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*Pharm III > Bipolar > Flashcards

Bipolar Flashcards

1
Q

one of the biggest reasons patients fail treatment?

A

not convinced that meds work

intolerant to ADRs

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2
Q

what is the neurobiology of mani

A

norepi- relative excess
serotonin- deficiency
dopamine- excess

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3
Q

what are used to help control manic episodes

A

antipsychotics and mood stailizers

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4
Q

what need to be d/c in acute manic episodes

A

antidperessants

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5
Q

what is the main mood stabilizer

A

lithium

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6
Q

what are anticonvulsants used as mood stabilizers

A

valproate
carbamazepine
lamotrigine

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7
Q

what are 2nd gen antipsycoitics used a mood stabilizers

A 
aripiprazole
olanzapine
quetiapine
risperidone
ziprasidone
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8
Q

1st generation antipsychotics that are still used in acute mania

A

haloperidol

chlorpromazine

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9
Q

used PRN for short term in agitation, anxiety insomnia

A

lorazepam

clonazepam

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10
Q

what can antidepressant do w/ bipolar disorders?

A

induce mania or hypomania

switching b/w mania and depression

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11
Q

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

A

respond in 7-10 days

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12
Q

three primary drugs for bipolar disoder

A

lithium
carbamazapine
valproic acid

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13
Q

what labs should you get before starting lithium

A 
CBC
thyroid function 
UA
fasting blood sugar
ECGs
CrCl (shouldn't start w/ kidney failure)
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14
Q

ADRs w/ lithium

A 
N/V/D
muscle weakness
polyuria and polydipsia
fine hand tremor
edema
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15
Q

signs of acute toxicity w/ lithium

A 
coarse hand tremor
seizures
coma
diarrhea, persistent vomitting
hyperative DTRs
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16
Q

management of lithium toxicity

A

D/C lithium
use gastric lavage
hemodialysis

17
Q

chronic effects of lithium

A 
hypothyroidism
weight gain
diabetes insipidus
leukocytosis
rash (acne, psoraisis)
T wave flattening, QRS inversion
nephrotoxicty
18
Q

when to check levels for lithium

A

5-7 days after starting therapy

every 3-6 months

19
Q

lithium pregnancy category

A

Category D

20
Q

lithium disadvantages

A

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

21
Q

uses for carbamazepine w/ bipolar

A

acute manic episodes

patients who are treatment resistant, rapid cycler, lithium intolerant

22
Q

other uses for carbamazepine

A 
impulse control disorders
schizoaffective disorders
trigeminal neuralgia
mania secondary to head injury
agressive and violent behaviors/ rage rxns
23
Q

Big ADRs of carbamazepine

A

Stevens Johnson Syndrome
thrombocytopenia
asplastic anemia, agranulocytosis, thrombocytopenia

24
Q

other random adrs w/ carbamazepine

A

SIADH
slower cardiac conduction
teratogen
hepatotoxic

25
Q

kinetics w/ carbamazepine

A

autoinducer

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

26
Q

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

A

antipsychotics
TCAs
Warfarin
thyroid hormones

27
Q

drugs that can decrease carbamazepine concentrations

A

phenobarbital
phenytoin
primidone
theophylline

28
Q

valproic acid indications

A 
bipolar affective (rapid cycles, and mixed)
aggression and imuplse control
mania 2ndary to head injury
bulimia
schizoaffective disorder/ schizophrenia
29
Q

ADRs w/ valproic acid

A

GI

breast enlargement, galactorrhea, irregular menses

30
Q

best drugs for bipolar depression

A

olanzapine

quetiapine

31
Q

what is the only antidepressant approved for bipolar?

A

fluoxetine combined w/ olanzapine

32
Q

agent of choic for rapid cyclers

A 
Valproic acid
lithium (often don't respond) 
lamotrigine 
2nd Gen antipsychotics
ECT
33
Q

what is modafanil used for?

A

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

*Pharm III (8 decks)

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