Understanding and Treating Bipolar Disorder - Free CE

Page 9Understanding 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– Interferes with sodium and potassium channelfunction– Enhances inhibitory action of GABA– Varied inhibitory effects on the cAMP signalingpathway• Therapeutic Use– Treatment of manic episodes– May be more effective than lithium for rapid cyclingand mixed episodes• Pharmacokinetics– Slow and erratic oral absorption– Moderate protein binding– Metabolized by P450 system to active epoxidemetabolite; auto-inducer– t1/2 ~33 hrs (acute), ~15-25 hrs (chronic)• Dosage– Initial: 400-600 mg/d in divided doses– Usual range: 800-1600 mg/day– Therapeutic range: 6-12 mcg/mLPharmCon 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– Hematologic – aplastic anemia, agranulocytosis– Dermatologic – urticaria, rash, exfoliative dermatits– GI – nausea, vomiting, constipation– CNS – confusion, ataxia, sedation, tremor, myoclonus– Cardiovascular – SIADH, edema, CHF• Monitoring– Drug Levels – 4-6 weeks after dose change– CBC, lytes – q 2 wks 2 mos.; quarterly thereafter– LFT, renal function – mos. 1, 4, 7, 10; annually thereafter– D/C drug for – WBC < 3000, neutrophils