Patient JB comes to the emergency department complaining of confusion and nausea/vomiting. The nausea/vomiting has been occurring for 3 days, but the confusion started appearing today. JB's medication list includes lithium 600 mg BID, metformin 500 mg BID, and Vitamin D 25 mcg daily. The metformin and vitamin D have been on board for several years. A lithium level is drawn and comes back at 1.9 mEq/L. Creatinine is 0.8 mg/dL and A1C at last check was 7.7. What actions should be taken to help JB?

JB is now feeling better and is looking to be discharged today. They ask to speak to the pharmacist about their medication regimen and if there is anything to avoid while taking their medications, specifically their lithium. Which of these would you tell JB?

MP is a patient with schizophrenia coming to you frustrated with his medication regimen. He has trialed Haldol, Abilify, and Seroquel with no benefit. MP mentions that one of his friends trialed a medication that “made them get man boobs” and wants to avoid that. What medication would you recommend MP trial?

MP has been taking clozapine for a few weeks now and is in the clinic today to check his ANC. The ANC comes back at 842/mcL. What should MP do?

TL is a patient looking for a recommendation for an oral antipsychotic. She smokes 1.5 packs per day (15 year pack history) with no plans on quitting. She would like a medication that doesn’t need to be taken with food as she often feels nauseous and struggles to eat consistently. Would medication would be a good option for TL? 

KN is a patient looking for a medication to treat her bipolar disorder. She is trying to have a child and wants a medication that would be safe during pregnancy. What medication has the highest risk of birth defects?

What would you want to educate a patient about with the use of lamotrigine?

Which class of medication should be avoided in bipolar disorder as they may increase the likelihood of mania?

WI is a patient with schizophrenia who struggles with adherence. They would be okay with starting a long-acting injectable, but says “I’m kind of afraid of needles, so I would only want this to happen as minimal as possible.” Which long-acting injectable do you recommend for WI?

GE is the parent of SE, a 9-year-old female with bipolar disorder. GE would like to start a medication with SE for bipolar disorder but wants a medication that is FDA-approved for children. Which of these medications is FDA-approved for bipolar disorder in a child that is SE’s age?