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Bipolar Disorder Medication – Antipsychotics

by Pravin Shukle, MD
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    Let's go on to the classical drug, lithium. Lithium is a very old drug. It was used as much as 200 years ago. The clinical uses of lithium include the manic phase of bipolar disease, acute phase illness with psychotic diseases and to prevent recurrent manic and depressive episodes in mania. The pharmacokinetics of lithium is what makes it so important for us as pharmacologist and practising physician. It is rapidly absorbed. It has a half time of about 20 hours, so it stays in the body a long time. When you talk about clearance, it's cleared at 20% of the rate of creatinine clearance. So we have to monitor plasma levels for 4 weeks when we initiate therapy or when we change the dose. Lithium will cause dehydration. It can interact with diuretics. It can interact with ACE inhibitors and using these medications at the same time as lithium can cause lithium toxicity. Caffeine and theophylline increase the clearance of lithium. So heavy coffee drinkers can actually have their lithium levels lower to the point where their disease gets worst. How does lithium work? Lithium has a complex reaction and interplay with the cell membrane and some of the important molecules in the cell membrane. It reduces phosphatidylinositol bisphosphate levels or PIP2 levels. This ends up resulting in a reduction in IP3 or inositol triphosphate levels. There you have it there and this causes a reduced synaptic release of amines. So uses in clinical medicine include bipolar disorder and we often use it in combination with antidepressants in these syndromes. Remember that antidepressants can also precipitate mania which is why we like to use these medications in combination. In terms of toxicity, lithium is very complicated. It can cause tremor, ataxia, aphasia. It can cause something called nephrogenic diabetes...

    About the Lecture

    The lecture Bipolar Disorder Medication – Antipsychotics by Pravin Shukle, MD is from the course CNS - Pharmacology.


    Included Quiz Questions

    1. Reduction in phosphatidyl bisphosphate (PIP2) and inositol triphosphate (IP3)
    2. Reduction in intracellular calcium
    3. Membrane stabilization via potassium and chloride channels
    4. Inhibit GPCR receptors on the cell membrane and the production of cyclic AMP
    5. Reduction in intracellular sodium
    1. Breast feeding mother
    2. Bipolar Disorder I
    3. Bipolar Disorder II
    4. A patient currently using an antipsychotic
    5. A patient currently using an antidepressent
    1. Clozapine
    2. Carbamazepine
    3. Clonazepam
    4. Olanzapine
    5. Valproic Acid

    Author of lecture Bipolar Disorder Medication – Antipsychotics

     Pravin Shukle, MD

    Pravin Shukle, MD


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