University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

414

Pages:

1
Author:

rezancuk2j

4.1 – “Ski Man Mania”: ia”: Lithium • Bipolar consists of manic phases and depressive phases (two ski poles stabilize; peaks and valleys of mountains) • Lithium (lift) o Can be used to treat acute mania, or prophylactically for mania and depression. o Inhibits signal transduction pathways, including inositol triphosphate and other signaling. o Narrow therapeutic index (narrow window to get off the lift) o Urinary excreted. Anything that affects GFR will affect levels (e.g. diuretics such as thiazide may ↓ by as much as 25%; NSAIDS decrease) (kid on high dive; “low clearance” sign). o Adverse effects: ▪ Acute toxicity with GI SSx (skier on lift looks ill) ▪ Chronic → development of neuro SSx (e.g. tremor, confusion, ataxia) (trembling ski pole). ▪ Reversible thyroid inhibition in most patients (penguin with untied bow tie). Generally not symptomatic; may occasionally present with hypothyroid (e.g. weight gain) (snowboarder) ▪ Can induce diabetes insipidus (frozen fountain). Antagonizes action of ADH in collecting tubules. Polydipsia & polyuria usually resolve with cessation, but may be permanent with chronic use. ▪ Teratogenic (tarantula hats). Causes Epstein’s abnormality: arterialization of the R ventricle, ASD, malformation tricuspid (shapes of snowmen heads). Kids will present in later life with fatigue, tricuspid regurgitation. ▪ If patient on lithium presents with new onset neuro or psych SSx while on lithium, take a break from treatment. • Valproate therapy (“Festival” on violet banner) o Antiepileptic that can be used first line for acute mania or maintenance therapy. Can be combined with lithium for treatment refractory to either agent alone. • Carbamazepine (classic carved car) o Antiepileptic that can be used first line for acute mania or maintenance therapy • Lamotrigine (llama outfit) o Antiepileptic that can be used first line for maintenance therapy; can prevent depressive cycles. • Both first- & second-generation antipsychotics can treat acute mania (paintings on the peak) o Include haloperidol (halo in starry sky)