Bipolar - 3 Flashcards

1
Q

Line 0 - A patient comes in with Bipolar Depression

A

Offer evidence based psychological intervention -specific for bipolar

or

Offer a high intensity psychological intervention in line with Nice recommendations for depression

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2
Q

What are hi intensity psychological options for depression (NICE)

A

CBT
Interpersonal therapy
Behavioural couple therapy

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3
Q

Line 1- patients come in with moderate to severe Bipolar depression who is not on any bipolar treatments

A

Offer olan + fluoxentine

or

Quetiapine

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4
Q

What if patients did not want fluoxetine in Line 1

A

Offer Olan alone or Lamotrigine alone

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5
Q

What if patient in line 1 did not respond to olan+ fluoxetine or quetiapine?

A

Offer Lamotrigine alone

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6
Q

Line 2
what if patients with bipolar epression already are on lithium

A

-Check lithium level to optimize
-if necessary add combined olan +fluoxetine (fluox is optional for patient)
or
add quetiapin

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7
Q

What if patient in line 2 did not respond to que and olan addition

A

Add lamotrigine

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8
Q

Line 3
what if a patiet comes in with bipolar depression on valproate

A

_ increase dose to max
if no response
_add fluoxetine + olan (fluox optional) or quetiapine

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9
Q

What if patients in line 3 still did not improve

A

Add lamotrigine to valproate

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10
Q

Is lamotrigine level routinely checked

A

No

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11
Q

Target dose for lamotrigine

A

200 mg

(some might need 400 mg)

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12
Q

Mechanism of action Lamotrigine

A

Blocks calcium channel ==> inhibition of excitatory

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13
Q

Starting dose for lamotrigine

A

25 mg

start low and go slow

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14
Q

Titration for lamotrigine

A

In-patients —-25 mg / day until reach 100 mg then 50 mg /day

outpaitients —25 mg/2 weeks

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15
Q

Line 0 For long term biplar depression

A

Offer psychological interventions which prevent relapse

(indiviual, damily or group)

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16
Q

Line 1 1st line long term pharama Rx for bipolar depression

17
Q

Line 2 patient on long rerm Rx with lithium does not respond

A

add Valproate

18
Q

Iine 3 patient with bipolar depression not suitable for long term management with lithium

A

Valproate + olan
or

valproare + quetiapine (if has hx of good response)

19
Q

How common is bipolar II in older adults

20
Q

ICD 11 requires how mong the mood insrability to last for cyclothymic disorder

A

2 years or more

21
Q

How long does ICD11 requires symptoms for hypomanic episodes (bipolar II

A

Several days (not specified like dsm 5 [3 day])

22
Q

How ICD 11 requires mixed episodes to be?

A

Precense of several manic and depressive symptoms, simultaneously or alternatively, for 2 weeks…

23
Q

what drugs are known (good evidence) to induce mania?

A

Levadopa
Corticosteroids
Anabolic-androgenic steroid
Antdepressants (TCAs & MAOIs)

24
Q

Best treatments for drug-induced mania

A

_Aripirazole (Aro30)
_Quetiapine (750-800)
_Olanzapine (Ola20)
_Risperidone (RIs16+)

25
what other treatment can be affective for drug induced mania but with more side effects?
Tomoxifen
26
what are side effects of tamosifen
Uterine Malignancy Thromboembolic Embro-foetal toxicity
27
what mood stabilizer cause contraceptive failure?
Carbamazepine Pheytoin Topiramate
28
Drugs safe in females with mania who are on contraceptives
For preg gall Gabapentin ANtipsychotics Lamotrigine Lithium Only if nothing else is available...last resort is valproate