Bipolar Flashcards

Question

What are the 2nd generation antipsychotics used to treat acute mania that are FDA approved?

Answer 1

``` Aripiprazole Olanzapine Quetiapine Risperidone Ziprasidone ```

Answer 2

Haloperidol | Chlorpromazine

Answer 3

Yes Antidepressants may induce mania or hypomania, increase frequency of recurrence of acute episodes, promote tenancy for course of illness to become continuous. MUST TAPER

Answer 4

Treatment should be individualized: clinical presentation, severity, and frequency of episodes vary widely among patients.

Answer 5

Three primary drugs used are lithium, carbamazapine, and valproic acid.

Answer 6

Acute manic episodes Prophylaxis of affective disorders Acute depressive episodes ``` Other psychiatric disorders Schizoaffective disorder/Schizophrenia Aggressive/violent behaviors Impulse control disorders Self-injurious behavior Mania secondary to brain injury ```

Answer 7

``` CBC w/ diff Chem profile (Electrolytes, creatinine, BUN) Thyroid function tests UA FBS ECG VItals Serum pregnancy test ```

Answer 8

``` usually transient but may become chronic N,V,D muscle weakness polyuria, polydypsia fine hand tremor edema ```

Answer 9

persistent vomiting impaired renal function diarrhea lethargy/confusion COARSE HAND TREMOR somnolence dysarthria seizures muscle weakness coma hyperactive deep tendon reflexes (DTR) vertigo

Answer 10

-D/C lithium -Obtain lithium serum concentrations, renal panel, vitals, & EKG -Supportive Care -Maintain fluid and electrolyte balance -Gastric lavage if within 1 hour No charcoal, doesn’t bind lithium -Whole bowel irrigation with delayed release preparations -Hemodialysis

Answer 11

``` Weight gain Hypothyroidism (monitor function) Diabetes insipidus (tx with amiloride) Leukocytosis Rash (acne, psoriasis exacerbation) ECG changes (T wave flattening, QRS inversion Nephrotoxicity ```

Answer 12

- -Serum lithium concentration obtained 5-7 days after initiation of therapy and with every dose change, then every 3 mo. for 6 mo. and every 6 mo. thereafter. - -BUN, Scr, electrolytes - every 3 months for 6 mo. and every 6 mo. thereafter. - -Thyroid function test - every 3 months for 6 mo. and every 6 mo. thereafter. - -Urinalysis - -CBC - Q12 mo. - -Monitor for signs of toxicity; pregnancy test in females (Cat. D)

Answer 13

- Thiazide diuretics - Osmotic diuretics, acetazolamide - Aminophylline, Theophylline - SSRIs, Fluoxetine - Haloperidol - clozapine - Carbamazepine - Metronidazole - abx - ACE Inhibitors - NSAIDS - Calcium channel blockers, verapamil

Answer 14

- Will control a manic patient without a “drugged effect” - Will normalize mood - Very good prophylactically to decrease mood swings - Relapses, when they occur, are less severe and usually shorter in duration - Plasma concentration monitoring allows careful titration to therapeutic levels - Low drug cost

Answer 15

-Narrow range of therapeutic blood concentrations, requires close monitoring to prevent toxicity. -Patient compliance and understanding of the warning signs of toxicity is important. -Lag period before therapeutic effect in manic patients. Prophylactic effect may take 6 months to 1 year to maximize. -Rapid cyclers are poor responders. -Expense of blood tests

Answer 16

Acute manic episodes Usually in patients who are treatment resistant, rapid cyclers, lithium intolerant. Prophylaxis of affective disorders Other psychiatric disorders Impulse control disorders Schizoaffective disorder/schizophrenia (not first line) Neuropsychiatric disorders in the mentally retarded/developmentally disabled. Trigeminal neuralgia Mania secondary to head injury Aggressive and violent behaviors/rage reactions

Answer 17

Neurologic- sedation, ataxia, diplopia, dizziness, fatigue, headache, nystagmus, tingling, tremor Dermatologic- rash, steven johnson syndrome (Most concerning) Hematologic- transient leukopenia, THROMBOCYTOPENIA (most common), eisinophilia, aplastic anemia, and agranulocytosis GI- N/V/D Other- SIADH, slowed cardiac conduction, hepatotoxic, teratogen

Answer 18

Steven Johnson's Syndrome

Answer 19

-Every 2 weeks for 2 months, then every 3 to 6 months -Chemistry profile -CBC w/diff. and platelets (to check for SE) -Liver profile (check for SE) -Urinalysis -Carbamazapine blood levels for: initial stabilization of a pt therapy failure, inadequate response, worsening of symptoms complex drug regimens—dose related side effects, drug interactions Compliance issues differing plasma levels with stable prescribed doses

Answer 20

Carbamazepine is a potent liver enzyme inducer which can decrease levels of other drugs: - Antipsychotics - Tricyclic antidepressants - Theophylline - Steroids - Warfarin (narrow therapuetic so you risk worsening condition) - Chloramphenicol - Isoniazid - Thyroid Hormones (narrow therapuetic so you risk worsening condition) - Methadone

Answer 21

``` Erythromycin Fluoxetine Theophylline Cimetidine Verapamil Diltiazem Propoxyphyne (Darvon) ```

Answer 22

Phenobarbital Phenytoin Primidone Theophylline

Answer 23

``` Bipolar affective disorder (esp. rapid cyclers and mixed states) Aggression and impulse control disorder Mania secondary to head injury Bulimia Schizoaffective disorder/schizophrenia ```

Answer 24

``` --Gastrointestinal N,V, D, stomach cramps Constipation Anorexia, wt. loss/gain Hemorrhagic pancreatitis --Neurologic sedation/drowsiness Tremor Nystagmus/diplopia ---Endocrine Breast enlargement, galactorrhea, irregular menses ```

Answer 25

Phenobarbital Phenytoin Primidone Carbamazepine

Answer 26

Phenytoin | Phenobarbital

Answer 27

Absence seizures

Answer 28

``` Irritability Mood lability Racing thoughts Increased sexuality Distractability Increased risk for suicide ```

Answer 29

Remission of sx Return to normal functioning Avoid precipitation of mania or hypomania

Answer 30

Interpersonal psychotherapy Cognitive behavioral therapy Group psychotherapy

Answer 31

Olanzapine + fluoxetine | Quetiapine

Answer 32

``` May be used as montherapy or as add-on therapy for BP depression Lithium Lamotrigine Valproate Carbamazepine ```

Answer 33

Olanzapine | Quetiapine

Answer 34

None have been approved. The only one is FLX with olanzapine

Answer 35

``` Lithium Lamotrigine Quetiapine Olanzapine/fluoxetine Valproate Carbamazepine ```

Answer 36

``` Lithium Lamotragine Carbamazepine Valproate Antidepressants ```

Answer 37

``` Sx profile Course of illness Prior hx of response Family hx of response Tolerability issues Optimize first line, if no response augment/switch to another first line. If no response consider second-line tx, if inadequate response consider combos ```

Answer 38

``` Prevent re-occurrence Extend intervals b/w episodes Decrease severity of episodes Maximize patient functioning Minimize sub threshold sx Minimize med ADRs Prevent suicide Identify prodromal sx ```

Answer 39

Assess and tx medical condition Discontinue antidepressent Agents of choice- valproate, lithium, lamotrigine, 2nd gen antipsychotic, ECT

Answer 40

``` Medication combinations ECT Sleep deprivation Thyroid supplementation Vagal nerve stimulation Psychotherapy Homeopathy Vitamin supplements Herbs ```