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Pharmacology > Bipolar and related disorders > Flashcards

Bipolar and related disorders Flashcards

1
Q

What is the 1st line treatment option in bipolar disorders?

A

Lithium

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2
Q

What is the dose of lithium as a mood stabiliser according to?

A

Trough level of lithium in the blood

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3
Q

What is a safe lithium starting dose?

A

500mg po mane

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4
Q

Lithium has a very wide/narrow therapeutic index

A

Narrow

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5
Q

How often should lithium levels be checked?

A

4 days after treatment start/change

Every 6 months

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6
Q

What does it mean that lithium blood levels are trough levels?

A

Blood must be drawn right before the next dose

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7
Q

Give side effects of lithium

A 
Nausea
Vomiting
Diarrhoea
Postural tremor
Polyuria w/ polydipsia
Hypokalemia
Nonspecific interstitial fibrosis (>10y)
Hypothyroidism
Hyperthyroidism
Teratogenesis
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8
Q

Give thyroid side effects of hyperthyroidism

A

Goiter

Expothalmos

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9
Q

Give cardiac side effects of hypokalemia

A

T wave flattening/inversion
Sinus dysrythmias
Heart block
Syncope epipsodes

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10
Q

What is the teratogenic result of lithium use?

A

Ebstein’s anomaly

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11
Q

Give signs of lithium toxicity

A 
Tremor
Dysarthria
Ataxia
N+V
Diarrhoea
CVS changes
Renal dysfunction
Myoclonus
Muscular fasciculations
Seizures
Impaired LOC
Coma
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12
Q

Which investigations should be performed before a patient begins lithium treatment?

A 
UKE
Creatinine clearance
FBC
TSH
Beta-hcg
ECG
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13
Q

Why check UKE when starting lithium treatment?

A

Potassium levels

Kidney dysfunction

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14
Q

Why check creatinine clearance when starting lithium treatment?

A

Kidney excretion required

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15
Q

Why check FBC when starting lithium treatment?

A

Lithium causes leucocytosis

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16
Q

Why check TSH when starting lithium treatment?

A

Lithium interferes with thyroid function

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17
Q

Why check beta-hcg when starting lithium treatment?

A

Lithium is teratogenic

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18
Q

Why check ECG when starting lithium treatment?

A

Check for dysrhythmia

Check for heart block

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19
Q

What is the advantage of valproate in 1st line treatment?

A

Able to titrate dose upwards rapidly

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20
Q

What is the dose of valproate for bipolar disorders?

A

250-1250mg po bd

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21
Q

Name common side effects of valproate

A 
Sedation
Weight gain
Thrombocytopenia
Hair loss
Tremor
PCOS
Teratogenesis
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22
Q

What is the teratogenic result of valproate?

A

Neural tube defects

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23
Q

Which investigations should be performed before a patient begins valproate treatment?

A

LFTs
Beta-hcg
Pelvic sonar

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24
Q

What is the dose of carbamazepine in bipolar disorders?

A

Start 200mg po bd
Titrate 200mg at a time
Maintenance 600-800mg po bd

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25
Q

Name common side effects of carbamazepine

A 
Exfoliative dermatitis
Hyponatermia
SIADH
GIT S/E
Hepatitis
Agranulocytosis
Teratogenesis
Drug metabolism interference
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26
Q

Which investigations should be performed before a patient begins carbamazepine treatment?

A

LFTs
UKE
FBC
Beta-hcg

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27
Q

What is the teratogenic effect of carbamazepine?

A

Neural tube defects

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28
Q

Why check LFTs when starting valproate treatment

A

Liver metabolism of valproate

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29
Q

Why check LFTs when starting carbamazapine treatment

A

Liver metabolism of carbamazepine

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30
Q

Why check UKE when starting carbamazepine treatment

A

Hyponatremia

SIADH

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31
Q

Which medication is effective in treating bipolar depression?

A

Lamotrigine

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32
Q

Lamotrigine is useful in preventing manic episodes and treating manic episodes
True or false?

A

False

Not effective in treatment of manic episodes

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33
Q

What is the dose of lamotrigine in bipolar disorders?

A

Start 25mg po nocte
Titrate 25mg every 2 weeks
Maintence 100-200mg po nocte

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34
Q

What risk is there when titrating lamotrigine too rapidly?

