Patient Case: Bipolar Disorder and Epilepsy

Below is the patient case information: 63-year-old white male. Problem List Bipolar II disorder Insomnia Epilepsy (tonic-clonic seizures) Dyslipidemia/hypertriglyceridemia Hypertension Recent weight gain History of hyponatremia  Diabetes type 2(controlled) Medications Clonazepam 2 mg QHS Risperdal 2 mg twice daily Carbamazepine 200 mg twice daily Divalproex DR 500 mg three times daily Levetiracetam 1000 mg twice daily Losartan 100 mg daily HCTZ 25 mg daily Atorvastatin 40 mg daily Fenofibrate 48 mg daily Metformin ER 500 mg twice daily Vitals: Blood pressure is currently 144/86 mmHg Lipids: LDL-C: 98 Triglycerides: 245 (down from 423 4 months ago) CMP: Na+: 133 K+: 4.1 eGFR: 95 All others WNL as well CBC: Hgb: 10:1 g/dL MCV: 73 Ferritin: 17 A1c: 6.9% Current Appointment The patient has seen multiple neuro and psych providers over the last year.  The R­­isperdal and divalproex were for the bipolar II disorder. The patient is experiencing depression symptoms. His family notes that he has also been uncharacteristically aggressive lately and becomes agitated over minor issues. His family has recently noticed that while talking with him, his face is grimacing, his tongue will randomly protrude from his lips, as well as other facial movements. The clonazepam for insomnia. It helped with insomnia symptoms for a few weeks, but the symptoms are back to pre-treatment baseline. He was taking clonazepam 1 mg 2 hours prior to bed and zopidem 5 mg 30 minutes prior to bedtime. He didn’t feel like the zolpidem was working. The clonazepam was increased to 2 mg and the zolpidem was DC’d. He is also complaining of daytime fatigue He was recently hospitalized due to hyponatremia. The carbamazepine and levetiracetam were for seizure control. However, the patient has experienced multiple seizures per month for at least the last 3 months. Needs better blood pressure and triglyceride control Thanks for listening! We want to give a big thanks to our main sponsor Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.