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Pharm + Patient Year 3 Sem 2 > Bipolar > Flashcards

Bipolar Flashcards

1
Q

How is bipolar characterised?

A

Periods of high and low moods

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2
Q

What is bipolar I?

A

At least one manic episode with or without history of major depressive episodes

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3
Q

What is bipolar II?

A

One or more major depressive episodes, at least one hypomanic episode
No evidence of mania

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4
Q

Define mania.

A

Distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week
Severe enough to cause marked impairment in functioning or hospitalisation

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5
Q

What are the features of mania?

A

Includes psychotic features
At least 3 additional symptoms- increased energy, incomprehensible speech, disinhibition, extravagant plans, delusions, hallucinations

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6
Q

What is hypomania?

A

Similar to mania
Symptoms lasting 4 days
No psychotic features
Not severe enough to cause marked impairment

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7
Q

Describe the management of mania/hypomania.

A

Consider stopping any antidepressants
Start or maximise dose of mood stabiliser
Use antipsychotic
Add lithium or valproate if insufficient response

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8
Q

Which anti-epileptic should not be used in mania?

A

Lamotrigine

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9
Q

Which antipsychotics are first line in mania?

A

Haloperidol
Risperidone
Olanzapine
Quetiapine

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10
Q

What is bipolar depression?

A

Symptoms and diagnosis as with unipolar depression

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11
Q

What must be considered in diagnosis of depression?

A

Bipolar- risk of mania with treatment

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12
Q

Describe the acute management of moderate/severe bipolar depression.

A

Start or maximise dose of mood stabiliser
Antidepressant AND antipsychotic
Lamotrigine used last line if no response

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13
Q

Which antipsychotics are first line in bipolar depression?

A

Olanzapine AND fluoxetine
Quetiapine
Olanzapine alone

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14
Q

Describe the long term management of moderate/severe bipolar depression.

A 
Consider drugs used effectively in acute episodes
Lithium is most effective
Add/switch to valproate
Olanzapine
Quetiapine
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15
Q

Describe the features of the therapeutic range of lithium,.

A

4-7 days to reach steady state
12 hours post dosage, range should be 0.4-0.8mmol/L
Checked weekly until stable

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16
Q

Name 2 brands of lithium.

A

Priadel

Camcolit

17
Q

How is lithium cleared?

A

Renally

18
Q

What monitoring must be done for lithium?

A 
U&Es
eGFR
TFTs
Bone
FBC
ECG
BMI
19
Q

What drugs does lithium interact with?

A

NSAIDs
Diuretics
ACE inhibitors

20
Q

Give two side effects of lithium.

A

Fine tremor

Acneiform eruptions

21
Q

What are the signs of lithium toxicity?

A

Coarse tremor
Diarrhoea
Vomiting
CNS disturbances

22
Q

Describe the dosing of valproate in bipolar?

A

Semisodium valproate licensed in bipolar
Not available in liquid form
Twice daily dosing

23
Q

What monitoring must be done for valproate?

A

BMI
FBC
LFT

24
Q

What effects can be seen in a foetus of a woman taking valproate?

A 
Neural tube defects
Facial dysmorphism
Cleft lip/palate
Cardiac, renal and urogenital defects
Limb defects
25
Q

What developmental effects can be seen in child of woman taking valproate?

A

Developmental disorders
Autistic spectrum disorder
Autism
ADHD

26
Q

Describe the risk factors for bipolar?

A

First degree relative with history of bipolar
Black and minority ethnic groups
Psychological factors such as abuse and neglect during childhood

27
Q

What is the monoamine theory?

A

Lack of monoamine transmitters cause depression

Excess causes mania

28
Q

What is the HPA axis theory?

A

Cortisol and thyroid abnormalities

29
Q

What is cyclothymia?

A

Chronic mood disturbance with depression and hypomania symptoms that do not meet a full episode

30
Q

What is the only antidepressant effect in bipolar?

A

Fluoxetine

But only in combination with olanzapine

31
Q

What is the most effective treatment of bipolar?

A

Lithium

32
Q

When is lamotrigine licensed in bipolar?

A

Prevention of depression

Pharm + Patient Year 3 Sem 2 (29 decks)

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