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pharm test #5 > Bipolar > Flashcards

Bipolar Flashcards

1
Q

what is bipolar disorder?

A

characterized by recurrent episodes of mania and depression

  • 3-4% of populations
  • the periods of mania and/or depression alternate with intervening well periods
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2
Q

classification of bipolar disorders:

A
  • bipolar I: “one of more manic or mixed episodes and one or more major depressive episodes” Normal functioning is greatly impaired and the patient may be hospitalized
  • bipolar II: “one or more major depressive episodes accompanied by at least one hypomanic episode.” A hypomanic episode is similar to a manic episode, but isn’t as severe and doesn’t last as long
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3
Q

when is a patient likely to undergo lifetime treatment with mood stabilizing drugs?

A

a patient who experiences at least tow episodes of mania

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4
Q

DSM-IV criteria for mania

A

period of abnormally intense excitement last at least one week with at least 3 of the following:
-inflated self-esteem
-decreased need for sleep
-talkativeness
-racing thoughts
-easily distracted
-increased motivation
-unusual interest in activities that can lead to painful results
(basically they are more child-like, except the sleep thing)

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5
Q

less sever form of bipolar disorder which doesn’t reach the threshold for BP1 or 2
-may be a precursor (1/3 are eventually diagnosed with BP)

A

Cyclothymic disorder

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6
Q

category for bipolar disorders which don’t fit the criteria for BP1, 2 or cyclothymic disorder

A

Bipolar disorder not otherwise defined ((NED?)

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7
Q

what are the classes of bipolar treatment drugs?

A
  • mood stabilizers
  • anti-epileptic drugs (AED’s)
  • atypical atipsychotics
  • antidepressant drugs
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8
Q

what is the most popular mood stabilizers

A

lithium, effective in 60-80% of bipolar

-in normal ppl it basically has no effect

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9
Q

in the 1920’s it was used as a sedative-hypnotic compound (both calming and sleep inducing effects) and used as an anticonvulsant drug

A

lithium

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10
Q

pharmacokinetics of Lithium

A
  • When administered orally Lithium is absorbed rapidly and completely.
    • Within 3 hours peak blood levels are reached, and complete absorption occurs by 8 hours.
    • Its efficacy is directly correlated to its level in the blood.
    • It does cross the blood brain barrier; and it is not recommended during pregnancy
    -narrow therapeutic range (2-3), monitor plasma levels
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11
Q

structure of lithium upon excretion

A
  • lithium is not metabolized before excretion, thus unchanged
  • half of an oral dose is excreted within 18-24 hours
  • long half life
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12
Q

how long does it take for lithium therapy to become effective?

A

1-2 weeks

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13
Q

side effects of lithium

A
  • related to plasma concentration
  • Toxic effects involve the GI tract, kidneys, CV system, skin and nervous system
  • long term the gyroid may become enlarged, 30% pts become obese
  • pts often become dehydrated
  • Neurological: lethargy, impaired concentration and dizziness
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14
Q

drug interactions with lithium

A
  • NSAID’s reduce renal excretion of Lithium
  • indomethacin: strong effect
  • Ibuprofen and naproxed: moderate effect
  • aspirin and sulindac: weak effect
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15
Q

txt of lithium overdose

A

no specific antidote, but can:

  • sodium containing fluids to flush it out
  • hemodialysis
  • gastic lavage (pump stomach if Li is in there)
  • diuretic therapy
  • antiepileptic medications
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16
Q

big problem associated with lithium use

A
  • noncompliance (up to 50% of pts)

- comorbidity: more than 55% of bipolar patients have a history of substance abuse (esp alcohol)

17
Q

Lithium is often used in combination therapy with what other drugs?
-alone is only effective in 50-60% of cases

A
  • lithium+anticonvulsant
  • lithium + atypical antipsychotics
  • lithium + other drugs
18
Q

what three anticonvulsants have been shown to be effective in the treatment of bipolar disorder?

A
  • Carbamazepine
  • Lamotrigine
  • Valprotic Acid
19
Q
  • Effective for acute mania/mixed episodes and maintenance
  • Superior to Li+ in controlling rapid cycling bipolar disorder.
  • currently regarded as a “second line” treatment for mania, usually used in combination with Li+.
  • Broader spectrum of activity- used in patients with non-classical bipolar disorder.
A

Carbamazepine

20
Q

adverse effects of Carbamazepine

A
  • sedation
  • upset stomach
  • visual disturbances
  • cognitive functioning (limited)
  • white blood cell reduction, anemia (blood should be analyzed periodically)
21
Q

what drug produces neural tube defect in 1% of offspring?

A

carbamazepine

22
Q
  • Effective in acute mania/mixed episodes, rapid cyclers and for maintenance.
  • More effective than Li+ in patients with comorbid depression and/or cyclothymia.
  • augments post-synaptic action of GABA
  • Intravenous administration overcomes the 3 to 10 day waiting period for oral administration to take effect (also no need for sedatives to control mania before drug takes effect.)
A

Valproic Acid

23
Q
  • Approved in 2003 by FDA for Bipolar I disorder
  • Also effective for personality disorders, schizoaffective disorder, and PTSD.
  • Inhibits neuronal excitability by inhibiting release of glutamate
  • many drug interactions
  • can cause (fatal) rash
A

Lamotrigine

24
Q
  • NotformallyapprovedbyFDAforuseinbipolar treatment and limited controlled studies have shown it has no clinical efficacy.
  • PfizerandWarner-LambertsuedbyStatesAttorneys General for deceptive marketing for bipolar treatment
  • Veryfewdruginteractions,excretedunchanged.
  • DoesnotalterLi+activity
  • Unstudiedinpregnant/breast-feedingwomen tolerable side effects
A

Gabapentin

25
Q
  • Associated weight loss may be of use to obese patients taking other bipolar drugs
  • Efficacy in treating core disorder doubtful
A

Topiramate

26
Q
  • GABA reuptake inhibitor
  • side effects more prominent than relief from symptoms
  • No clinical trials showing efficacy for bipolar disorders
A

Tiagabine

27
Q

• More antimanic than antidepressant
• Many studies have demonstrated its efficacy;
“about 70% do well on therapy • Potentially fatal agranulocytosis

A

Clozapine

28
Q
  • Approved by the FDA in 2003 as a monotherapy or combined with lithium or valproate for Bipolar I treatment
  • Extrapyramidal symptoms common side effect
  • Can cause weight gain
A

Risperidone

29
Q
  • Approved by the FDA in 2000 for the short-term treatment of acute mania.
  • Studies have shown its efficacy and safety.
  • Patients that meet with the most therapeutic success tend to be young females who have not experienced the disorder long.
A

Olanzapine

30
Q

• Approved by FDA in 2004 for treatment of Bipolar I
• Side effects
– Very sedating
– Weight gain/loss
– Chance of Tardive dyskinesia (less than typicals) – Neuroleptic malignant syndrome (potentially fatal)

A

Quetiapine

31
Q

Omega-3 fatty acids and the txt of bipolar disorder

A

• Are present in marine or plant sources
• They are able to inhibit neuronal
signaling transduction pathways.
• One study showed an effect better than placebo while a second study showed no efficacy.

pharm test #5 (2 decks)

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