Bipolar Disorder Flashcards
Bipolar 1
Manic episode +/- major depressive or hypomanic episodes
Bipolar 2
Major depressive episode + hypomanic episode
Bipolar Sx/Risk Factors
<25 yo
family hx
increased sleep + appetite
psychomotor retardation
atypical depression
Co-occurring substance abuse
4 A’s of Atypical Depression
Anxious
Anger
Agitation
Lack of Attention
Rapid cycling
More than 4 episodes per year
Dysthymia
persistent depressive disorder (mild but long term depression)
Cyclothymia
cycle of ups and downs similar to bipolar disorder but more mild
Schizoaffective disorder
mix of schizophrenia with mode episodes of bipolar disorder
treatment:
-mood stabilizers + APS (Paliperidone, Clozapine)
Drugs 1st line drugs FDA approved for Acute Mania & Mixed Episodes
Lithium**
AED:
-Valproate**
-Carbamazepine ER + IR
SGA:
-Quetiapine**
-Aripiprazole*
-Asenapine*
-Cariprazine*
-Olanzapine*
-Risperidone*
-Ziprasidone
Drugs 1st line drugs FDA approved for Maintenance Therapy
Lithium
AEDs:
-Valproic Acid
-Lamotrigine
SGAs:
-Aripiprazole
-Olanzapine
-Quetiapine
-Risperidone
-Ziprasidone (adjunct to Li/VPA)
Drugs 1st line drugs FDA approved for Acute Depression
Lithium
AEDs:
-Lamotrigine (BP II only)
-Cariprazine (Vraylar)
SGAs:
-Lurasidone (Latuda)
-Olanzapine w/ fluoxetine (BP II only)
-Quetiapine (Seroquel)
Antidepressants can be used but not as monotherapy (SNRI better than TCA)
Drugs for treatment of Agitation in Bipolar Disorder
Aripiprazole
Lorazepam
Loxapine
Olanzapine
Meds NOT recommended in acute mania
gabapentin
topiramate
lamotrigine
verapamil
tiagabine
risperidone + carbamazepine
olanzapine + carbamazepine
Meds NOT to use in depressive episodes
gabapentin
aripiprazole
ziprasidone
adjunct levetiracetam (Keppra)
Meds NOT to use in maintenance
gabapentin
topiramate
antidepressants
adjunct fluphenthixol
Lithium dosing
900mg - 2400mg /day in 2-4 div doses
take with food
Target lithium serum concentration
0.6-1.2 mEq/L
Toxic lithium serum concentration
> 1.5 mEq/L
When is the best time to perform TDM for lithium concentrations
at trough:
8-12 hrs after last dose
5 days after stable dose is achieved
may draw sooner if toxicity or nonadherence concerns
Lithium ADE
- nephrotoxicity (Polydipsia and polyuria +/- nephrogenic diabetes insipidus) -> can have irreversible consequences
- AKI, CKD
- GI and CNS (dose related, worst at peak)
- muscle weakness and lethargy
- CV events
- hypothyroidism
- floppy baby syndrome
Lithium ADE: Management of GI and CNS effects
lowest effective dose
once daily dosing (XL) at bedtime
take with food
liquid formulation for diarrhea
Lithium ADE: Tremor management
long acting preparations
lower dose
add beta blocker (propranolol)
Valproate ADE
Dose related:
- GI (transient)
-Tremor (dose decrease / BB)
- Sedation (HS dosing)
Prolonged bleeding
Weight gain
Hyperammonemia
Alopecia (dose dependent)
BBW: pancreatitis and/or hepatotoxicity, urea disorders
Lamotrigine ADE
SJS
aseptic meningitis
prodrome chills
sore throat
fever
