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Anxiolytics, Antidepressants and Antipsychotics 2 (LITHIUM (Treatment and…
Anxiolytics, Antidepressants and Antipsychotics 2
Bipolar Disorder
Manic Phase
1st line- Anti-psychotics (Haliperidol, RIsperidone, Olanzapine)
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Don't use anti-depressants and stimulants and some OTC medication such as cold remedies as they precipitate mania
Depressive Phase
Antidepressants used in combination with mood stabilizers. SSRI are less likely to result in mania compared to TCA.
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LITHIUM
Treatment and prophylaxis of mania, bipolar disorder, recurrent depression and self-harming behaviour
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S.E- tremors, GIT, renal, coma
MOA- Mimics Na+ in tissues by entering through the Na+ channels and accumulating in the cell. It won't be pumped out through the Na+/K+ ATPase pump so there will be partial loss of K+ cell depolarisation
It inhibits IMPase which is the rate-limiting enzyme in inositol recycling. So the phosphatidyl inositol pathway is blocked and inositol phosphate is hydrolysed to free inositol
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Toxicity S.E- Thyroid disorders, hair loss, mild cognitive impairment, acne and weight gain
Toxicity symptoms are metallic taste, thirst from polyuria, weight gain and oedema and causes of toxicity include intentional overdose or reduced drug excretion. When conc >1.5
Patient counselling- Regular fluid intake, full compliance and regular monitoring essential and avoid crash diets
Anti-psychotics
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Patients with schizophrenia are likely to smoke but the hydrocarbons in cigarette smoke induce the cytochrome P450 enzymes which decreases the serum levels of the anti-psychotic medication. The levels of CLOZAPINE are the most affected so when the patient stops smoking, the CLOZAPINE levels increase and so there will be an increased risk of seizures. The CLOZAPINE levels need to be monitored.