Week 7

Question 1

What is Bi-polar

Answer 1

mood disorder that affects daily functioning and is characterized by extreme mood swings

Question 2

What are the indications of lithium

Answer 2

Treatment and prevention of bi-polar
T & P of mania
T & P of recurrent depression
T & P of aggressive or SH

Question 3

what is the most common age bi-polar begins to present

Answer 3

15-25

Question 4

what is the main thing to note about the different states of mind

Answer 4

there are different states of mind including

depressive
mania
stable

main thing is that people with bi-polar can swing dramatically through these ones

Question 5

What are the two main drugs that are used in the treatment of bi-polar

Answer 5

lithium + valporate

Question 6

what is an additional therapy aside from lithium and valporate that may be used to stabilize mood

Answer 6

antipsychotics e.g. quitiapine!

Question 7

what are some other antipsychotics

Answer 7

Haloperidol
prochlorperazine
olanzapine
risperidone

Question 8

is kemadrin a anti-psychotic

Answer 8

no

Question 9

why might a person on an antidepressant be stopped if they had bi-polar

Answer 9

the antidepressant may be elevating mood too high and is putting patient prone to manic episodes

Question 10

A patient presents to you with harm and has bi-polar is in a manic mood what should we do

Answer 10

check to see what medications the patient is on

stop anti-depressants

ensure that patient is on antipsychotic to help stabilize

Question 11

The same patient presents to you next year with harm and has bipolar and is on a manic episode

this is their drug history

Priadel 200
sertraline 50
cetirizine

what are 4 things you should do to best help

Answer 11

stop sertraline

query cetirizine as lots of anticholinergic action

review lithium levels and adjust dose accordingly

in addition add in an antipsychotic

Question 12

The same patient presents to you next year with harm and has bipolar and is on a manic episode

this is their drug history

Valproate

Answer 12

increase dose

add in dual therapy with antipsychotic if necessary based on preferences in the past

Question 13

how long after a patient presenting with acute mania should they continue their antipsychotic

Answer 13

minimum 4 weeks

Question 14

what is the rule before adding in lithium

Answer 14

try 1

try another

then try lithium

Question 15

what is the rule before adding valporate

Answer 15

try 1

try another

then try valporate

Question 16

is valporate licensed to help manage bi-polar

Answer 16

yes

Question 17

is valproate licensed for migraine prophylaxis

Answer 17

no

Question 18

is lithium licensed to help manage bi-polar

Answer 18

no

Question 19

what form of bi-polar should lamotrigine not be used

Answer 19

bi-polar mania as it only used in bi-polar depression to help lift the mood

Question 20

What are the main pharmacological treatment options for bi-polar depression

Answer 20

FLUOXETINE (preferred antidepressant) + olanzapine (works on serotonin receptors)

quetiapine

olanzapine

lamotrigine

Question 21

what is the two forms of treatment for bipolar depression

Answer 21

psychological

pharmacological

Question 22

what is first line prophylaxis for bi-polar

Answer 22

lithium

Question 23

what is second line prophylaxis for bi-polar

Answer 23

valproate

Question 24

what is the therapeutic range of lithium

Answer 24

0.4-1mmol/L

Question 25

what is the therapeutic range for acute mania with lithium

Answer 25

0.8-1mmol/L

Question 26

what is the therapeutic range for maintenance of bi-polar

Answer 26

0.6-0.8

Question 27

why should lithium be brand prescribed

Answer 27

in long-term use, lithium can have adverse effects on the kidneys, the thyroid, and the parathyroid glands. Routine monitoring of function is therefore required. Lithium should always be prescribed by brand and form.

Question 28

if a patient is not adherent with blood tests is lithium an appropriate choice

Answer 28

no

Question 29

would we ever need to do blood tests to see the level for valproate

Answer 29

no

Question 30

when should we monitor lithium

Answer 30

Weekly after initiation and after each dose change then when they are stable do every 3 monthly for 1 year then 6 montly worth noting testing should be taken 12 hours after their dose.

Question 31

what do we need to monitor in lithium

Answer 31

renal function ECG recommended thyroid function BMI U&E FBCs

Question 32

where is lithium excreted

Answer 32

renal

Question 33

Why do we need to monitor thyroid function in lithium

Answer 33

can cause hypo or hyperthyroidism

Question 34

what are the main contraindications of lithium?

