Bipolar Flashcards
one of the biggest reasons patients fail treatment?
not convinced that meds work
intolerant to ADRs
what is the neurobiology of mani
norepi- relative excess
serotonin- deficiency
dopamine- excess
what are used to help control manic episodes
antipsychotics and mood stailizers
what need to be d/c in acute manic episodes
antidperessants
what is the main mood stabilizer
lithium
what are anticonvulsants used as mood stabilizers
valproate
carbamazepine
lamotrigine
what are 2nd gen antipsycoitics used a mood stabilizers
aripiprazole olanzapine quetiapine risperidone ziprasidone
1st generation antipsychotics that are still used in acute mania
haloperidol
chlorpromazine
used PRN for short term in agitation, anxiety insomnia
lorazepam
clonazepam
what can antidepressant do w/ bipolar disorders?
induce mania or hypomania
switching b/w mania and depression
how long will it take for patients to respond to drugs for manic episodes
respond in 7-10 days
three primary drugs for bipolar disoder
lithium
carbamazapine
valproic acid
what labs should you get before starting lithium
CBC thyroid function UA fasting blood sugar ECGs CrCl (shouldn't start w/ kidney failure)
ADRs w/ lithium
N/V/D muscle weakness polyuria and polydipsia fine hand tremor edema
signs of acute toxicity w/ lithium
coarse hand tremor seizures coma diarrhea, persistent vomitting hyperative DTRs
management of lithium toxicity
D/C lithium
use gastric lavage
hemodialysis
chronic effects of lithium
hypothyroidism weight gain diabetes insipidus leukocytosis rash (acne, psoraisis) T wave flattening, QRS inversion nephrotoxicty
when to check levels for lithium
5-7 days after starting therapy
every 3-6 months
lithium pregnancy category
Category D
lithium disadvantages
narrow therapeutic index
2 week onset
takes awhile to get prophylactic effects
expense of blood tests
uses for carbamazepine w/ bipolar
acute manic episodes
patients who are treatment resistant, rapid cycler, lithium intolerant
other uses for carbamazepine
impulse control disorders schizoaffective disorders trigeminal neuralgia mania secondary to head injury agressive and violent behaviors/ rage rxns
Big ADRs of carbamazepine
Stevens Johnson Syndrome
thrombocytopenia
asplastic anemia, agranulocytosis, thrombocytopenia
other random adrs w/ carbamazepine
SIADH
slower cardiac conduction
teratogen
hepatotoxic
kinetics w/ carbamazepine
autoinducer
must draw levels every 2 weeks for 2 months then every 3-6 months
carbamazepine is a potent liver enzyme inducer which can decrease levels of what other drugs
antipsychotics
TCAs
Warfarin
thyroid hormones
drugs that can decrease carbamazepine concentrations
phenobarbital
phenytoin
primidone
theophylline
valproic acid indications
bipolar affective (rapid cycles, and mixed) aggression and imuplse control mania 2ndary to head injury bulimia schizoaffective disorder/ schizophrenia
ADRs w/ valproic acid
GI
breast enlargement, galactorrhea, irregular menses
best drugs for bipolar depression
olanzapine
quetiapine
what is the only antidepressant approved for bipolar?
fluoxetine combined w/ olanzapine
agent of choic for rapid cyclers
Valproic acid lithium (often don't respond) lamotrigine 2nd Gen antipsychotics ECT
what is modafanil used for?
stimulant for bipolar disorder if person is depressed. can switch them into mani though
