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Therapeutics > Bipolar & Anxiety > Flashcards

Bipolar & Anxiety Flashcards

1
Q

type 1 BPD is characterized by

A

manic episodes

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2
Q

type 2 BPD is characterized by

A

hypomanic episodes

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3
Q

what agents/classes are used for acute mania in BPD

A

lithium, valproate, carbamazepine, or APS
monotherapy or combo

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4
Q

what agents/classes are used for BPD depressive episodes

A

lithium, lamotrigine, APS

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5
Q

which 2 classes of AD are more likely to precipitate a manic episode

A

SNRI, TCA

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6
Q

should AD be continued during a manic episode

A

no- d/c if possible

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7
Q

which agents/classes are used for BPD maintenance

A

lithium, lamotrigine, valproate, APS

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8
Q

lithium is best for what type of BPD?
not as good for?

A

best- euphoric mania
not work as well- rapid cyclers, mixed states

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9
Q

lithium elimination is entirely

A

renal

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10
Q

lithium decreases the risk of

A

suicide

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11
Q

lithium is not good for patients with poor adherence due to risk for

A

toxicity at high doses

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12
Q

minor AEs of lithium

A

GI, CNS, muscle weakness, tremor, lethargy, cardiac

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13
Q

to avoid GI effects of lithium

A

take with food, lower dose, XL QD dose, goes away with time

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14
Q

what can be added to treat hand tremor from lithium

A

propranolol

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15
Q

more serious AEs of lithium

A

polydipsia & polyuria +/- NDI, AKI, CKD, Brugada, floppy baby

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16
Q

which meds affect renal function and should be avoided on lithium

A

NSAIDs, ACE, ARB, diuretics, CCB. ECT, caffeine, clozapine

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17
Q

lithium is CI in

A

severe renal or cardiac disease, breastfeeding

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18
Q

2 main things requiring monitoring when on lithium

A

renal function, thyroid

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19
Q

valproate is good for what type of BPD

A

rapid cycling and mixed states

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20
Q

AEs of valproate

A

GI, tremor, sedation, bleeding/thrombocytopenia, weight gain, hyperammonemia, alopecia

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21
Q

BBW valproate

A

pancreatitis, liver toxicity, hepatotoxicity, urea disorders

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22
Q

AE of carbamazepine

A

neutropenia, leukopenia, hyponatremia

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23
Q

carbamazepine BBW

A

SJS/TEN- Asian risk

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24
Q

aside from carbamazepine & valproate, what other AED can be used for BPD

A

lamotrigine

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25
Q

which 2nd gen APS can be used for manic/mixed episodes (7)?
maintenance? (6)

A

aripiprazole, asenapine, cariprazine, olanzapine (+/- sadimorphan), quetiapine, risperidone, ziprasidone

**maintenance same except no asenapine

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26
Q

which 2nd gen APS can be used for BPD depression (5)

A

cariprazine, lumateperone, lurasidone, olanzapine (+fluoxetine), quetiapine

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27
Q

which LAI are approved for BPD

A

aripiprazole (maintena, asimtufii)
risperidone (consta, rykindo)

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28
Q

selective a-2 adrenergic receptor agonist taken SL approved for agitation in BPD

A

dexmedetomidine

29
Q

3 APS agents used in BPD that also are indicated for adjunct in MDD

A

aripiprazole, olanzapine (w/ fluoxetine), quetiapine

30
Q

should AD ever be used alone in BPD? when are they used?

A

never monotherapy
add on for depressive episodes PRN

31
Q

what drug class can be added as adjunct in BPD short term for anxiety, panic, or agitation during acute mania

A

benzos- usually clonazepam or lorazepam

32
Q

aside from benzos, what can be added for manic episodes as adjunctive therapy

A

add SGA to lithium or valproate
add additional mood stabilizer

33
Q

which SGA is better for depression in BPD? maintenance?

A

depression- quetiapine
maintenance- olanzapine

34
Q

which APS is available as a short acting injection and can be used for BPD

A

olanzapine

35
Q

what 2 conditions does anxiety often coexist with

A

sub abuse and depression

36
Q

examples of drugs/classes than can induce anxiety

A

bupropion, SSRI, quinolones, albuterol, prednisone, illicit drugs, stimulants, withdrawal

37
Q

major AE considerations in the elderly when treating for anxiety

A

anticholinergic sensitivity
paradoxical disinhibition risk
fall risk

38
Q

is buspirone used for GAD continuously or PRN

A

continuously- takes time for affect
NOT FOR PRN USE!!!!!!!!

39
Q

which 4 AD are used for GAD

A

escitalopram, paroxetine, duloxetine, venlafaxine

40
Q

how should AD be dosed for GAD? why?

A

low and slow to avoid precipitating anxiety

41
Q

3 major AE of AD that do not go away with time

A

sexual dysfunction, weight gain, drowsiness

42
Q

which 6 benzodiazepines are approved for use in anxiety

A

alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, lorazepam

43
Q

BZD are best for rapid relief of which symptoms of anxiety

A

somatic & autonomic (physical)

44
Q

alprazolam & clonazepam are also indicated for

A

panic

45
Q

2 major AE of benzos

A

paradoxical inhibition
anterograde amnesia (alprazolam)

46
Q

CI for benzos

A

hx of sub abuse, severe hepatic disease, pregnancy/lactation, etc.

47
Q

which 3 benzos are best for use in hepatic disease? which is approved for anxiety?

A

lorazepam – anxiety
oxazepam & triazolam

48
Q

benzo BBW

A

risks when taken with opiates, dependence risk, abuse/misuse

49
Q

which benzo is a prodrug requiring acid for conversion

A

clorazepate

50
Q

which benzo crosses the BBB quickly & has a long t1/2? what does this lead to?

A

diazepam- high potential for euphoria and misuse

51
Q

which 2 benzos are high potency

A

clonazepam and alprazolam

52
Q

benzos should be tapered when being d/c to avoid

A

rebound anxiety, withdrawal, seizures

53
Q

options to manage sleep disturbances with GAD

A

switch agents to more sedating (hydroxyzine, pregabalin), trazodone

54
Q

which GAD agent is best for elderly

A

escitalopram

55
Q

which 4 agents are used for panic disorder

A

fluoxetine, paroxetine, sertraline, venlafaxine

56
Q

are drugs used for specific phobias in panic disorder? what is used?

A

no drugs, use CBT

57
Q

which drugs should NOT be used when receiving CBT

A

benzos

58
Q

which 3 agents are used for SAD

A

paroxetine, sertraline, venlafaxine

59
Q

3 alternate drug classes used for SAD

A

anticonvulsants, benzos, B-blockers

60
Q

which 2 anticonvulsants can be used for SAD

A

gabapentin, pregabalin

61
Q

when can benzos be used in SAD

A

IF OTHER OPTIONS FAIL

62
Q

propranolol and atenolol are used in SAD to reduce

A

autonomic anxiety (tremor, high HR)

63
Q

which drug has no benefit and should NOT be used for SAD

A

buspirone

64
Q

3 preferred therapies for PTSD

A

paroxetine, sertraline, CBT

65
Q

which 6 agents/classes should NOT be used for PTSD

A

ketamine, divalproex, prazosin, benzos, cannabis, APS

66
Q

what drug is used to treat nightmares in PTSD

A

prazosin

67
Q

which 4 agents are used for OCD

A

fluoxetine, fluvoxamine, paroxetine, sertraline

68
Q

which 3 agents should NOT be used for OCD

A

clonazepam, desipramine, clonidine

Therapeutics (27 decks)

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