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AIDS or other medically ill patients prone to dehydration or malabsorption with wide swings in serum lithium levels Valproic acid has also been used effectively in panic disorder and migraine headache Treatment is often started at a dose of 750 mg/d orally in divided doses, and dosage is then titrated to achieve therapeutic serum levels Oral loading in acutely manic bipolar patients in an inpatient setting (initiated at a dosage of 20 mg/kg/d) can safely achieve serum therapeutic levels in 2 3 days Concomitant use of aspirin, carbamazepine, warfarin, or phenytoin may affect serum levels Gastrointestinal symptoms and weight gain are the main side effects Liver function tests, complete blood counts, glucose levels, and weight should be monitored, and teratogenic effects are a concern

As you saw in 3, the assignment operator causes the operand on the left side of the operator to have its value changed to whatever is on the right side of the operator. The following expression assigns the value 15 to myVariable:

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Carbamazepine, an antiseizure drug that stabilizes the activity of cell membranes, has been used with increasing frequency in the treatment of bipolar patients who cannot be satisfactorily treated with lithium (nonresponsive, excessive side effects, or rapid cycling) It is often effective at 800 1600 mg/d orally It has also been used in the treatment of resistant depressions, alcohol withdrawal, and hallucinations (in conjunction with neuroleptics) and in patients with behavioral dyscontrol or panic attacks It suppresses some phases of kindling (see Stimulants) and has been used to treat residual symptoms in previous stimulant abusers (eg, PTSD with impulse control problems) Dose-related side effects include sedation and ataxia Dosages start at 400 600 mg orally daily and are increased slowly to therapeutic levels Skin rashes and a mild reduction in white count are common SIADH occurs rarely Nonsteroidal anti-inflammatory drugs (except aspirin), the antibiotics erythromycin and isoniazid, the calcium channel blockers verapamil and diltiazem (but not nifedipine), fluoxe-

Valproic acid (divalproex) is an antiseizure drug whose activity is at least partially related to GABA neurotransmission It is a first-line treatment for mania because it has a broader index of safety than lithium This issue is particularly important in

tine, propoxyphene, and cimetidine all increase carbamazepine levels Carbamazepine can be effective in conjunction with lithium, although there have been reports of reversible neurotoxicity with the combination Carbamazepine stimulates hepatic microsomal enzymes and so tends to decrease levels of haloperidol and oral contraceptives It also lowers T4, free T4, and T3 levels Cases of fetal malformation (particularly spina bifida) have been reported along with growth deficiency and developmental delay Liver tests and complete blood counts should be monitored in patients taking carbamazepine Oxcarbazepine, a derivative of carbamazepine, does not appear to induce its own metabolism and is associated with fewer drug interactions, although it may impose a higher risk of hyponatremia FDA-approved for partial seizures, oxcarbazepine may have efficacy in acute mania It appears to be a safer alternative to carbamazepine due to its lower risk of hepatotoxicity

myVariable = 15;

Lamotrigine is thought to inhibit neuronal sodium channels and the release of the excitatory amino acids, glutamate and aspartate It is FDA approved for long-term maintenance of bipolar disorder Two double-blind studies support its efficacy in the treatment of acute bipolar depression as adjunctive therapy or as monotherapy Its metabolism is inhibited by coadministration of valproic acid doubling its half-life and accelerated by hepatic enzyme-inducing agents such as carbamazepine More frequent mild side effects include headache, dizziness, nausea, and diplopia Rash occurring in 10% of patients is an indication for immediate cessation of dosing, since lamotrigine has been associated with Stevens-Johnson syndrome (1:1000) and, rarely, toxic epidermal necrolysis Dosing starts at 25 50 mg/d and is titrated upward slowly to decrease the likelihood of rash Slower titration and a lower total dose are indicated for patients taking valproic acid Topiramate, which has been labeled for use as an anticonvulsant, has been found to be effective in the adjunctive treatment of bipolar disorder in a series of open-label studies It has the unique feature of promoting weight loss as a side effect Other common side effects include somnolence, difficulty with memory, dizziness, and anxiety

The Mac OS organizes memory into system and application partitions. Figure C.3 provides an overview of the Mac OS memory layout. System components exclusively occupy the system partition; they include system software, extensions loaded at boot time, and device drivers. The lowest area of memory is reserved for the system s global variables, which include the current application, the system uptime, and the height of the menu bar. Programs typically access this information through Toolbox calls; the Mac OS does not restrict direct access. The next area of memory is the system heap. It holds operating system code and data structures.

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