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SHPCPJEN3 > Bipoladisorder > Flashcards

Bipoladisorder Flashcards

1
Q

Lithium and divalproex combined w/ an antipsychotic is more effective than mono therapy

A

T

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2
Q

Divalproex

A

Depakote

Anticonvulsant that works for bipolar disorder

Divalproex with an antipsychotic is more effective than mono therapy

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3
Q

Lamotrigine

A

Lamictal

anticonvulsant can be used for bipolar

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4
Q

Carbamazepine

A

Equetro

Anticonvulsant that can be used for bipolar

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5
Q

Quetiapine

A

Seroquel XR

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6
Q

Olanzapine

A

Zyprexa

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7
Q

Olanzapine / fluoxetine

A

Symbyax

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8
Q

Risperidone

A

Risperdal

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9
Q

Ziprasidone

A

Geodon

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10
Q

Aripiprazole

A

Abilify

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11
Q

Lurasidone

A

Latuda

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12
Q

Asepnapine

A

Saphris

This medication comes as sublingual

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13
Q

SIDE effects for Valproic acid

A

VaLProic Acid
L-check LFT severe hepatotoxicity
P- Pancreatitis
A- alopecia, can increase Amonia
And THOROMBOCYTOPENIA ( can increase bleed )

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14
Q

Lamotrigine SE

A

Main is rash : SJ : D/C on first sign. Dont rechallenge

Lam ODT trigine : comes ODT

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15
Q

Carbamazepine

A

Recall Carbamazepines looks like TCA ( tricyclic antidpressent ) = thats why they have anticholinergic effects

Aplastic anemia,
Agranulocytosis ( CBC )

If patient is Asian ( Asian ancestry ) must recommend HLA-B*1502

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16
Q

If patient is bipolar and is depressive bipolar and comes in with Major depression, i never give a SSRI/SNRI or any antidepressant alone

A

T

Bc it make some patients more manic

Combination of olanzapine and fluoxetine ( symbyax ) can be used. But never just an SSRI or SNRI alone.

17
Q

Lithium
Indication
MOA
Levels

A

Really good for bipolar. DOC: Lithium But lots of SE’s

Levels need to be 0.6 to 1. If you above more toxicity
Positively charged element or ion. ( eg. Patient has severe diarrhea and loses a lot of electrolytes. You see positively charged sodium levels have dropped. What goes up ? Lithium levels go up. Lithium will often go in the opposite direction of sodium. Lithium toxicity.

Off label use depression.

MOA: exact is unknown. Increases Serotonin and NE. Dont want to give MAOIs.

18
Q

Pregnancy category for lithium

A

D

19
Q

Lithium levels

A

Draw serum levels just before the next dose ( 12 hours post dose ) after 5 days of treatment

Acute levels 0.8 - 1.2 mEq/L
- maintenance: 0.6 - 1.0 mEq/L

Lithium’s effect usually begin in 1 week & full effect is seen by 2 to 3 weeks

LITHIUM is 100 percent through renal system. No liver metabolism at all. As patient ages renal goes down. So reduce dose in elderly. 300 mg day with levels of 0.4 to 0.6

Regular patient is 300-600 mg BID to TID starting
Effective range is 900 to 1800 mg /day ( 15-20 mg/kg )

20
Q

Lithium side effects

A

GI: take with food. High w/citrate form due to direct effect on GI mucosa. Take with food. Divide doses

Fine international hand tremor. : reducing the dose and add a bb ( propranolol )

• nephrogenic diabetic insipidus : if patient on been for LT could see this se. This is due to effect on Collecting duct and affecting ADH. Resistance to ADH, resulting in polyuria and polydispsia —-> could lead to lithium toxicity
-if possible Lithium should be D/C’d
- if Li absolutely necessary add the K-sparing diuretic amiloride

21
Q

Lithium maintenance dose

A

0.6 - 1.0 mEQ/L

22
Q

Management of lithium toxicity

A

No antidote

Accuse toxicity: NVD. Give whole bowel irrigation w PEG. Never use charcoal. Does not absorb lithium.

Chronic toxicity : has used lithium chronically and therapeutic level is up. You can have major CNS effects. Could lead to seizures/coma/death.
- lithium is dialyzable : hemodialysis ( low molecular weight ).
If greater than 2.5 with s/sx seizures use hemodialysis. If > 5 use hemodialysis

23
Q

What drugs can increase lithium?
Why

A

Thiazides and ACE , and NSAIDs ( sulidac and ASA do not appear to affect [ Li ] )
•Lithium goes in opposite direction of sodium. Thats why Thiazides and ACE increase lithium
•NSAIDs increase lithium bc NSAIDs work on kidneys and lithium work on kidneys and NSAIDs do not allow that lithium to be secreted.
• sodium restriction/ dehydration —> increase lithium toxicity

24
Q

SSRI and lithium ddi

A

Additive. Li increase H-HT and so do SSRI —> risk of seratonin syndrome

25
Q

what to monitor for Lithium?

A

•Serum Li ( 0.6 to 1)
•BUN and SCr: baseline then q 2-3 and once every 6 months then once a year.
• CBC : increase in wbc
•calcium: li can cause hypercalcemia. —> hyperparathyroidism could lead to osteoporosis
•sodium

TSH : can cause hypothyroidism ( rarely hyper )
EKG
Weight gain

26
Q
A
27
Q

Dystonia

A
28
Q

Tardive Dyskinesia

A
29
Q

Neuroleptic Malignant Syndrome

A
30
Q

Akathisia

A
31
Q

Drug induced parkinsons

A
32
Q

Dy

A
33
Q

If there is a deficit in central dopamine transmission it can result in

A

Overactive striatal acetylcholine release. That leads to dystonic reactions.

34
Q

ODT antipsychotics

A

ORCA

Olanzapine
Risperidone
Clozapine
Aripiprazole

35
Q

Available in oral liquid solution

A

Aripiprazole
Clozapine
Risperidone

36
Q

This medication is administered by a healthcare professional by oral inhalation

A

Loxapine ( Adusuve ) for acute agitation

37
Q

Rapid antipsychotic IM formulation

A

Haloperidol ( Haldol )

Ziprasidone ( Geodon )

Zyprexa ( olanzapine )

38
Q

Decanoate formulations for antipsychotics

A

Haloperidol
Palipeidone
Olanzapine
Risperidone
Fluphenazine

SHPCPJEN3 (13 decks)

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