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AI Exam 2 > Bipolar > Flashcards

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
Q

What are the worse mood stabilisers in hepatic impairment?

A

-Lamotrigine
-Valproate
-Carbamazepine

26
Q

What are the worst mood stabilisers in renal impairment?

A

-Lithium
-Sulfiride
-Amulsuride
-Lamotrigine

27
Q

If a patient has had symptoms of an episode for 7+ days, has severe functional impairment and have psychotic features, what is this?

28
Q

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?

29
Q

What medication is gold standard for relapse prevention in Bipolar?

30
Q

Why isn’t lithium used in mania?

A

It takes 5-7 days to kick in

31
Q

What neurotransmitters production and turnover are modified by lithium?

A

-Serotonin
-May block Dopamine receptors

32
Q

Is lithium BRAND specific?

33
Q

What strength is Priadel liquid (Lithium) ?

34
Q

What can Lithium do to a patients ECG?

A

QT interval prolongation

35
Q

What physical monitoring needs to be done before initiating treatment on Lithium?

A

-ECG
-Renal function
-Thyroid
-Weight/BMI
-Ca
-U&E’s
-FBC

36
Q

What is lithium excreted via?

A

The Kidneys

37
Q

How often do plasma levels need to be taken on lithium?

A

Weekly until stable

38
Q

When should plasma levels be taken after a dose change of lithium?

A

4-7 days after each dose change

39
Q

What is the lithium range?

A

0.4-1 mmol/L

40
Q

What is the lithium range in mania?

41
Q

What is the usual dose range of lithium?

A

400mg-1.2g daily

42
Q

If a patient is less than 50kg should we avoid lithium?

43
Q

What drug can make you gain up to 27kg?

44
Q

If you get swollen ankles when on lithium what should we do?

A

Dose reduction

45
Q

If a patients lithium levels are over 1.5 what does this mean?

A

May be fatal and have a toxic effect

46
Q

If lithium levels are over 2mmol/L what should we do?

A

Requires URGENT medical attention! = Kidney damage

47
Q

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?

A

Lithium Toxicity

48
Q

What can severe toxicity of lithium cause?

A

-Convulsions
-Coma
-Renal and circulatory failure
-Hyperreflexia
-Toxic Psychoses

49
Q

Do ACE inhibitors increase or decrease lithium levels?

50
Q

Do ARB’s increase or decrease lithium levels?

51
Q

Do COX 2 inhibitors increase or decrease lithium levels?

52
Q

Does Metronidazole increase or decrease lithium levels?

53
Q

Do SSRI’s increase or decrease lithium levels?

54
Q

Do Diuretics and Aldosterone antagonists increase or decrease lithium levels?

55
Q

Does Caffeine increase or decrease lithium levels?

56
Q

Does sodium bicarbonate increase or decrease lithium levels?

57
Q

Can a patient have Lithium and Amiodarone together?

58
Q

If sodium levels are depleted what can this do to Lithium and why?

A

Increases Lithium conc due to competitive reabsorption at the renal level

59
Q

Once a patient is on lithium and stable how often should their bloods be checked?

AI Exam 2 (16 decks)

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