Bipolar

Question 1

one of the biggest reasons patients fail treatment?

Answer 1

not convinced that meds work

intolerant to ADRs

Question 2

what is the neurobiology of mani

Answer 2

norepi- relative excess
serotonin- deficiency
dopamine- excess

Question 3

what are used to help control manic episodes

Answer 3

antipsychotics and mood stailizers

Question 4

what need to be d/c in acute manic episodes

Answer 4

antidperessants

Question 5

what is the main mood stabilizer

Answer 5

lithium

Question 6

what are anticonvulsants used as mood stabilizers

Answer 6

valproate
carbamazepine
lamotrigine

Question 7

what are 2nd gen antipsycoitics used a mood stabilizers

Answer 7

aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone

Question 8

1st generation antipsychotics that are still used in acute mania

Answer 8

haloperidol

chlorpromazine

Question 9

used PRN for short term in agitation, anxiety insomnia

Answer 9

lorazepam

clonazepam

Question 10

what can antidepressant do w/ bipolar disorders?

Answer 10

induce mania or hypomania

switching b/w mania and depression

Question 11

how long will it take for patients to respond to drugs for manic episodes

Answer 11

respond in 7-10 days

Question 12

three primary drugs for bipolar disoder

Answer 12

lithium
carbamazapine
valproic acid

Question 13

what labs should you get before starting lithium

Answer 13

CBC
thyroid function 
UA
fasting blood sugar
ECGs
CrCl (shouldn't start w/ kidney failure)

Question 14

ADRs w/ lithium

Answer 14

N/V/D
muscle weakness
polyuria and polydipsia
fine hand tremor
edema

Question 15

signs of acute toxicity w/ lithium

Answer 15

coarse hand tremor
seizures
coma
diarrhea, persistent vomitting
hyperative DTRs

Question 16

management of lithium toxicity

Answer 16

D/C lithium
use gastric lavage
hemodialysis

Question 17

chronic effects of lithium

Answer 17

hypothyroidism
weight gain
diabetes insipidus
leukocytosis
rash (acne, psoraisis)
T wave flattening, QRS inversion
nephrotoxicty

Question 18

when to check levels for lithium

Answer 18

5-7 days after starting therapy

every 3-6 months

Question 19

lithium pregnancy category

Answer 19

Category D

Question 20

lithium disadvantages

Answer 20

narrow therapeutic index
2 week onset
takes awhile to get prophylactic effects
expense of blood tests

Question 21

uses for carbamazepine w/ bipolar

Answer 21

acute manic episodes

patients who are treatment resistant, rapid cycler, lithium intolerant

Question 22

other uses for carbamazepine

Answer 22

impulse control disorders
schizoaffective disorders
trigeminal neuralgia
mania secondary to head injury
agressive and violent behaviors/ rage rxns

Question 23

Big ADRs of carbamazepine

Answer 23

Stevens Johnson Syndrome
thrombocytopenia
asplastic anemia, agranulocytosis, thrombocytopenia

Question 24

other random adrs w/ carbamazepine

Answer 24

SIADH
slower cardiac conduction
teratogen
hepatotoxic

Question 25

kinetics w/ carbamazepine

Answer 25

autoinducer | must draw levels every 2 weeks for 2 months then every 3-6 months

Question 26

carbamazepine is a potent liver enzyme inducer which can decrease levels of what other drugs

Answer 26

antipsychotics TCAs Warfarin thyroid hormones

Question 27

drugs that can decrease carbamazepine concentrations

Answer 27

phenobarbital phenytoin primidone theophylline

Question 28

valproic acid indications

Answer 28

``` bipolar affective (rapid cycles, and mixed) aggression and imuplse control mania 2ndary to head injury bulimia schizoaffective disorder/ schizophrenia ```

Question 29

ADRs w/ valproic acid

Answer 29

GI | breast enlargement, galactorrhea, irregular menses

Question 30

best drugs for bipolar depression

Answer 30

olanzapine | quetiapine

Question 31

what is the only antidepressant approved for bipolar?

Answer 31

fluoxetine combined w/ olanzapine

Question 32

agent of choic for rapid cyclers

Answer 32

``` Valproic acid lithium (often don't respond) lamotrigine 2nd Gen antipsychotics ECT ```

Question 33

what is modafanil used for?

Answer 33

stimulant for bipolar disorder if person is depressed. can switch them into mani though