A

Steven-Johnson syndrome

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35
Q

Name common side effects of lamotrigine

A 
Dizziness
Ataxia
Blurred vision
Diplopia
Headache
Sedation
N+V
SJS
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36
Q

What do you do in a patient who has started lamotrigine and begun developing a rash?

A

IMMEDIATELY STOP LAMOTRIGINE

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37
Q

Which atypical antipsychotics can be used in the treatment of bipolar disorder?

A

Olanzapine 10-20mg po nocte
Quetiapine 300-800mg po nocte
Aripriprazole 10-30mg po nocte

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38
Q

Name a common side effect of atypical antipscyhotics

A

Metabolic syndrome

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39
Q

Name common side effects of olanzapine

A 
Severe MS
Sedation
Dizziness
Dry mouth
Consstipation
Dyspepsia
Akathisia
40
Q

Name common side effects of quetiapine

A

MS
Sever sedation
Dizziness
Postural hypotension

41
Q

Name common side effects of aripriprazole

A 
Headache
Sedation
Akathisia
Agitation
Anxiety
Dyspesia
Nausea
42
Q

What is NOT a side effect of aripriprazole that is a side effect of olanzapine and quietapine?

A

MS

43
Q

What should be monitored in a patient on an atypical antipsychotic?

A 
Fasting glucose
Lipogram
BP
WC
Weight
44
Q

Name atypical bipolar features

A

Hypersomnia
Weight gain
Sensitive interpersonal communication
Leaden paralysis

45
Q

Define rapid cycling

A

At least 4 distinctive episodes within 1 year

46
Q

Which drug class can result in mania in bipolar disorder?

A

Antidepressants

47
Q

Name specifiers in a current/most recent bipolar disorder episode

A 
Mild, moderate, severe
W/ anxious distress
W/ mixed features
W/ melancholic features
W/ atypical features
W/ psychotic features (mood congruent/incongruent)
W/ catatonia
W/ peripartum onset
48
Q

Name lifetime pattern specifiers in bipolar disorder

A

W/ rapid cycling
W/ seasonal pattern
In partial remission
In full remission

49
Q

Give the aetiology of bipolar disorder

A

Multifactorial
Biological
Genetic
Psychosocial

50
Q

Which bipolar disorder patients should be hospitalised?

A

Risk of suicide
Risk of homicide
Relapse w/ grossly impaired ability food/shelter in absence of proper support system
Rapidly progressing symptoms

51
Q

Which bipolar disorder patients are usually hospitalised?

A

Manic episodes
Severe depressive episodes
Mixed features

52
Q

Which bipolar disorder patients usually receive outpatient treatment?

A

Hypomanic

Mild-moderately severe depressive episodes

53
Q

Psycotherapy and pharmcotherapy in bipolar disorder are more effective when used alone/in combination

A

In combination

54
Q

During which phases and episodes is psychotherapy useful?

A

Maintenance phase
Hypomania
Mild-moderate depression

55
Q

During which episodes is psychotherapy unuseful?

A

Manic
Severe depressive
Psychotic
Mixed features

56
Q

What is the psychotherapy treatment of choice in bipolar disorder?

A

Cognitive behavioural therapy

57
Q

Which drug class is the mainstay of bipolar disorder pharmacotherapy treatment?

A

Mood stabilisers

58
Q

Combination mood stabilisers in severe bipolar pathology is unusual
True or false?

A

False

59
Q

Name the 4 domains of mood stabiliser

A

Treat from above
Stabilise from above
Treat from below
Stabilise from below

60
Q

Which domain of mood stabiliser does manic episode treatment follow?

A

Treat from above

61
Q

Which domain of mood stabiliser does manic episode prevention follow?

A

Stabilise from above

62
Q

Which domain of mood stabiliser does depressive episode treatment follow?

A

Treat from below

63
Q

Which domain of mood stabiliser does depressive episode prevention follow?

A

Stabilise from below

64
Q

Why avoid antidepressants in bipolar disorder management?

A

Hypomania risk

Rapid cycling risk

65
Q

Name mood stabilisers effective in treating depression in bipolar disorder

A 
Lamotrigine
Olanzepine
Quetiapine
Aripiprazole
Lithium
Valproate
66
Q

Which mood stabiliser is best in severe depression requiring urgent treatment and why?

