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Cartilage damage
0%
0/50
Ototoxicity
2%
1/50
Kernicterus
Inhibition of bone growth
Cardiac malformations
96%
48/50
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In addition to the 5-10% risk of bipolar disorder in this patient's unborn child, exposure to lithium in utero may result in Ebstein anomaly and malformation of the great vessels. Lithium is the most established treatment for bipolar disorder. It is effective in both maintenance therapy, blocking relapse, as well as in acute manic events. However, the drug may also cause a wide range of side effects to the adult and the unborn fetus. In the adult, common side effects include tremor, sedation, edema, heart block, hypothyroidism, and nephrogenic diabetes insipidus. In the fetus, the drug is a known teratogen which may cause Ebstein anomaly. This congenital heart defect is characterized by displacement of the septal leaflet of the tricuspid valve towards the apex of the right ventricle. This leads to atrialization of the right ventricle which may result in cardiac failure at birth and requires surgical correction. In pregnancy the risks of continuing lithium should be balanced against the risks of stopping lithium for the mother. Griswold and Pessar review management of bipolar disorder. The disease is commonly diagnosed in patients between 18 and 24 and is commonly comorbid with substance abuse and anxiety disorders. The disease is characterized by variation in mood from elevation and or irritability to depression. Price and Marzani-Nissen review bipolar disorder and note that mood stabilizers such as lithium and anticonvulsants should be continued indefinitely because of the risk of relapse. Antidepressants are contraindicated in mixed states, manic episodes, and bipolar I disorder because they may worsen symptoms. Sharma and Pope discuss pregnancy and bipolar disorder. Historically, the postpartum period had been considered to be a time of heightened vulnerability to bipolar disorder. Initial evidence suggests that pregnancy may have a positive impact on bipolar disorder. However, after pregnancy, patients who discontinue their mood stabilizers still have a high rate of recurrence despite the positive effect. Illustration A represents atrialization of the right ventricle seen in Ebstein anomaly. Incorrect Answers: Answer 1: Cartilage damage may be caused by use of fluoroquinolones during pregnancy. Answer 2: Ototoxicity may be caused by aminoglycoside use in pregnancy. Answer 3: Kernicterus may be caused by sulfonamide use during pregnancy. Answer 4: Tetracycline use during pregnancy may cause inhibition of bone growth.
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