Valproate NTD inc risk of fetal anomalies fetal valproate syndrome and long

Valproate ntd inc risk of fetal anomalies fetal

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Valproate: NTD, inc risk of fetal anomalies, fetal valproate syndrome and long term AE cognitively AVOID especially in first trimester CBZ: fetal CBZ syndrome→ facial abnormalities AVOID especially in first trimester Lithium: inc in congenital cardiac malformation and other abnormalities Second gen AP’s are safer Lurasidone has the safest SE profile, however it is only FDA approved for bipolar depression Lithium: influences reupatek of serotonin and/or NE and inhibits postsynaptic D2 receptor supersensitivity May be neuroprotective Start at 150-900mg/day divided TID max 900-1800 mg/day divided TID-QID ER taken BID Trough: 0.6-1.2mEq/L Acute mania may need 1.5 mEq/L initially BBW: toxicity SE: GI upset, cognitive effects, cogwheel rigidity, tremor, wt gain, polyuria, polydipsia, hypothyroidism Toxicity: >1.5 mEq/L: coarse hand tremor, vomiting persistent diarrhea, ataxia >2.5 mEq/L: CNS depression, arrhythmia, seizures, irreversible brain damage, coma 100% renally cleared Li levels inc by dec Na intake (ACEi/ARBs or thiazides dec Na) Li levels dec by inc salt intake, caffeine and theophylline Inc risk of serotonin syndrome with DDIs Inc risk of neurotoxicity: verapamil, diltiazem, phenytoin, and CBZ Dosing: 5 mL Li citrate=8 mEq 8 mEq= 300 mg Li carbonate tabs/caps Make sure to stay hydrated
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  • Summer '17
  • fetal valproate syndrome

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