A

Quetiapine (quicker onset of action)

67
Q

Why is lamotrigine started slowly?

A

Side effect profile

SJS

68
Q

What do you always need to give antidepressants in bipolar disorder?

A

In combination with at least 1 mood stabiliser

  • 1 effective in treating depression
  • 1 effective at preventing manic episodes
69
Q

Discuss management of psychotic depression in bipolar disorder

A

Add an antipsychotic
Use atypical antipsychotic
Avoid haloperidol

70
Q

Why avoid haloperidol in psychotic depression of bipolar disorder

A

Causes dysphoria

71
Q

Which antipsychotics are best for psychotic depression in bipolar disorder

A

Olanzapine
Quetiapine
Aripiprazole

72
Q

Discuss treatment of a manic episode

A
  1. Start mood stabiliser for mania
  2. Add antipsychotic if needed
  3. Add long acting BZD if needed
  4. ECT if needed
  5. Stop antidepressants
  6. Sedate in emergency if needed
73
Q

Name mood stabilisers effective in treating mania

A

Valproate
Lithium
Atypical antipsychotic

74
Q

Name the advantage of valproate in the manic episode

A

Can titrate dose upwards rapidly

75
Q

Name the disadvantage of lithium in the manic episode

A

Slow titration due to toxicity risk

76
Q

Which antipsychotics are effective in a manic episode for psychosis?

A 
Haloperidol
Atypical antipsychotic (olanzepine)
77
Q

Which BZD is effective in a manic episode if needed?

A

Clonazepam 2mg po tds

78
Q

Give examples of emergency sedation options in treatment of a manic episode

A 
Lorazepam
Haloperidol
Olanzapine
Ziprasidone
Clopixol acuphase
79
Q

Which medication MUST be stopped during a manic episode?

A

Antidepressant

80
Q

Discuss treatment of a hypomanic episode

A
  1. Start mood stabiliser for mania
  2. Add antipsychotic if needed
  3. Add long acting BZD if needed
  4. Stop antidepressants
81
Q

Which antipsychotics are effective in a hypomanic episode for psychosis?

A

Haloperidol
Atypical antipsychotic
UNUSUAL AS IMPLIES MANIC

82
Q

Which BZD is effective in a hypomanic episode if needed?

A

Clonazepam 2mg po tds

UNUSUAL AS IMPLIES MANIC

83
Q

Discuss treatment of mixed features

A
  1. Start mood stabiliser

2. Add antipsychotic if needed

84
Q

Which mood stabilisers are effective in treating mixed features?

A

Valproate
Lamotrigine
Consider atypical antipsychotic

85
Q

What is the issue with valproate and lamotrigine combined?

A

Lamotrigine metabolised by CYP450 in liver -> valproate ihibits the CY450 -> incr serum lamotrigine -> SJS risk increases

86
Q

What medications are used for the maintenance phase of bipolar disorder?

A

Lithium
Valproate
Carbamazepine/oxcarbazepine
Lamotrigine

87
Q

What is lithium most effective in treating and preventing?

A

Manic episodes

88
Q

What is valproate most effective in treating and preventing?

A

Manic episodes

89
Q

What is valproate the treatment of choice for?

A

Mixed features

Rapid cycling

90
Q

Is valproate effective in treatment and prevention of depression?

A

NO

91
Q

Why is carbamazepine no longer routinely used?

A

Same use profile as valproate

Less effective

92
Q

What is lamotrigine the treatment of choice for?

A

Preventing depressive episodes

93
Q

What is lamotrigine effective in treating?

A

Depressive episodes treatment

Manic episode prevention

94
Q

Which episodes is lamotrigine not effective in?

A

Treatment of manic episodes

95
Q

What are atypical antipsychotics not effective in?

A

Preventing depressive episodes

96
Q

Name medications claimed to have efficacy but mostly ineffective as mood stabilisers

A 
Topiramate
Gabapentin
Levetiracetam
Pregabalin
Riluzole
Memantine
Ketamine
Amantadine
CCBs
97
Q

What are atypical antipsychotics effective in treating?

A

Treating manic episodes
Preventing manic episodes
Treating depressive episodes

Pharmacology (32 decks)

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