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Bipolar Flashcards

1
Q

What are the stages of bipolar?

A

-Mania
-Hypomania
-Depression
-Mixed episodes

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2
Q

What does it mean when a mood is euthymia?

A

Stable

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3
Q

A patient presents with increased activity, rapid speech, elevated mood and insomnia, what can this be an example of?

A

Drug Induced Mania

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4
Q

What medications can induce mania?

A

-Hallucinogens - LSD
-CNS stimulants - Amphetamine, Caffeine
-Antidepressants - Depression to mania
-Antipsychotics

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5
Q

If someone is having a manic episode what should be stopped?

A

Antidepressants and stimulants

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6
Q

What medications should be commenced during Mania?

A

Benzodiazepines, Antipsychotics

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7
Q

When can hypnotics/sedatives be used in mania?

A

When sleep deprivation is likely to escalate manic behaviour

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8
Q

What anti-psychotic must start with a slow dose due to the risk of postural HTN?

A

Quetiapine

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9
Q

What medication can you not give benzo’s within an hour of short-acting IM?

A

Olanzapine

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10
Q

Does smoking interact with Olanzapine?

A

Yes

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11
Q

What medications are first lime for Mania/Hypomania, acute phase?

A

-Lithium
-Valproate
-Olanzapine
-Quietiapine
-Aripiprazole

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12
Q

What medications are first like for mania/hypomania relapse prevention?

A

-Lithium
-Valproate
-Olanzapine
-Quietiapine
-Aripiprazole

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13
Q

What medications are second line for mania/hypomania acute phase? *Licensed?

A

-Carbamazepine
-Risperidone
-Asenapine

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14
Q

What medications are second like for mania/hypomania? Relapse prevention? *Licensed?

A

-Carbamazepine
-Risperidone

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15
Q

What medications are First line licensed for Acute Bipolar Depression?

A

-Lithium
-Quetiapine

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16
Q

What medications are Second line licensed for Acute Bipolar Depression?

A

Carbamazepine

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17
Q

What medications are First line licensed for Relapse prevention Bipolar Depression?

A

-Lithium
-Quetiapine

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18
Q

What medications are second line licensed for Relapse prevention Bipolar Depression?

A

Carbamazepine

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19
Q

What medication has a rare but serious side effect of Stevens-Johnson Syndrome (SJS)?

A

Lamotrigine = Skin!!!

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20
Q

If antidepressants are used in bipolar they should be combined with what in order to be safe?

A

Mood stabilisers

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21
Q

What is the standard drug combination for Bipolar Mania?

A

Antipsychotic and/or mood stabiliser + benzodiazepines

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22
Q

What is the standard drug combination for Bipolar Depression?

A

Lithium, lamotrigine or valproate, quetiapine, risperidone or olanzapine

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23
Q

What is the standard drug combination used for relapse prevention?

A

Mood stabilisers + Antidepressants
OR
Lamotrigine + Antidepressants

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24
Q

What are the worst mood stabilisers in pregnancy?

A

-Lithium
-Carbamazepine
-Valproate

25
What are the worse mood stabilisers in hepatic impairment?
-Lamotrigine -Valproate -Carbamazepine
26
What are the worst mood stabilisers in renal impairment?
-Lithium -Sulfiride -Amulsuride -Lamotrigine
27
If a patient has had symptoms of an episode for 7+ days, has severe functional impairment and have psychotic features, what is this?
Mania
28
If a patient has elevated and irritable mood for 4 days or more, and a decreased or increased function without Psychotic features what is this?
Hypomania
29
What medication is gold standard for relapse prevention in Bipolar?
Lithium
30
Why isn't lithium used in mania?
It takes 5-7 days to kick in
31
What neurotransmitters production and turnover are modified by lithium?
-Serotonin -May block Dopamine receptors
32
Is lithium BRAND specific?
YES!
33
What strength is Priadel liquid (Lithium) ?
520mg/5ml
34
What can Lithium do to a patients ECG?
QT interval prolongation
35
What physical monitoring needs to be done before initiating treatment on Lithium?
-ECG -Renal function -Thyroid -Weight/BMI -Ca -U&E's -FBC
36
What is lithium excreted via?
The Kidneys
37
How often do plasma levels need to be taken on lithium?
Weekly until stable
38
When should plasma levels be taken after a dose change of lithium?
4-7 days after each dose change
39
What is the lithium range?
0.4-1 mmol/L
40
What is the lithium range in mania?
0.8
41
What is the usual dose range of lithium?
400mg-1.2g daily
42
If a patient is less than 50kg should we avoid lithium?
YES
43
What drug can make you gain up to 27kg?
Lithium
44
If you get swollen ankles when on lithium what should we do?
Dose reduction
45
If a patients lithium levels are over 1.5 what does this mean?
May be fatal and have a toxic effect
46
If lithium levels are over 2mmol/L what should we do?
Requires URGENT medical attention! = Kidney damage
47
Pt X, presents with severe hand tremor, stomach ache and n&d, Muscle weakness, unsteady, slurring, blurred vision, confused, usually sleepy and has muscle twitches, what drug can cause this?
Lithium Toxicity
48
What can severe toxicity of lithium cause?
-Convulsions -Coma -Renal and circulatory failure -Hyperreflexia -Toxic Psychoses
49
Do ACE inhibitors increase or decrease lithium levels?
INCREASE
50
Do ARB's increase or decrease lithium levels?
INCREASE
51
Do COX 2 inhibitors increase or decrease lithium levels?
INCREASE
52
Does Metronidazole increase or decrease lithium levels?
INCREASE
53
Do SSRI's increase or decrease lithium levels?
INCREASE
54
Do Diuretics and Aldosterone antagonists increase or decrease lithium levels?
INCREASE
55
Does Caffeine increase or decrease lithium levels?
Decrease
56
Does sodium bicarbonate increase or decrease lithium levels?
Decrease
57
Can a patient have Lithium and Amiodarone together?
AVOID
58
If sodium levels are depleted what can this do to Lithium and why?
Increases Lithium conc due to competitive reabsorption at the renal level
59
Once a patient is on lithium and stable how often should their bloods be checked?
3 monthly

AI Exam 2 (16 decks)

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