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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
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
26
which 2nd gen APS can be used for BPD depression (5)
cariprazine, lumateperone, lurasidone, olanzapine (+fluoxetine), quetiapine
27
which LAI are approved for BPD
aripiprazole (maintena, asimtufii) risperidone (consta, rykindo)
28
selective a-2 adrenergic receptor agonist taken SL approved for agitation in BPD
dexmedetomidine
29
3 APS agents used in BPD that also are indicated for adjunct in MDD
aripiprazole, olanzapine (w/ fluoxetine), quetiapine
30
should AD ever be used alone in BPD? when are they used?
never monotherapy add on for depressive episodes PRN
31
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
32
aside from benzos, what can be added for manic episodes as adjunctive therapy
add SGA to lithium or valproate add additional mood stabilizer
33
which SGA is better for depression in BPD? maintenance?
depression- quetiapine maintenance- olanzapine
34
which APS is available as a short acting injection and can be used for BPD
olanzapine
35
what 2 conditions does anxiety often coexist with
sub abuse and depression
36
examples of drugs/classes than can induce anxiety
bupropion, SSRI, quinolones, albuterol, prednisone, illicit drugs, stimulants, withdrawal
37
major AE considerations in the elderly when treating for anxiety
anticholinergic sensitivity paradoxical disinhibition risk fall risk
38
is buspirone used for GAD continuously or PRN
continuously- takes time for affect NOT FOR PRN USE!!!!!!!!
39
which 4 AD are used for GAD
escitalopram, paroxetine, duloxetine, venlafaxine
40
how should AD be dosed for GAD? why?
low and slow to avoid precipitating anxiety
41
3 major AE of AD that do not go away with time
sexual dysfunction, weight gain, drowsiness
42
which 6 benzodiazepines are approved for use in anxiety
alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, lorazepam
43
BZD are best for rapid relief of which symptoms of anxiety
somatic & autonomic (physical)
44
alprazolam & clonazepam are also indicated for
panic
45
2 major AE of benzos
paradoxical inhibition anterograde amnesia (alprazolam)
46
CI for benzos
hx of sub abuse, severe hepatic disease, pregnancy/lactation, etc.
47
which 3 benzos are best for use in hepatic disease? which is approved for anxiety?
lorazepam -- anxiety oxazepam & triazolam
48
benzo BBW
risks when taken with opiates, dependence risk, abuse/misuse
49
which benzo is a prodrug requiring acid for conversion
clorazepate
50
which benzo crosses the BBB quickly & has a long t1/2? what does this lead to?
diazepam- high potential for euphoria and misuse
51
which 2 benzos are high potency
clonazepam and alprazolam
52
benzos should be tapered when being d/c to avoid
rebound anxiety, withdrawal, seizures
53
options to manage sleep disturbances with GAD
switch agents to more sedating (hydroxyzine, pregabalin), trazodone
54
which GAD agent is best for elderly
escitalopram
55
which 4 agents are used for panic disorder
fluoxetine, paroxetine, sertraline, venlafaxine
56
are drugs used for specific phobias in panic disorder? what is used?
no drugs, use CBT
57
which drugs should NOT be used when receiving CBT
benzos
58
which 3 agents are used for SAD
paroxetine, sertraline, venlafaxine
59
3 alternate drug classes used for SAD
anticonvulsants, benzos, B-blockers
60
which 2 anticonvulsants can be used for SAD
gabapentin, pregabalin
61
when can benzos be used in SAD
IF OTHER OPTIONS FAIL
62
propranolol and atenolol are used in SAD to reduce
autonomic anxiety (tremor, high HR)
63
which drug has no benefit and should NOT be used for SAD
buspirone
64
3 preferred therapies for PTSD
paroxetine, sertraline, CBT
65
which 6 agents/classes should NOT be used for PTSD
ketamine, divalproex, prazosin, benzos, cannabis, APS
66
what drug is used to treat nightmares in PTSD
prazosin
67
which 4 agents are used for OCD
fluoxetine, fluvoxamine, paroxetine, sertraline
68
which 3 agents should NOT be used for OCD
clonazepam, desipramine, clonidine

Therapeutics (34 decks)

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