Bipolar & Anxiety Flashcards
type 1 BPD is characterized by
manic episodes
type 2 BPD is characterized by
hypomanic episodes
what agents/classes are used for acute mania in BPD
lithium, valproate, carbamazepine, or APS
monotherapy or combo
what agents/classes are used for BPD depressive episodes
lithium, lamotrigine, APS
which 2 classes of AD are more likely to precipitate a manic episode
SNRI, TCA
should AD be continued during a manic episode
no- d/c if possible
which agents/classes are used for BPD maintenance
lithium, lamotrigine, valproate, APS
lithium is best for what type of BPD?
not as good for?
best- euphoric mania
not work as well- rapid cyclers, mixed states
lithium elimination is entirely
renal
lithium decreases the risk of
suicide
lithium is not good for patients with poor adherence due to risk for
toxicity at high doses
minor AEs of lithium
GI, CNS, muscle weakness, tremor, lethargy, cardiac
to avoid GI effects of lithium
take with food, lower dose, XL QD dose, goes away with time
what can be added to treat hand tremor from lithium
propranolol
more serious AEs of lithium
polydipsia & polyuria +/- NDI, AKI, CKD, Brugada, floppy baby
which meds affect renal function and should be avoided on lithium
NSAIDs, ACE, ARB, diuretics, CCB. ECT, caffeine, clozapine
lithium is CI in
severe renal or cardiac disease, breastfeeding
2 main things requiring monitoring when on lithium
renal function, thyroid
valproate is good for what type of BPD
rapid cycling and mixed states
AEs of valproate
GI, tremor, sedation, bleeding/thrombocytopenia, weight gain, hyperammonemia, alopecia
BBW valproate
pancreatitis, liver toxicity, hepatotoxicity, urea disorders
AE of carbamazepine
neutropenia, leukopenia, hyponatremia
carbamazepine BBW
SJS/TEN- Asian risk
aside from carbamazepine & valproate, what other AED can be used for BPD
lamotrigine
which 2nd gen APS can be used for manic/mixed episodes (7)?
maintenance? (6)
aripiprazole, asenapine, cariprazine, olanzapine (+/- sadimorphan), quetiapine, risperidone, ziprasidone
**maintenance same except no asenapine
which 2nd gen APS can be used for BPD depression (5)
cariprazine, lumateperone, lurasidone, olanzapine (+fluoxetine), quetiapine
which LAI are approved for BPD
aripiprazole (maintena, asimtufii)
risperidone (consta, rykindo)
selective a-2 adrenergic receptor agonist taken SL approved for agitation in BPD
dexmedetomidine
3 APS agents used in BPD that also are indicated for adjunct in MDD
aripiprazole, olanzapine (w/ fluoxetine), quetiapine
should AD ever be used alone in BPD? when are they used?
never monotherapy
add on for depressive episodes PRN
what drug class can be added as adjunct in BPD short term for anxiety, panic, or agitation during acute mania
benzos- usually clonazepam or lorazepam
aside from benzos, what can be added for manic episodes as adjunctive therapy
add SGA to lithium or valproate
add additional mood stabilizer
which SGA is better for depression in BPD? maintenance?
depression- quetiapine
maintenance- olanzapine
which APS is available as a short acting injection and can be used for BPD
olanzapine
what 2 conditions does anxiety often coexist with
sub abuse and depression
examples of drugs/classes than can induce anxiety
bupropion, SSRI, quinolones, albuterol, prednisone, illicit drugs, stimulants, withdrawal
major AE considerations in the elderly when treating for anxiety
anticholinergic sensitivity
paradoxical disinhibition risk
fall risk
is buspirone used for GAD continuously or PRN
continuously- takes time for affect
NOT FOR PRN USE!!!!!!!!
which 4 AD are used for GAD
escitalopram, paroxetine, duloxetine, venlafaxine
how should AD be dosed for GAD? why?
low and slow to avoid precipitating anxiety
3 major AE of AD that do not go away with time
sexual dysfunction, weight gain, drowsiness
which 6 benzodiazepines are approved for use in anxiety
alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, lorazepam
BZD are best for rapid relief of which symptoms of anxiety
somatic & autonomic (physical)
alprazolam & clonazepam are also indicated for
panic
2 major AE of benzos
paradoxical inhibition
anterograde amnesia (alprazolam)
CI for benzos
hx of sub abuse, severe hepatic disease, pregnancy/lactation, etc.
which 3 benzos are best for use in hepatic disease? which is approved for anxiety?
lorazepam – anxiety
oxazepam & triazolam
benzo BBW
risks when taken with opiates, dependence risk, abuse/misuse
which benzo is a prodrug requiring acid for conversion
clorazepate
which benzo crosses the BBB quickly & has a long t1/2? what does this lead to?
diazepam- high potential for euphoria and misuse
which 2 benzos are high potency
clonazepam and alprazolam
benzos should be tapered when being d/c to avoid
rebound anxiety, withdrawal, seizures
options to manage sleep disturbances with GAD
switch agents to more sedating (hydroxyzine, pregabalin), trazodone
which GAD agent is best for elderly
escitalopram
which 4 agents are used for panic disorder
fluoxetine, paroxetine, sertraline, venlafaxine
are drugs used for specific phobias in panic disorder? what is used?
no drugs, use CBT
which drugs should NOT be used when receiving CBT
benzos
which 3 agents are used for SAD
paroxetine, sertraline, venlafaxine
3 alternate drug classes used for SAD
anticonvulsants, benzos, B-blockers
which 2 anticonvulsants can be used for SAD
gabapentin, pregabalin
when can benzos be used in SAD
IF OTHER OPTIONS FAIL
propranolol and atenolol are used in SAD to reduce
autonomic anxiety (tremor, high HR)
which drug has no benefit and should NOT be used for SAD
buspirone
3 preferred therapies for PTSD
paroxetine, sertraline, CBT
which 6 agents/classes should NOT be used for PTSD
ketamine, divalproex, prazosin, benzos, cannabis, APS
what drug is used to treat nightmares in PTSD
prazosin
which 4 agents are used for OCD
fluoxetine, fluvoxamine, paroxetine, sertraline
which 3 agents should NOT be used for OCD
clonazepam, desipramine, clonidine
