcript of Copy of Copy of Untitled Prezi

Mood Stabilizers
-
(4–12 mcg/mL)
,
-push it higher on the basis of tolerability and effect.
-Consider potential
drug interactions
-monitor complete blood cell count, liver function, and serum sodium.
-
Hyponatremia
can occur,
discontinued
if sodium concentrations fall
below 130 mEq/L
lithium
Bipolar Disorder
Lithium
Divalproex
Carbamazepine
Lamotrigine
Antipsychotics
pre-lithium work-up
complete blood cell count
electrolytes
renal function
thyroid function tests
urinalysis
EKG
pregnancy test for women of childbearing age
Complete blood cell count
(leukocytosis
Electrolytes
(Na )
EKG
Pregnancy test
(teratogen)
Renal function & Urinalysis
(Interstitial fibrosis glomerulosclerosis)
Thyroid function tests
(hypothyroidism
valproic acid
Serum concentrations
:
50 to 125 mcg/mL.
checked
3–5 days
after initiation or after a change of dose.
IF tolerated push the level upward in the range.
Nonresponse to treatment if the dose is too low
Hypoalbuminemia
increases free concentrations.
Liver toxicity
risk IN young children— metabolic diseases several medications.
Dose and Pharmacokinetics
Half-life

=

24
hours

so waiting
5–6
days for steady state
1–2 weeks
to see the full effects
Excreted
95%
renally
Initial dosing:
600–900
mg/day then titrated Maintenance doses
based on serum concentrations
0.8–1.2
mEq/L
in acute mania
0.6–1.0
mEq/L
during maintenance
12 hours after the last evening dose
Perform renal function tests, thyroid function tests, and
a urinalysis every
6–12
months
Adverse Effects of lithium
Rash or ↑ psoriasis
D.C
Tremor Reduce dose (Cp)+
add β-blocker
CNS ( agitation, confusion) Reduce dose (Cp)
GI (nausea/vomiting, diarrhea) Reduce dose; try extended-release
Hypothyroidism
D.C
or give levothyroxine
Polydipsia/polyuria Reduce dose, manage intake, and try
amiloride
Teratogenicity Avoid during first trimester
Drug interactions
Neuroleptics Li may potentiate EPS
Carbamazepine ↑ CNS toxicity
Neuromuscular blockers Li prolongs action

Theophylline
decrease
Li Cp
Furosemide Little effect
Amiloride Little effect

**NSAIDs
Li Cp
**Thiazide
Li Cp
**ACEIs


li cp
**hyponatremia (dehydration)
li cp

first mesure :lithium level and sodium /renal function
serum levels greater than 1.5 mEq/L,
GIT
:vomiting, diarrhea ,lethargy,
CNS
:coarse tremor, confusion, seizures, and coma and may even result in
death
Hemodialysis
iF
> 4 mEq/L
Lamotrigine
Rash :

1)start with lower doses
- 2)correct the dosing schedule if
valproic acid
is also used
discontinue

agent if rash is observed.
Risk factors include
1-concurrent use of valproic acid,
2-younger age,
3- too high a dose
4-too rapid a dose titration.
The

onset of rash i
s most often noted during the first
2–8 weeks of therapy
and may also present as a Stevens-Johnson syndrome rash.
Carbamazepine, oral contraceptives, primidone, phenobarbital, andphenytoin can also induce the metabolism of lamotrigine.
Acute Depressive Episode
Acute Manic Episode
lithium toxicity
carbamazepine
1
How to manage ?
How to manage?
mood swings that range from the lows of depression to the highs of mania
Bipolar disorder mean :
DSM-IV define the manic episode as
A manic episode is characterized by at least
1week
of an abnormal elevated mood. and:
inflated selfesteem
irritability,
decreased need for sleep
pressured speech
flight of ideas
poor attention
increased hyperactivity or agitation, and
involvement in high-risk,
activities without regard to the consequences
Types of Bipolar Disorders
Bipolar I
BipolarII
2
first :what is the goal ?
return to usual levels of psychosocial functioning.
• Rapidly control agitation, aggression, and impulsivity
Antidepressants should be tapered and discontinued if possible.
-If it a“breakthrough” episode optimize the medicationdose.
-Achieve a higher serum level (but still withinthe therapeutic range).
Choose an initial treatment
Short-term adjunctive treatment with a benzodiazepine maybe helpful.
3
Antipsychotics
fast-acting
These drugs help with agitation

**All atypical
antipsychotics have received approval for use in
acute
mania or mixed episodes
except for clozapine
**Olanzapine and aripiprazole
have been approved for use in bipolar
maintenance asmonotherapy
APA guidelines
*lithum OR valproate OR anti psychotis (the first choice)
*Carbamzebine (second choice)
*For mixed episodes, valproate may be preferred over lithium
1
2
3
4
what is the goal?
-Remission of the symptoms of major depression and return
the patient to usual levels of psychosocial functioning.
- Avoid precipitating a manic or hypomanic episode.
IF a breakthrough depressive episode while
on maintenance treatment, optimize the medication dosage
Choose an initial treatment
Antidepressant monotherapy is not recommended
OR
Lithium
1
2
3
MIRA EID
BCPS

keep in mind :
*in maintainance all mood stabilizers can be used .

*antipsychotics:
1)mania

acute : all except clozapine as mono therapy
maintainance: olanazpine and arpiprazole
2)depressive eisodes :
acute :Qeitapine as add on therapy
maintainance :olanzapine and arpiprazole as mono therapy
quetiapine as add on therapy
Quitapine
but add on therapy
Maintainance therapy
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