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MOD 4 > Bipolar and Drugs > Flashcards

Bipolar and Drugs Flashcards

1
Q

What is the crtiteria for manic episode?

A
  • abnormally elevated, expansive, or irritable mood, lasting atleast 1 week
  • 3 or more (4 if the mood is only irritable: grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increase in activity or psychomotor agitation, risky behavior)
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2
Q

Mixed Bipolar Episode criteria/definition

A

Criteria for both a major depressive episode and a manic episode; for atleast 1 week

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3
Q

Bipolar I disorder

A

atleast 1 manic/mixed episode (rule out medical conditions or substance induced mood disorder); distress or impairment in functioning

this is an extreme form of the disorder, and much more manic episodes

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4
Q

What is the defintion of a hypomanic episode?

A

Same as mania except:

  • 4 or more days (can be less now)
  • no severe dysfunction
  • no psychosis
  • no hospitalization
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5
Q

Bipolar II disorder criteria (3)

A
  1. atleast: 1 hypomanic episode, 1 major depressive episode (see a lot more depression than manic)
  2. NEVER manic or mixed
  3. distress or impairment (but not as severe as bipolar I)
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6
Q

What is cyclothymic disorder?

A
  • many hypomanic and depressive periods
  • atleast 2 years (1 in children)
  • no major depressive, manic, or mixed episodes
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7
Q

when do bipolar disorders typically develop?

A

Late adolescence or early adulthood

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8
Q

gender for bipolar I and II

mean age of onset and peak age of onset

A

bipolar I: male = female

bipolar II: female > male

mean age: 21 yrs

peak age: 15-19

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9
Q

what percentage of bipolar disorder patients remain euthymic for a year?

A

1/3

euthymic = normal, non-depressed

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10
Q

In terms of neuroimaging, what is the proposed problem with bipolar disorders?

A

It is a cortical limbic problem: limbic is where emotions reside, and cortical controls the limbic. Suppression of limbic causes a compromise in connection. The suppression fo mood and emotions don’t happen.

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11
Q

main categories of bipolar drug (5)

A
  1. Lithium
  2. Anticonvulsants
  3. Antipsychotics
  4. Antidepressants
  5. Anxiolytics

+ Combination therapy

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12
Q

What are the indications (use) for Lithium? What is its role?

A

Indications: acute and prophylactic treatment of mania/hypomania (more effective in classic mania)

Role: potential acute and prophylactive treatment of depression

*adjunctive use with other mood stabilizers*

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13
Q

While the MOA of lithium is unclear, what are the implicated actions?

What are the pharmacokinetics/absorption like for Lithium?

A

Inhibits protein kinase and activates protein phosphatase (targets signal transduction)

Pharmacokinetics: lithium is a salt, so it’s rapidly absorbed and handled like sodium

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14
Q

Litihium has a (low/high) therapeutic index

What is its maximum effectiveness?

A

low therapeutic index (toxic at lower levels)

max effectiveness: 2-3 weeks

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15
Q

Prior to initiating lithium therapy, what functions shuold be evaluated? What test should be performed?

A
  • renal and thyroid function
  • ECG performed
  • females of childbearing age should get pregnancy test (teratogenic effects)
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16
Q

which drug causes quite a bit of acne?

A

Lithium

17
Q

Major side effects of Lithium (8)

A
  1. Cognitive
  2. Tremor
  3. GI
  4. Weight Gain
  5. Endocrine (thyroid, parathyroid)
  6. Dermatologic (acne)
  7. Teratogenic (cardiovascular)
  8. Renal (impaired concentrating ability, polyuria)
18
Q

how does dehydration affect serum Lithium levels?

A

Increases it. Just know there are many medications and conditions that can compromise lithium levels

Increased: Thiazides, NSAIDs, ACE-I, low sodium diet, dehydration, elderly, renal disease

Decreased: Acetazolamide, Mannitol, Aminophylline, Theophylline, Caffeine, Mania, Pregnancy

*Lithium is only metabolized through the kidneys*

19
Q

3 main anticonvulsants

A

DIVALPROEX SODIUM

CARBAMAZEPINE

LAMOTRIGINE

20
Q

Proposed MOA of divalproex sodium (anticonvulsants) - 3

A
  1. enhancing GABAergic activity or K+ flow at neuronal membrane
  2. decreasing DA turnover
  3. decreasing gluamic acid N-methyl-D-asparate receptor mediated currents
21
Q

Prior to initiating tx of divalproex sodium what tests do you need to assess and why?

A

assess liver function, CBC, and platelets (also pregnancy test for women)

dival is metabolized by liver and can compromise its function

drug is not an effective antidepressant

22
Q

4 MOA of carbamazepina (anticonvulsants)

A
  1. blocks voltage-dependent Na channels
  2. inhibits glutamatergic neurotransmission
  3. modifies adenosine receptors
  4. increases extracellular serotonin
23
Q

What is important to note if pt on carbamazepin and an anti-pscyhotic and why?

A

It will cause induction of levels of the antipsychotic because carba is metabolized by CYP3A4

24
Q

side effects of carbamazepine on sodium

A

hyponatremia

25
Q

black box warnings for carbamazepine (2)

monitoring levels (3)

A
  • asplastici anemia
  • agranulocytosis

(carba side effect is hematopoietic suppression

  • blood levels
  • CBC, platelets
  • LFTs
26
Q

MOA of lamotrigine (anticonvulsant)

A
  • blocks voltage-gated Na channel
  • weak 5Ht3 receptor antagonist

*recall that lamotrigine was first used as tx for epilepsy, then got approved for bipolar treatment

27
Q

Lamotrigine has favorable side effects. Why though must it be slowly titrated?

A

A rare side effect is Stevens-Johnson syndrome and toxic epidermal necrolysis

28
Q

What is the major common risk specific for Antipsychotics?

A

Metabolic syndrome

29
Q

When you prescribe an antidepressant for bipolar, what other tx is absolutely essential?

A

A mood stabilizer (i.e. lithium, anticonvulsants, antipsychotics)

30
Q

General rule with antidepressants:

A

treat as unipolar major depression with concomitant mood stabilizer

31
Q

in terms of antidepressants, what does treatment depend on?

A

treatment depends on the severity of the depression and current treatment

*mood stabilizer should be restarted if lapsed, and if on mood stabilizer, dose should be increased to the upper end of the therapeutic range*

32
Q

MOA of clonazepam (anxiolytics)

A

enhance GABA effects, primarily at GABA-A receptors

MOD 4 (14 decks)

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