Speech and motor hyperactivity

reduced need for sleep

flight of ideas

grandiosity

elation

poor judgment

aggressiveness

hostility

Being on top of the world, nothing can go wrong, like the energizer bunny. 

Lithium therapy can alter levels of what electrolyte?

Decrease in # and severity of episodes

Effective in 80% of cases

Dry mouth, nausea, diarrhea, thirts, drowsiness, weight gain, sleeplessness in early weeks.

Higher levels produce more weight gain, metallic taste, altered taste in food, headache, pruritis, edema of hands and feet.

LOW margin of safety

VERY LOW

Therapeutic level: 0.8-1.2 mEq/L

Toxic level: 1.5-2.0 mEq/L

Lithium therapy: 

If a patient is affected by diarrhea, high fevers, or dehydration, will this increase or decrease serum levels?

Increase serum levels

Lithium therapy:

If a patient is taking diuretics or is on a low salt diet, will lithium serum levels be increased or decreased?

Lithium therapy:

If a patient has a high intake of sodium bicarbonate, or high salt intake, will this increase or decrease serum levels?

Lithium therapy:

During pregnancy, is a patient likely to have decreased or increased serum levels?

How does lithium interact with diuretics?

Thyroid hormone

it may be inhibited, and may require replacement therapy

GI disturbances

anorexia, bloating, slight nausea

Can be present in therapeutic or overdose range.

Drowsiness,

worsened nausea and diarrhea

(sometimes, a patient will have a degree of nausea/diarrhea when levels are normal, but if it suddenly gets worse, it may be an indication of early toxicity)

Vomiting

Muscle weakness

ataxia

polyuria

circulatory collapse

Delayed release has less GI SE

Still need to draw for drug levels.

Timing of a blood draw for a patient on valproic acid

(When are peak serum levels?)

Peak levels:

• Regular release:
•  1-4 hours after taking drug
• Extended release:
• 3-4 hours

• Act as cortical and RAS stimulant by releasing catecholamines
• improve concentration and ability to focus on incoming stimuli
• Paradoxically calms hyperactive children

Controlled substances

Rapidly absorbed from GI tract

Half life: 2-15 hr

Allergy

Marked anxiety, agitation, glaucoma

severe fatigue, cardiac disease, pregnancy

CNS stimulants: Side effects

• CNS
• Nervousness, insomnia, dizziness, HA, blurred vision
• GI
• Anorexia, Nausea, weight loss
• CV
• Hypertension, angina, dysrhythmias
• Skin rash is common rxn

MAOI

anti-hypertensives (will decrease/reverse effects)

Increased toxicity with TCAs or Dilantin

Caution if seizure disorder or ETOH/drug dependence

Names of CNS stimulants

Methylphenidate (Ritalin, Concerta)

Dextroamphetamine (Dexedrine)

Pemoline (Cylert)

Stattera

Not a controlled substance, not amphetamine based

Modafinil (Provigil)

for narcolepsy

Fewer cardiac SE

Not controlled, so wouldn't need to visit doctor on monthly basis

insomnia (are they sleeping?)

Suppressed appetite (are they eating?)

Monitor weight gain (if they aren't gaining weight, we need to switch to a non-amphetamine drug so we don't interfere with growth)

The work on monoamine oxidase - an enzyme found in the nerve cells, liver, and brain

Block MAO on the surface of the cell mitochondra,

result:

more NE available for release and in the synapse

CNS depresssants

anesthetics

antidepressants

antidiabetic agents

dextromethorphan

opioids

ritalin

sympathomimetis

OTC

The list goes on...

Marplan

Nardil

Parnate

When nothing else seems to work

Also a big cornerstone for parkinson's care

Tyramine-rich foods:

aged cheese, yogurt, sour cream, cottage cheese, chocolate, bananas, rasins, salami, bologna, caffeine, soy sauec, beef & chicken liver, dried fish, alcohol