Understanding and Treating Bipolar Disorder - Free CE

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Page 7Understanding and Treating Bipolar Disorder© 2012 Pharmaceutical Education Consultants, Inc. unless otherwise noted. All rights reserved.Reproduction in whole or in part without permission is prohibited.Side Effect Symptoms ManagementCardiacT wave flattening/inversionArrhythmiasBenign; monitorDiscontinue drugDermatologic Acne, psoriasis Topical benzoyl peroxide orerythromycinWeight gainHematologic Leukocytosis BenignDiet and exercise, lowcalorie beveragesPharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.• Unstable renal function• Recent myocardial infarction – due to bradycardia• Sinus node dysfunction• Ulcerative Colitis, Crohn’s Disease – may worsen lower GIsymptoms• Psoriasis – may be worsened on lithium• Cerebellar disorders – effects on coordination• Hypothyroidism – use would require increased monitoring• Pregnancy – Increased risk of congenital anomalies (~4-12%),including Ebstein’s anomaly of the heart• Initial workup– Renal function tests– Electrolytes– Thyroid panel– CBC– EKG (elderly, cardiovasculardisease)– Pregnancy test• Efficacy– Resolution of symptoms– Assessments for adverseeffects– Weight– Neurologic exam– Patient report on GIsymptoms, urinary frequency,etc.– Periodic serum Li levelsPharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.
Page 8Understanding and Treating Bipolar Disorder© 2012 Pharmaceutical Education Consultants, Inc. unless otherwise noted. All rights reserved.Reproduction in whole or in part without permission is prohibited.• Mechanism of Action– Inhibits sodium and calcium channel function– Enhances GABA; inhibits glutamate– Exerts effects on second messenger systems• Therapeutic Uses– Treats manic and depressive episodes– Superior to lithium for rapid cycling, mixed episodes,and psychotic episodes– Synergistic use with other mood stabilizers• Dosage forms– IR (valproic acid): oral capsules and liquid concentrate– DR, ER (divalproex sodium): oral tablets and sprinklecapsules• Dosing and Administration– Starting dose: 750-1000 mg in 2-3 divided doses– Oral loading: 20 mg/kg/day x 5 days– Target conc: 50-100 mcg/mL; up to 150 mcg/mL maybe toleratedPharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.• Adverse Effects– GI – N/V/D (less with Depakote®)– CNS – sedation, tremor– Hepatic – elevated LFT’s, rare liver failure– Hematologic – thrombocytopenia– Pancreatitis– Rash– Weight gain– Alopecia• Contraindications– Pregnancy– Age < 10 yrs• ASA/warfarin – increased risk of bleeding• Anticonvulsants– Displacement from protein binding sites– Inhibition of AED metabolism– May potentiate activity of other anticonvulsants– Augmented CNS depressant effectsPharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.
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Understanding and Treating Bipolar Disorder - Free CE

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