Bipolar Disorder Flashcards
BP is classified as BP I and BP II, which differ primary by what?
the severity of mania
At least one episode of mania, and usually, bouts of intense depression (a depressive episode is not required for diagnosis)
Bipolar I
mania is associated with at least one of the following: significant impact in social or work functioning, psychosis or delusions or requires hospitalizations
At last one episode of hypomania (lasting >4 consecutive days) and at least one depressive episode last >2 weeks
Bipolar II
hypomania does NOT affect social or work functioning, does not cause psychosis nor hospitalization
How is mania diagnosed?
exhibits >3 symptoms
- inflated self-esteem
- needs less sleep
- more talkative than normal
- topic jumping
- easily distracted
- goal-directed activity inc
- high-risk pleasure activities
What are the traditional mood stabilizers that treat both mania and depression?
lithium, valproate, lamotrigine, carbamazepine
These drugs can help stabilize the mood when mania occurs with psychosis
antipsychotics
these drugs can induce or exacerbate a mania episode when used as monotherapy, so they should only be used in combination with a mood stabilizer
antidepressants
What is the acute treatment for a manic episode?
first line: valproate, lithium or an antipsychotic
severe: antipsychotic+ (lithium or valproate)
Acute treatment for a depressive episode?
First line: lithium
alt: lamotrigine
Maintenance treatment?
should be initiated after the acute episode
lithium and valproate are preferred for maintenance monotherapy
alt: lamotrigine, carbamazepine, SGAs
What is required with all antidepressants and with all antipsychotics
medguides
Valproate
carbamazepine
and lithium in preg can cause
cognitive effects.
AVOID, esp in 1st trimester
What is the safer option in pregnancy?
lamotrigine.
Lurasidone has the most favorable safety profile in preg, but its use is limited for dipolar depression
Lamotrigine should not be used for
acute mania
slow titration
Lamictal
lamotrigine
Depakote, Depacon, Depakene
Valproate/Valproic acid
Equetro
Carbamazepine
What is the major concern with antipsychotics?
EPS
first-generation has a higher incidence than SGAs
What are the more common SGAs that can be used alone or in combo with mood stabilizers for acute mania and or maintenance treatment
Abilify Zyprexa Seroquel Risperdal Geodon
Brand: abilify
Generic: aripiprazole
Brand: Zyprexa
Generic: Olanzapine
Brand: Seroquel
Generic: Quetiapine
Grand: Risperdal
Generic: Risperdone
Brand: Geodon
Ziprasidone
This drug can be used alone or in combo with mood stabilizer for bipolar depressive episodes
lurasidone/latuda
Brand: Latuda
Generic: lurasidone
This drug works by influencing the reuptake of serotonin and or NE or by moderating glutamate levels in the brain
Lithium (Lithobid)
could cause serotonin syndrome
What is the therapeutic range of lithium?
0.6-1.2mEq/L trough
This drug side effect profile:
GI upset, cognitive effects, cogwheel rigidity, hand tremor, thirst/polyuria/polydipsia, weight gain, hypothyyoidism
Lithium
Lithium toxicity level >1.5 could cause
ataxia, course hand tremor, vomiting
Lithium toxicity level >2.5 could cause
CNS depression, arrhythmia, seizure, coma
Lithium monitoring:
lithium levels, renal, thyroid function
This drug has drug interactions with:
INC drug:
sodium loss (ACE/ARBs)
NSAIDs
DEC drug:
inc salt intake, caffeine
Lithium
5mL of lithium citrate syrup = ___ mEq of lithium ion
8mEq
8mEq of lithium ion = ___mg of lithium carbonate
300mg
