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| Lamotrigine (Lamictal): Side Effects |
(Anticonvulsant)
CNS - dizziness, headache, ataxia, drowsiness, & tremor.
GI - nausea & vomiting.
Dermatological - Steven Johnson Syndrome [i.e. a rash that attacks all the mucus areas in the body (e.g. eye, nose, etc.)].
Well tolerated. |
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ucbruinette Wed, 17 Mar 2010 21:40:15 GMT |
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| Lamotrigine (Lamictal): Main Uses |
(Anticonvulsant)
1st liine for bipolar depression, acute & maintenance.
2nd line for rapid cycling.
[Newest medication; used for bipolar II, maybe for bipolar I also.]
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:40:15 GMT |
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| Divalproex (Depakote): Main Uses |
(Anticonvulsant)
1st line for mania & rapid cycling.
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:40:15 GMT |
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| Carbamazepine (Tegretol): Main Uses |
(Anticonvulsant)
1st line for mixed episodes.
2nd line for mania.
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:39:20 GMT |
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| Divalproex (Depakote): Side Effects |
(Anticonvulsant)
CNS - better tolerated than carbamazepine, less fatigue & dizziness.
GI - nausea, vomiting, & indigestion (but are usually transient).
Sustained-release tablets may reduce these side effects.
Interferes with normal blood-clotting cycle.
Cases of liver damage in children.
Blood level monitoring weekly for first 3 months, and then monthly.
Overdose causes somnolence & coma.
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:39:20 GMT |
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| Carbamazepine (Tegretol): Side Effects |
(Anticonvulsant)
CNS - sedation, dizziness, drowsiness, blurred vision, incoordination.
GI - nausea, vomiting, diarrhea, & abdominal pain.
Dermatological Effects - red, itching rash or hives.
Watch patients with history of cardiac problems and liver disease, because can reduce white blood cells.
Blood level monitoring weekly for first 3 months, and then monthly.
Toxicity causes neurological and cardiac malfunctions.
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:39:20 GMT |
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| Anticonvulsants: Main Uses |
[Call David Later - Then David Late]
Carbamazepine (Tegretol)
1st line for mixed episodes.
2nd line for mania.
Divalproex (Depakote)
1st line for mania & rapid cycling
Lamotrigine (Lamictal)
1st line for bipolar depression, acute and maintenance
2nd line for rapid cycling
[Newest medicine; used for bipolar II, maybe for bipolar I also.]
[Depakote & Tegretol are constantly used.]
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:39:20 GMT |
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| 3 Types of Anticonvulsants |
[Call David Later - Then David Late]
1. Carbamazepine (Tegretol)
2. Divalproex (Depakote)
3. Lamotrigine (Lamictal)
(L4-5, P5) |
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ucbruinette Wed, 17 Mar 2010 21:37:45 GMT |
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| Lithium's Side Effects: Monitoring Blood Levels |
Initiation of treatment: 3-7 days for several weeks.
Routine treatment: Every 1-3 months
Dosage changes: 3-5 days.
Signs of toxicity: immediate measurements.
(L4-5, P4) |
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ucbruinette Wed, 17 Mar 2010 21:37:45 GMT |
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| LIthium's Side Effects: Renal |
>>Know<<
Renal (i.e. kidney) excretion [need to be careful, because a person with dialysis will maintain more sodium = toxicity].
Sodium loss increases retention of lithium.
Causes of excessive sodium loos: vomiting, diarrhea, dehydration, sweating, diuretics, salt restricted diets, [& fever].
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:57:21 GMT |
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| Lithium's Side Effects: Teratogenesis |
>>Know<<
Contraindicated during pregnancy, especially 1st trimester.
[Can't give it to a woman during the 1st trimester of pregnancy, because it'll cause malfunctions.]
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:57:11 GMT |
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| Lithium's Side Effects: Weight Gain |
>>Know<<
Up to 20 pounds in at least 20% of patients.
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:57:05 GMT |
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| Lithium's Side Effects: Dermatological |
>>Know<<
Rash, acne.
Only stop lithium therapy if severe.
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:56:58 GMT |
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| Lithium's Side Effects: Cardiovascular |
>>Know<<
EKG changes
[Lithium has specific influences on EKG peaks, so changes on EKG is very important.]
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:56:47 GMT |
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| Lithium's Side Effects: Hermatological |
>>Know<<
Benign increase in white blood cell count.
(L4-5, P4) |
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ucbruinette Thu, 18 Mar 2010 06:56:39 GMT |
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| Lithium's Side Effects: Endocrine |
>>Know<<
Hypothyroidism & goiter.
