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Behavioral Medicine > Bi-Polar Meds > Flashcards

Bi-Polar Meds Flashcards

1
Q

What medications may cause mania?

A

L- dopa and corticosteroids

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2
Q

In general with bipolar disorder what 5 things should you do before prescribing medication?

A

Asses if there is a drug/alcohol problem

D/c anti depressants

taper caffeine/stimulants

treat substance abuse

encourage diet and exercise

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3
Q

What drug might you chose to treat hypomania initially (4)

A

Lithium, valproate, carbamazepine, SGAs

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4
Q

If mono therapy is inadequate in treating hypomania what combonation drugs might you try?

A

Lithium + anticonvulsant or SGA

Anticonvolsant + SGA

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5
Q

What is an alternative for benzos when treating agitation?

A

oxcarbazepine

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6
Q

What drugs could you use to first treat mania?

A

Lithium, valproate and/or SGA and benzos

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7
Q

What is lorazepam especially indicated for?

A

Catatonia

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8
Q

How many drugs should you initially start off with in patients who have mania?

A

2-3

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9
Q

What is an alternative med in treating mania?

A

carbamazepine or oxcarbazepine

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10
Q

If lithium, valproate and or benzos/SGA do not work to treat mania what can be used?

A

Lithium + antipsychotic + anticonvulsant

Anticonvulsant + anticonvulsant + antipsychotic

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11
Q

What can be used in the most resistant cases of mania?

A

clozapine or ECT

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12
Q

What is preferred over valproate for treating bipolar depression?

A

lithium + lamotragine

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13
Q

What is the drug of choice for mania?

A

lihtium

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14
Q

What are the only approved mono therapies for bipolar disorder?

A

quetiapine- seroquel and lurasidone-latuda

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15
Q

How long to anti depressants take to star working with bipolar?

A

6-8 wks

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16
Q

What is lithiums half life and maintenance levels in blod?

A

0.6-1

24 hour half life

17
Q

What are the potential side effects for lithium?

A

rash/psoriasis

tremor/akathesia

hypothyroidisn

teratogenicity

18
Q

What drugs does lithium interact with to decrease concentration?

A

Pregnancy and theophylline

19
Q

What 3 main categories increase lithium concentrations?

A

ACEI, ARBS, NSIADS by decreasing kidney function

20
Q

What tests should be performed pre-lithium initiation and every 6 mos

A

pre :
CBC, BMP, TSH, urinalysis

6mo:
Serum Li, renal function, thyroid function

21
Q

What 3 anticonvulsants can be used to treat bi-polar disorder?

A

divalproex - depacon(IV)
valproic acid - Depakote

Carbamazepin(Tegretol

Lamotrigine ( Lamictal)

22
Q

How does divalproex work?

S/e

A

increases GABA available

great for mania, not so much depressive episodes

S/e: wt gain, hair loss, tremor “fat bald and shaky”
hepatotoxic and teratogenic

23
Q

What drug does valproic acid have an interaction with?

A

lamotrigine - competes for gluconoridation so you need to decrease lamotrigine by 50%

24
Q

When does carbamazepine work exceptionally well?

A

Head injuries for acute and maintenance biolar

25
Q

What is the most drastic side effect with carbamazepine along with the other 2 side effects?

A

Steven johnson syndrome in Asain ancestry with HLA B gene

SIADH

agranulocytosis and liver failure

26
Q

What type of inducer is carbamazepine? What does that mean?

A

CYP3A4 AUTOinduer… it induces itself so you progressively have to increase the dose

27
Q

What drug is structurally related to carbamazepine?

A

oxcarbazepine

28
Q

What is the MOA of lamotrigine?

What pts does it work best in?

S/e?

A

MOA: inhibit glutamate transmission

Works best in depressive bipolar bc glutamate is left in synapse

Steven Johnson Syndrome

29
Q

What drug interactions does lamotrigine have? how do you adjust for these TWO drug interactions?

A

valproic acid and carbamazepine

valproic - decrease by 50%
carbamazepine - increase by 50%

30
Q

What antipsychotic drugs should and should not be used with acute mania or mixed treatment?

A

all SGA can be used except:

brexpiprazole
cloxapine
iloperidone

31
Q

What are the only two antipsychotic medications approved to treat bipolar depression?

A

quetiapine - seroquel

lurasidone - latuda

32
Q

What should you never use as a mono therapy in bipolar patients due to the possibility of switching over to mania?

A

antidepressants

33
Q

What drug is significant in causing akathisia like tremors when treating bipolar disorder?

A

Lithium

Behavioral Medicine (9 decks)

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