1. BIPOLAR DISORDER MANAGEMENT
BY:AMIRUL IZWAN BIN MANSOR

3. MODE OF THERAPY

4. 1)PHARMACOTHERAPHY
LITHIUM
ANTICONVULSANT
ATYPICAL ANTIPSYCOTIC

5. LITHIUM MOOD STABILIZER
DOC FOR ACUTE MANIA AND PROPHYLAXIS FOR MANIC AND DEPRESSIVE BIPOLAR DISORDER.
MOA: unknown but has shown it may alter neuronal sodium transport
ONSET OF ACTION: 7-14 DAY

6. LITHIUM
EXCRETION = 95%
ATTENTION!!! : IT HAS LOW THERAPEUTIC INDEX. DAILY DOSE = MG
LEVEL: 0.7 – 1.2 (TOXIC > 1.5, LETHAL >2.0)

7. L EUKOCYTOSIS (BENIGN) I NSIPIDUS ( NEPHROGENIC DIABETES) *
SIDE EFFECT
L EUKOCYTOSIS (BENIGN)
I NSIPIDUS ( NEPHROGENIC DIABETES) *
T REMOR,TERATOGENIC (EBSTEIN ANOMALY)*
H YPOTYROID *, HYDRATION > DRY MOUTH
, THIRST, HYPERPARATHYROIDISM
I SHAL (DIARRHEA), INCREASE URINE , (POLYUREA)
U NCONTROL VOLUNTARY MOVEMENT , (ATAXIA)
M ETALLIC TASTE, NAUSEA, VOMITING.
*LONG TERM EFFECT

11. BEFORE U GIVE PATIENT LITHIUM….CHECK……

12. 1- Pregnancy test
2- Thyroid function test
3- KFT
4- CBC

13. MONITOR????? SERUM LEVEL OF LITHIUM 2. TYROID FUNCTION TEST
- 2-3 TIMES PER WEEK INITIALLY AFTER GIVING LITHIUM TO PATIENT
- EVERY 3 MONTH ONCE THERAPEUTIC LEVEL HAS REACHED
2. TYROID FUNCTION TEST
-EVERY 3 M INITIALLY, THEN EVERY 6 M.
3. KIDNEY FUNCTION TEST
-EVERY 3 M
4. OTHERS:
-ECG, SERUM NA, CALCIUM, PTH

15. WHAT MAY AFFECT LITHIUM LEVEL?????
INCREASE
DECREASE
NSAIDS
DIURETICS
ACEI,ARB
LOW SODIUM INTAKE
DEHYDRATION
THEOPHYLLINE
CAFFEINE
ANTACID

16. ANTICONVULSANT
CARBAMAZEPINE
VALPROIC ACID

17. CARBAMAZEPINE (tegretol)
USE: MIXED EPISODE AND RAPID-CYCLING BIPOLAR DISORDER
MOA: act by blocking sodium channels and inhibiting action potentials, GABA receptor agonist.
Onset of action is 5-7 days
DAILY DOSE: UP TO 1200MG DAILY IN 3 OR 4 DIVIDED DOSE.
OTHER USAGE: TRIGEMINAL NEURALGIA, EPILEPSY,DIABETIC NEUROPHATY.
MAY DECREASE EFFICIENCY OF COCP….

18. SIDE EFFECT C NS (DIZZINESS, DROWSINEES, CONFUSION) A TAXIA
R ASH (STEVEN’S JOHNSON SYNDROME)
B LUR VISION
A PLASTIC ANEMIA
M IGRAINE
A GRANULOCYTOSIS (ESP NEUTROPHIL)
Z zzzzzz PROBLEM
E LEVATION LIVER ENZYME
P LATELET DECREASE
I RREGULAR HEARTBEAT
N AUSEA AND VOMITING

20. CHECK!!!!
CBC
LFT

22. VALPROIC ACID(depakine)
Use: mixed manic episodes and rapid cycling bipolar disorder
Mechanism : unknown but it has been shown to increase central nervous system level of gama-aminobutyricacid (GABA)
Safest drug for breastfeeding mom with bipolar disorder

23. SIDE EFFECT V OMITING AND NAUSEA A LOPECIA
L IVER TOXICITY (HEPATOTOXICITY)
P ANCREATITIS
R ETENTION FAT(W.GAIN)
O EDEMA (PERIPHERAL)
A LLERGIC / APPETITE INCREASE
T HROMBOCYTOPENIA / TERATOGENIC , TREMOR
E FFECT SLEEP (INSOMNIA)

25. CHECK!!!!
CBC
LFT

27. ANTI PSYCOTIC
ATYPICAL ANTI-PSYCOTIC LIKE OLANZAPINE, QUETIAPINE, RISPERIDONE, ARIPRAZOLE, ZIPRASIDONE, CLOZAPINE.
EARLY, SHORT TERM
USE: ADJUNCTS IN THE EARLY COURSE OF MANIC EPISODE IF PSCHOTIC SYMPTOM ARE PRESENT

28. SIDE EFFECT
Anti-HAM (antihistaminic , antiadrenergic , antimuscarinic)
Agranulocytosis about 1%
Seizures about 2-5%
Hyperlipidemia
Glucose intolerance
Weight gain
Liver toxicity (so clinician monitor LFTs)

29. QUIZ
Patient with bipolar disorder coming to the clinic, after suffering of blistering skin. Now, he is on the medication for bipolar disorder. Which drugs that may cause this problem?

30. A 32 year old female , newly given birth to a baby , she is a known case of bipolar, she is a breast feeding mother , she came to the clinic seeking medical help and refusing to be hospitalized . What is the safest drug that u will give her?

31. THE END