DrPak
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The huband of a 31 year old woman brings his wife to you for treatment. He says his wife has been behaving very recklessly of late. She would go out on expensive shopping sprees to buy things they didn't need, she would start projects like painting the house only to leave the job undone, she would act irritably, wouldn't sleep much or pay attention to events around her and generally would be on the move all the time. Hhe said such episodes would last about a week until she exhausted herself and would thereafter sleep for 14 hours a day, and feel tired even when she woke up. She would cry impulsively and wouldn't eat. After a week of this sort of behavior, she would go back to her previous pattern of behavior. He said this cycle of behavior has been repeating itself for half a year now. Her husband in the end reveals to you that his wife is 2 months pregnant.
What medication would you give to this patient?
a. Carbamazepine
b. Clonazepam
c. Valproic Acid
d. Fluoxetine
e. Lithium
f. Bupropion
g. Clozapine
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| Doc2378
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Hmmm...good question DrPak...
Looks like that this female has bipolar disorder (?) so we can try Lithium, a mood stabilizing drug albeit with close monitoring of serum levels due to shifting plasma levels in pregnancy.
Clozapine is quite safe in pregnancy but it indicated more in Schizophrenia...
Both carbamazepine (A) and valproate (C) are associated with increased risk for spina bifida in fetuses exposed in the first trimester...
Anyone else?
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| sarika
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clozapine
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| sarika
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sorry in pregnant bipolar patients we used clonazepam or gabapenten instead of lithium since lithium is teratogenic. So the answer is Clonazepam
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| DrPak
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Yes, clonazepam is the right answer. The woman obviously has bipolar disorder so your choice of drugs is lithium and then the backup drugs, valproic acid, carbamazepine, gabapentin and clonazepam. Of these choices, only clonazepam and gabapentin can be given to pregnant patients, and the answer available is clonazepam.
Clozapine isn't an option at all here, it's an antipsychotic and even for that is mostly a drug of last resort. It was actually taken off the market for 10 years for the agranulocytosis side effects and if used now requires mandatory regular blood monitoring. I think you're confusing the use of clozapine with that of the older antipsychotics in bipolar disorder. Antipsychotics are used for bipolar disorder (Kaplan Pharma page 162), but Anthony Trevor said that it's real use in such conditions is to calm the patient down through the sedative effects that antipsychotics have. Sedation occurs with the older antipsychotics, not the newer ones, like clozapine.
Bottom line:
pregnant bipolar=clonazepam or gabapentin.
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| Doc2378
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Thanks DrPak..very useful discussion.
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Courage does not always ROAR. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow" - Mary Anne Radmacher
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| sturge_weber
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good ques
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