Lithium for Bipolar Disorder Quiz

Corticosteroids and Bipolar Disorder

• Corticosteroids can increase mania in patients with bipolar disorder
• Side effects of corticosteroids include: • Increased appetite and weight gain • Fluid retention leading to bloating and increased blood pressure • Mood changes, including irritability, mania, and anxiety • Insomnia or disrupted sleep patterns • Increased risk of infections due to immune suppression • Osteoporosis and increased fracture risk • Muscle weakness and atrophy • Glaucoma and cataracts, particularly with topical or high-dose use • Gastrointestinal issues like heartburn and ulcers • Skin changes such as thinning, bruising, and stretch marks • Adrenal suppression/DM with long-term use

Migraine Treatment

• First-line abortive treatments for mild to moderate attacks: • Acetaminophen • NSAIDs • Aspirin-acetaminophen–caffeine (Excedrin Migraine)
• First-line abortive treatments for moderate to severe attacks: • Triptans • Antiemetics: dopamine antagonists
• Triptans: • Sumatriptan (rapid onset) • Rizatriptan • Naratriptan (slow onset but long half-lives) • Zolmitriptan • Frovatriptan (slow onset but long half-lives) • Eletriptan
• Contraindications for triptans and ergots: coronary artery or uncontrolled hypertension
• Precautions: • Frequent use of acute-treatment drugs can result in MOH (especially Excedrin, triptans, butalbital) • Triptan common adverse reactions: chest pain, flushing, weakness, dizziness, and paresthesias
• Second-line abortive treatment: • Ubrogepant • Rimegepant • Dihydroergotamine (drug of choice in status migrainosus and triptan resistance or failure)

Preventive Treatment for Migraines

• Consider prophylactic treatment if: • Quality of life is severely impaired • ≥6 headache days per month, ≥4 headache days per month of moderate severity, or ≥2 headache days per month of severe impairment • Migraines not responding to abortives • Frequent, long, or uncomfortable auras
• First-line preventive treatment: • Lifestyle modifications • Trigger reduction • CBT
• Other options: • Divalproex • Topiramate • Metoprolol • Propranolol • Amitriptyline • Venlafaxine • Lisinopril • Candesartan

Abortive Therapy for Migraines

• Triptans: constrict blood vessels and block pain pathways
• NSAIDs: reduce pain and inflammation
• Acetaminophen: provides relief for mild migraines, often combined with caffeine
• Ergotamines: constrict blood vessels and block pain pathways
• Anti-nausea medications: relieve nausea and vomiting

Red Flag Symptoms for Headaches

• Sudden onset of severe headache
• Headache associated with neurological symptoms
• Headache after head injury
• Headache accompanied by fever, stiff neck, rash, or confusion
• New headache in individuals over 50 years old
• Headache worsened by coughing, exertion, or sexual activity
• Headache that wakes a person from sleep
• Headache in patients with a history of cancer or HIV/AIDS
• Progressive headache that increases in severity and frequency
• Headache triggered by certain activities or positions
• Pain is disabling, burning, or boring and centered around one eye

Bipolar Disorder Treatment

• Lithium is primarily used to treat bipolar disorder, including acute mania, acute episodes with mixed features, acute hypomania, and acute bipolar major depression
• Therapeutic response occurs with serum concentrations between 0.8 and 1.2 mEq/L
• Dosage varies by age and weight, with adjustments for pediatric and older adult patients
• Contraindicated in severe cardiovascular or renal disease and interacts with many drugs
• Side effects can be significant, including lithium toxicity