Term
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Definition
better for mixed episodes & rapid cycling than lithium
better for bipolar mania than bipolar depression
good for migraine prophilaxis? |
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Term
| Depakote can double lamitcal levels so always use half the dose of lamictal when on depokaote |
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Definition
do platelet count & LFT's before starting
& reguarly
consider coagulation studies before surgeries |
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Term
pt's weight prior to starting since it causes weight gain
overwight=BMI 25-29
obese= BMI over 30 |
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Definition
consider how weight gain might affect
risk for
diabetes or hyperlipidemia
if gained alot of wt on it consider testing for these |
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|
Term
Starting Dose:
250-500 first day for mild mania
acute mania may stat 1000mg??? |
|
Definition
Usual Dosages:
mania- 1200-1500mg
(qHS for depakote ER or BID for regular divalproex sodium (depakote) |
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Term
side effects:
sedation,
tremor (propranolol 20mg BID or TID may help)
dizziness,
ataxia?
GI, sausea, pain vomitting, diarrhea, reduced appitite,
alopecia (zinc & selenium may help)
weight gain
polycystic ivaries??
hyperandrogenism
hepatotoxicity , liver failure
rare oancreatitis
rare suicidality??? |
|
Definition
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|
Term
syrup = depakene
comes in depakote sprinkles too
depacon- injection |
|
Definition
| ER has less GI side effects & less alopecia than regular |
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|
Term
| er = 80% bioavailable so levels will be 10-20% lower |
|
Definition
trough blood level of 100 good
up to 125 may be better for acutely manic |
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|
Term
| doseages fir adeuadte blood level vary between 750-3000mg?? |
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Definition
| overdose may result in coma, heart block, hallucinations, sedation, restlessness |
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|
Term
may need to adjust other drugs during taper
patients may have seizures on withdrawal if abrupt |
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Definition
| metabolized by lover mostly |
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Term
| aspirin may increase levels by inhibiting its metabolism |
|
Definition
prozac, luvox & thorazine (chlorpromizine)
may increase depakote levels also
topamax also
erythromycin, advil & cimetidine also |
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Term
| ok with lithium & atypcial antipsychotics |
|
Definition
becareful of using depakote
with klonopin
-some reports of absense status |
|
|
Term
if change in mental status, lethargy, and vomitting develop draw an
ammonia level!!
-may develop hyperammonenmia with or without encephalopathy
(especially if with topamax) |
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Definition
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|
Term
hepatoxicity signs:
malaise
weakness
lethargy
facial edema
anorexia
vomitting
yellowing of the skin & eyes |
|
Definition
| abdonimal pain may also mean pancreatitis |
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|
Term
Teratogenic!
neural tube defects (in first trimester)
(spina bifida)
(Catagory D)
if used consider vitamin K to reduce bleeding risks in last 6 weeks
(try to discontinue before pregnancy
restart after delivery
(Atypical antipsychotics may be prefered in pregnancy)
(generally safe to breast feed although some in milk)(monitor infant for adverse effects-irritability or sedation) |
|
Definition
don't use in patients with
thrombocytopenia
(bleeding brusing) |
|
|
Term
Do not use
if urea cycle abnormilities |
|
Definition
| warn of activation of suicidal ideation? |
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|
Term
(under age 2 has high risk of hepatoxicity)
(can't eliminate it well) |
|
Definition
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|
Term
because of contriversial relationship to polycyctic ovary disease use caution in giving depakote to women of child bearing age & adolscent bipolar s.
Monitor wt, endocrine stats & ovairian size & function?? |
|
Definition
| inform females of the risk of harm to fetus in case they get pregnant |
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