Answer 34

arrhythmias severe renal impairment (renally excreted) untreated or untreatable thyroid disorders (can cause hypo or hyper thyroidism) low sodium pregnant and breast feeding

Question 35

what are the side effects of lithium

Answer 35

Gi weight gain Tremor muscle weakness polyuria polydipsia ankle oedema

Question 36

what is one of the long term adverse effects that can lead to hypercalcemia

Answer 36

hyperparathyroidism

Question 37

what are the five long term adverse effects that are associated with lithium -++ rn

Answer 37

hypothyroidism hyperthyroidism hyperparathyroidism rhabdo nephrotoxicity

Question 38

patient presents with diarrhoea anorexia muscle weakness what level of lithium would we expect

Answer 38

>1.5

Question 39

patient presents with vomitting ataxia and a course tremor what level of lithium would we expect

Answer 39

>1.5

Question 40

patient presents with syncope, and renal failure what level of lithium would we expect

Answer 40

>2

Question 41

patient presents in a coma and is found to have lithium toxicity what level would we be looking at

Answer 41

>2

Question 42

patient complains of a hyperextension of limbs and vomitting and is found to be on lithium what would the level of toxicity be

Answer 42

>2

Question 43

so how do we treat lithium toxicity

Answer 43

rehydration (bruh) no antidote

Question 44

what are the interactions of lithium

Answer 44

NSAIDS DIURETICS (IF MUST BE ON BUT LOOP BETTER) ACE INHIBITORS QT PROLONGERS HYPOKALAEMIA CAUSES DAPAGLIFLOZIN METRONIDAZOLE

Question 45

what are the 3 ds of lithium

Answer 45

diarrhoea diuretics dehydration

Question 46

what low sodium cause

Answer 46

lithium toxicity

Question 47

what is addisons disease

Answer 47

need to add steroids as patient does not have enough corticosteroids.

Question 48

what is cushings disease

Answer 48

theres too much steroids so you need to cushion to protect yourself.

Question 49

should lithium ever be stopped abruptly?

Answer 49

no never.

Question 50

when does a patient need to be reviewed

Answer 50

diarrhoea elderly vomiting surgery intercurrent infection

Question 51

when to reassess for lithium

Answer 51

see if the need for continuous therapy regularly after 3 - 5 years only if benefits persist.

Question 52

what is the pnuemonic to remember lithium side effects

Answer 52

lithium level increased urination tremor thirst and teratoneginec hypothyroidism hyperthyroidism and hyperparathyroidism interactions (NSAIDS/ACE/ARB/Diuretic/ANTCIDS) upset stomach muscle weakness skin effects

Question 53

what does the L in the LITHIUMs pnuemonic mean

Answer 53

levels

Question 54

what does the first I in the lithiums pnuemonic mean

Answer 54

increased urination

Question 55

what does the t in lithiums pnuemonic mean

Answer 55

thirst tremors teratogenic

Question 56

what does the h in the lithiums pnuemonic mean

Answer 56

hypothyroidism hyperthyroidism hyperparathyroidism

Question 57

what does the i in the lithiums pnuemonic mean

Answer 57

interactions

Question 58

what are the main interactions of lithium

Answer 58

ace / arb diuretics nsaids antacids

Question 59

what is the u mean in the lithiums pnuemonic

Answer 59

upset stomach

Question 60

what does the m mean in the lithiums pnuemonic

Answer 60

muscle weakness

Question 61

what does the s in lithiums pnuemonic mean

Answer 61

skin effects e.g. acne and psoriasis

Question 62

can we breastfeed with lithium?

Answer 62

no

Question 63

can we be pregnant while on lithium

Answer 63

avoid if possible but if absolute must then avoid in first trimester but the dose requirements increase during the second and third trimester.

Question 64

what drugs can increase lithiums concentrations

Answer 64

ace inhibitors arbs diuretics nsaids metronidazole tetracyclines

Question 65

what drugs can decrease lithium concentrations

Answer 65

sodium containing ant acids and soluble analgesics due to high salt contents urinary alkalinising agents for cystitis theophylline osmotic and carbonic anhydrase inhibitor diuretics

Question 66

which drugs increase neurotoxicity with lithium

Answer 66

carbamazepine antipsychotics ssris triptans ccbs

Question 67

what type of med is tranexamic acid

Answer 67

p med and pom

Question 68

what is tranexamic acid used for

Answer 68

mennorhia nose bleeds heriditary angioedema local fibrinolysis

Question 69

what is the dose of tranexamic acid for periods

Answer 69

1g tds for 4 days

Question 70

what is the dose of tranexamic acid for nose bleeds

Answer 70

1g tds for 7 days

Question 71

what are the main side effects of tranexamic acid

Answer 71

diarrhoea vomit nausea

Question 72

what do we need to monitor in the long term use of tranexamic acid

Answer 72

monitor lfts

Question 73

what do we need to monitor in the long term use of tranexamic acid of angiodema

Answer 73

lfts

Question 74

when can we not give tranexamic acid indication

Answer 74

if anything other than mennorhea

Question 75

when would we not give tranexamic acid conditions

Answer 75

history of DVT irregular periods Epileptic Pregnant

Question 76

with what medication does tranexamic acid increase the risk of a dvt when given together with

Answer 76

contraceptive pil