Podcast
Questions and Answers
What side effect can corticosteroids cause in terms of mood changes?
What side effect can corticosteroids cause in terms of mood changes?
What side effect can corticosteroids cause in terms of bone health?
What side effect can corticosteroids cause in terms of bone health?
Which GI issue can be a side effect of corticosteroids?
Which GI issue can be a side effect of corticosteroids?
Which condition is a contraindication for using triptans or ergots for migraine?
Which condition is a contraindication for using triptans or ergots for migraine?
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Which drug is considered first-line for preventive treatment of migraines?
Which drug is considered first-line for preventive treatment of migraines?
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Which class of medications is effective in prophylactic treatment of migraines?
Which class of medications is effective in prophylactic treatment of migraines?
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Which type of medication constricts blood vessels and blocks pain pathways in migraine treatment?
Which type of medication constricts blood vessels and blocks pain pathways in migraine treatment?
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What is a red flag symptom for headaches that should raise concern?
What is a red flag symptom for headaches that should raise concern?
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Which condition would lead a healthcare provider to consider prophylactic treatment for migraines?
Which condition would lead a healthcare provider to consider prophylactic treatment for migraines?
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Which symptom should prompt immediate medical attention in individuals with headaches?
Which symptom should prompt immediate medical attention in individuals with headaches?
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What is the primary use of lithium according to the text?
What is the primary use of lithium according to the text?
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What serum concentration range is typically effective for most patients treated with lithium?
What serum concentration range is typically effective for most patients treated with lithium?
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Why is it crucial to monitor serum lithium levels closely according to the text?
Why is it crucial to monitor serum lithium levels closely according to the text?
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In addition to mania, what other acute episode in bipolar disorder can lithium be used to treat?
In addition to mania, what other acute episode in bipolar disorder can lithium be used to treat?
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What is a contraindication for the use of lithium according to the text?
What is a contraindication for the use of lithium according to the text?
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What can occur even at therapeutic doses of lithium based on the text?
What can occur even at therapeutic doses of lithium based on the text?
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Study Notes
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
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Description
Test your knowledge about the use of lithium in treating bipolar disorder, including its narrow safety profile, therapeutic serum concentrations, and various off-label uses. This quiz covers the primary and alternative uses of lithium in managing different phases of bipolar disorder.