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:56:33 GMT |
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| Lithium's Side Effects: Nervous System [& Neuromuscular] |
>>Know<<
Early headache, lethargy, muscle weakness, fine hand tremor (any time).
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:56:27 GMT |
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| Lithium's Side Effects: Gastrointestinal |
>>Know<<
Nausea, vomiting, diarrhea.
Watch toxic levels [because GI symptoms may be critical indicators of lithium toxicity].
(L4-5, P4) |
1 |
ucbruinette Thu, 18 Mar 2010 06:56:21 GMT |
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Lithium: Side Effects on 9 Systems
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>>Know the different systems it affects<<
1. Gastrointestinal
2. Nervous System [& Neuromuscular]
3. Endocrine
4. Hematological
5. Cardiovascular
6. Dermatological
7. Weight gain
8. Teratogenesis
9. Renal (i.e. Kidney)
(L4-5, P4) |
2 |
ucbruinette Thu, 18 Mar 2010 09:55:24 GMT |
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| Lithium: Precautions & Onset |
>>E.g. What's the therapeutic window? Narrow because it's close to toxicity<<
Narrow "therapeutic window" - therapeutic effect is close to toxicity.
Need to evaluate blood concentration levels to avoid toxicity.
Onset action is from 5-14 days.
[Depends on metabolism, weight, gender, etc. of individual.]
[Need to constantly check the client's blood level & weight.]
(L4-5, P3) |
1 |
ucbruinette Thu, 18 Mar 2010 06:55:21 GMT |
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| Bipolar Disorder Treatment: First & Second Line Agents, Adjunctive Treatments |
[First choice is lithium, then Depakote.]
First line agent - lithium & divalproex (Depakote)
Second line agent - carbamazepine (Tegretol)
Anticonvulsants - valproic acid (e.g. Depakote, Tegretol).
Used today: mood stabilizers
Benzodiazepines or antipsychotics (e.g. Olanzapine) are antidepressant and adjunctive-like [i.e. adjunctive treatments].
[Benzodiazepines work really fast, so may use it initially for fast effect. Lithium is a bit slower.]
(L4-5, P3) |
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ucbruinette Wed, 17 Mar 2010 21:33:32 GMT |
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| Bipolar I v. Bipolar II |
>>Be able to differentiate between I & II<<
Bipolar I - can occur without major depressive episode; 1 or more manic/mixed episode(s); occupational/social impairment; hospitalization needed.
Bipolar II - 1 or more major depressive episodes; 1 or more hypomanic episode(s); never manic/mixed episode; no significant impairment; no hospitalization needed.
(L4-5, P2) |
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ucbruinette Thu, 18 Mar 2010 06:54:38 GMT |
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| Bipolar II Disorder: Hypomanic Episode |
Hypomanic episode last at least 4 days.
Change in functioning uncharacteristic of behavior.
Hypomania has no significant impairment, no hospitalization needed.
(L4-5, P2) |
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ucbruinette Wed, 17 Mar 2010 21:33:32 GMT |
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| Bipolar II Disorder |
1 or more major depressive episodes with at least 1 hypomanic episode.
Never manic or mixed episode.
Difficult diagnosis, sometimes patients are unable to recall the elated mood.
[Must be accompanied with major depressive episode. Can be diagnosed with Bipolar II when have at least 1 hypomanic episode.]
(L4-5, P2) |
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ucbruinette Wed, 17 Mar 2010 21:31:52 GMT |
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| Bipolar I: Manic Episode |
Distinct episode, elevated expansive or irritable mood at least 1 week.
Racing thoughts, pressured speech, grandiosity, increased activity, distractibility, engage in pleasurable activities, decreased need for sleep, with or without psychotic features.
[EXTREME pleasurable activities (e.g. extreme sexuality, using drugs).]
Can be abrupt or gradual stages.
Impaired occupational/social function, hospitalization.
(L4-5, P2) |
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ucbruinette Wed, 17 Mar 2010 21:31:51 GMT |
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| Bipolar I Disorder |
1 or more manic/mixed episodes, with or without a major depressive episode.
Manic episode is rarely a diagnosis on its own. Even without depressive episode, diagnosis of Bipolar I.
Impaired occupational/social function, hospitalization.
(L4-5, P2) |
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ucbruinette Wed, 17 Mar 2010 21:31:51 GMT |
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| Bipolar Disorder |
Disorders that follow cyclic patterns of mood, behavior, and thought alterations.
Alternates between mania, hypomania, and depression.
1. Bipolar I
2. Bipolar II
3. Cyclotimic
4. Undifferentiated [i.e. Not Otherwise Specified - NOS]
(L4-5, P1) |
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ucbruinette Wed, 17 Mar 2010 21:31:51 GMT |
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