DrVirgo
Forum Hero
Topics: 1084
Posts: 3,469
|
E? D/C Valproate?
C? Check platelet ct since valproic acid could cause thrombocytopenia;
Attached Files:
3.19.JPG (79 KB, 154 downloads)
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
C
___________________
The Key to Succeed is Patience.
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
Do not discontinue lithium and valproate because of relapse risk. Reduce dose may be ok
___________________
The Key to Succeed is Patience.
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
lithium is above the therapeutic index, & LITHIUM ADVERSE EFFECTS are DOSE DEPENDANT, so stop lithium first..
|
| khorshid
Forum Guru
Topics: 32
Posts: 591
|
C
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
can someone atleast explain how we can leave lithium above its therapeutic index??
i know its only 0.1 above the index but isn this cosidered safe??
|
| DrVirgo
Forum Hero
Topics: 1084
Posts: 3,469
|
cirus,
The THERAPEUTIC range as they say in the question is 0.6-1.2...
But for TOXICITY, we must keep the Lithium under 1.5
his level is 1.3 so he is ok. Plus his bipolar is well controlled on it so I wouldn't change dose, or anything... Just monitor the levels and watch for toxicity and other side effects.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
DrVirgo wrote:
cirus,
The THERAPEUTIC range as they say in the question is 0.6-1.2...
But for TOXICITY, we must keep the Lithium under 1.5
his level is 1.3 so he is ok. Plus his bipolar is well controlled on it so I wouldn't change dose, or anything... Just monitor the levels and watch for toxicity and other side effects.
Thnx, appreciate it
|
| DrVirgo
Forum Hero
Topics: 1084
Posts: 3,469
|
He has nose bleeds, which means there must be thrombocytopenia.
What is the cause of the nose bleeds here?
Which of these drugs (lithium, valproate, or bupropion) causes thrombocytopenia?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
I know that lithium may cause it
Valproic acid can do it
Valproic acid induced hepatotixicity & thrombocytopenia so it is usually associated with elevated LFTs
Bupropion causes leukopenia
Attached Files:
b-antidepressants and their hematologic side effects.jpg (194 KB, 50 downloads)
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
Mood hemat s eff
Attached Files:
mood stabilizers.jpg (203 KB, 33 downloads)
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
Antidep part A
Attached Files:
antidepressants and their hematologic side effects.jpg (117 KB, 31 downloads)
|
| DrVirgo
Forum Hero
Topics: 1084
Posts: 3,469
|
Thanks cirus, that was useful.
Are you sure about Lithium? Can it cause thrombocytopenia?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| gr8doc
Forum Senior
Topics: 8
Posts: 210
|
Good Work Cirus. However, I didn't see lithium as the culprit in any of the imaGES. i FEEL THAT a IS THE ANSWER, WE SHOULD CHECK FOR THE LIVER ENZYMES. AS mentioned in one of the earlier comments of Cirus, valproic acid is hepatotoxic. & the patient has presented with bleeding diathesis. I would have gone for A.
|
| DrVirgo
Forum Hero
Topics: 1084
Posts: 3,469
|
If its true that Valproic Acid causes hepatotoxicity AND thrombocytopenia, WHICH ONE shouls we check??? LFTs OR PLATELET COUNT???
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| drfax
Forum Elite
Topics: 21
Posts: 233
|
A is the answer
idiosyncratic fatal hepatotoxicity of valproate is rare but very important and can be monitored by checking LFT every 6 month in patients taking valproate
notice that this side effect occurs in therapeutic level (as in this patient) , not in overdose.
___________________
My best friends are these Gentlemen :Why & How.
|
| neuroblastoma
Forum Guru
Topics: 100
Posts: 1,018
|
C PLATELET COUNT is the first step to see if drug induced thrombocytopenia.
AST,ALT liver enzymes cannt tell u bleeding,rather PT,PTT should be chekced...so not agree with A
WE can reduce does of lithium But cannt stop it.
|
| neuroblastoma
Forum Guru
Topics: 100
Posts: 1,018
|
C PLATELET COUNT is the first step to see if drug induced thrombocytopenia.
AST,ALT liver enzymes cannt tell u bleeding,rather PT,PTT should be chekced...so not agree with A
WE can reduce dose of lithium But cannt stop it.
|
|
| |
| | | | | | | | | | | | | | | | | | |
