Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Chapter 16 Cholinesterase Inhibitors
Document related concepts
no text concepts found
Transcript
Drugs for Bipolar Disorder Bipolar Disorder Formerly known as manic-depressive illness Afflicts an estimated 3.7% of the adult population Mainstays of therapy Lithium, valproic acid Many also receive an antipsychotic Chronic condition that requires lifelong treatment Bipolar Disorder Definition of bipolar disorder (BPD) Cyclic disorder Recurrent fluctuations in mood Episodes of mania and depression persist for months without treatment Treatment Drugs Psychotherapy Characteristics of Bipolar Disorder Types of mood episodes seen in bipolar disorder (BPD) Pure manic episode (euphoric mania) Hypomanic episode (hypomania) Major depressive episode (depression) Mixed episode Patterns of Mood Episodes Subdivided into two major categories Bipolar I disorder • Manic or mixed episodes • Usually depressive episodes Bipolar II disorder • Hypomanic or depressive episodes • Not manic or mixed episodes Treatment of Bipolar Disorder Drug therapy Nondrug therapy Drug Therapy Types of drugs employed Mood stabilizers (Lithium) • Relieve symptoms during manic and depressive episodes • Prevent recurrence of manic and depressive episodes • Do not worsen symptoms of mania or depression; do not accelerate the rate of cycling Antipsychotics • Given during severe manic episodes Antidepressants • Given during depressive episodes Drug Therapy Drug selection Short-term therapy: manic episodes Short-term therapy: depressive episodes Long-term preventive treatment Promoting compliance Short-term hospitalization Long-term prophylactic therapy Education for both patient and family Nondrug Therapy Education Psychotherapy Patient and family Individual, group, family Electroconvulsive therapy Last resort Mood-Stabilizing Drugs Lithium Antiepileptic drugs Lithium (Lithonate, Lithotabs) Chemistry Simple inorganic ion Found naturally in animal tissues Therapeutic uses Bipolar disorder Other uses • Alcoholism • Bulimia • Schizophrenia • Glucocorticoid-induced psychosis Lithium (Lithonate, Lithotabs) Mechanism of action Altered distribution of certain ions Altered synthesis and release of norepinephrine, serotonin, and dopamine Mediates intracellular responses to neurotransmitters Shown to facilitate regeneration of damaged optic nerves Can increase total gray matter in regions known to atrophy in BPD Lithium (Lithonate, Lithotabs) Pharmacokinetics Absorption and distribution Excretion • Short half-life • Excreted by the kidneys • Sodium levels: lithium excretion reduced when sodium level low Plasma levels • 0.8–1.4 mEq/L Lithium (Lithonate, Lithotabs) Adverse effects Excessive lithium levels • Greater than 1.5 mEq/L • Monitor levels q 2–3 days at initiation of therapy and then q 3–6 months Therapeutic lithium levels • Gastrointestinal • Tremors • Polyuria • Renal toxicity • Goiter and hypothyroidism • Teratogenesis Lithium (Lithonate, Lithotabs) Drug interactions Diuretics Nonsteroidal anti-inflammatory drugs (NSAIDs) Anticholinergic drugs Preparations, dosage, and administration Lithium carbonate Lithium citrate Dosage is highly individualized Antiepileptic Drugs Divalproex sodium (Valproate) Carbamazepine Reduces symptoms Protects against recurrence of mania and depression Target trough plasma level: 4–12 mcg/mL Lamotrigine Indicated for long-term maintenance Can be used alone or in combination Antipsychotic Drugs in BPD Used to acutely control symptoms during manic episodes Used long term to help stabilize mood Benefit patients with or without psychotic symptoms Can be combined with mood stabilizer Five antipsychotics approved for use Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), and ziprasidone (Geodon)
