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IDT Fall > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

why are bipolar meds considered “neuroprotective”?

A

during mania glutamate is released which increases intracellular calcium and cortisol which can damage nerve cells

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2
Q

name the list of drugs that can increase risk of mania in bipolar

A

-alcohol
-bronchodilators
-caffeine
-cocaine
-stimulants
-steroids
-antidepressants
-hallucinogens
-dopamine agonists
-pseudophedrine
-interferon

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3
Q

how to diagnose bipolar I?

A

previous manic or mixed features lasting at least 7 days or requiring hospitalization

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4
Q

what are the alternating symptoms of bipolar I?

A

full manic episodes alternate with full major depressive episodes

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5
Q

what are the alternative symptoms of bipolar II?

A

full major depressive episodes alternate with hypomanic episodes

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6
Q

T/F both BP I and II spend majority of life in a depressive state

A

True

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7
Q

what is leaden paralysis?

A

when you don’t want to get up or do anything

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8
Q

people with ADHD have a ____ chance of bipolar disorder

A

10-20%

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9
Q

people with anxiety have a ____ chance of bipolar disorder

A

35-50%

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10
Q

people with OCD have a ____ chance of bipolar disorder

A

12-20%

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11
Q

people with alcoholism have a ____ chance of bipolar disorder

A

60%

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12
Q

people with an eating disorder have a ____ chance of bipolar disorder

A

8-14%

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13
Q

which drug to treat bipolar has the most evidence for protecting against suicidality?

A

lithium

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14
Q

T/F people with atypical bipolar and bipolar with mixed features are more responsive to lithium than in classic bipolar

A

false, it’s the opposite

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15
Q

With bipolar, there is reduced grey matter volume in the _________ which impacts decision making and judgement

A

prefrontal cortical regions

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16
Q

elevated cortisol reduces ______ size and promotes stress hormones and glutamate neurotoxicity

A

hippocampal

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17
Q

why is misdiagnosis of depression a major concern in bipolar patients?

A

antidepressants trigger manic disorder

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18
Q

which two drugs are best for treating manic episodes?

A

divalproex and lithium

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19
Q

which drugs are used for bipolar depression?

A

lamotrigine
lithium
quetiapine
cariprazine
olanzapine/fluoxetine
lurasidone
lumateperone

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20
Q

which drugs are used for mania and mixed bipolar treatment

A

divalproex
carbamazepine
aripiprazole
ziprasidone
risperidone
asenapine
cariprazine
olanzapine

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21
Q

which drug is used for mania, mixed, and depression bipolar?

A

cariprazine

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22
Q

what are the SEs of lumateperone?

A

drowsiness, dizziness, dry mouth, and nausea

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23
Q

SEs of cariprazine?

A

drowsiness and sedation

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24
Q

what are the benefits of cariprazine? (lower risk of what SEs?)

A

low risk for EPS, weight gain, and metabolic SEs

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25
Q

what is the downside of cariprazine? (time for full efficacy)

A

takes 2-3 months for full efficacy

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26
Q

what are the top drugs of choice as monotherapy for bipolar I?

A

lithium, valproic acid, aripiprazole, risperidone, ziprasidone, olanzapine, and quetiapine

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27
Q

adjunctive therapy (most common) for bipolar I is combinations of?

A

Lithium + valproic acid OR Lithium/valproic acid with quetiapine or risperidone or aripiprazole or ziprasidone

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28
Q

drugs for monotherapy for bipolar II?

A

lithium, lamotrigine, olanzapine/fluoxetine, lurasidone

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29
Q

adjunctive therapy for bipolar II?

A

lithium or valproic acid with lamotrigine or quetiapine or lurasidone or olanzapine or olanzapine/fluoxetine

30
Q

T/F lithium is not effective in bipolar with mixed or atypical features as monotherapy

A

True

31
Q

what’s the best antipsych for children?

A

risperidone

32
Q

T/F ADHD is the strongest predictor of poor lithium response in children

A

true

33
Q

why is depakote ER and sprinkles a good choice for elderly with bipolar?

A

provides steadier serum levels with reduced peak level side effects

34
Q

what is the best drug for pregnancy?

A

lurasidone

35
Q

what is another good drug for pregnancy?

A

clozapine

36
Q

which drugs should be avoided in 1st trimester and at delivery in pregnancy?

A

lithium
lamotrigine
valproic acid
carbamazepine

37
Q

which drug class should be avoided in pregnancy?

A

benzos

38
Q

why do we not typically prescribe lamotrigine to individuals using oral contraceptives?

A

lowers lamotrigine levels by ~50%

39
Q

why do we not prescribe carbamazepine to people using oral contraceptives?

A

it may decrease the oral contraceptives efficacy

40
Q

what signs should a mother look for for infant toxicity of drugs passing through breast milk?

A

poor feeding
jaundice
rash
sedation

41
Q

what are the lithium adverse effects? (LITHIUM acronym)

A

Leukocytosis (incr WBC)
Diabetes Insipidus/ polyuria
Tremor
Hypothyroidism
Increased weight, edema
Unwanted acne, alopecia (hair thinning/loss), dermatitis
Memory impairment

42
Q

what interaction is there b/w NSAIDs and lithium?

A

NSAIDs cause lithium toxicity, presenting as N/V, restlessness, and racing heart

43
Q

what interaction is there b/w ACE-i/ARBs and lithium?

A

cause lithium toxicity

44
Q

which “anti-inflammatory” agent is okay to take while on lithium?

A

aspirin

45
Q

what interaction is there b/w diuretics and lithium?

A

cause lithium toxicity

46
Q

what interaction is there b/w methylxanthines (like caffeine) and lithium?

A

can decrease lithium levels

47
Q

what is the recommendation to patients taking lithium who consume a lot of caffeine?

A

don’t abruptly decrease or increase caffeine intake

48
Q

what is the maintenance range of plasma concentration of lithium?

A

0.6-1

49
Q

what is the acute mania range of plasma concentration of lithium?

A

0.8-1.2

50
Q

what is the elderly range of plasma concentration of lithium?

A

0.4-1

51
Q

is a maintenance level of 1.1 plasma concentration of lithium concerning?

A

no, only if patient is showing signs of an adverse reaction

52
Q

what are the warning signs of initial lithium toxicity (0.9-1.4)

A

fine hand tremor
polyuria
mild thirst

53
Q

counseling points for lithium:

A

take with food to avoid nausea and stomach upset
take at bedtime

54
Q

what can pt do if they develop a mild tremor on lithium?

A

use beta blockers like atenolol and propranolol or a BZD

55
Q

what can pt do if they have increased urination on lithium?

A

can add amiloride to treat it

56
Q

T/F valproic acid is a safe alternative in pregnancy

A

false, do not use in pregnancy

57
Q

what are the SEs of valproic acid?

A

weight gain, reduced platelets and WBCs, increased ammonia levels, and alopecia (hair loss)

58
Q

why should aspirin not be used with valproic acid?

A

it increase valproic acid levels in body and can lead to higher ammonia levels

59
Q

what is the treatment for hyperammonemic encephalopathy?

A

lactulose 30-45 ml every hour until a bowel movement, then q8-12 hrs for 5 days

60
Q

list the drugs with interactions with valproic acid

A

lamotrigine, salicylates, carbapenem antibiotics, and warfarin

61
Q

whats an adverse reaction to counsel on for lamotrigine?

A

stop use if a rash occurs and let prescriber know

62
Q

what is the interaction b/w lamotrigine and estrogen products?
what to do about interaction?

A

they reduce lamotrigine levels
may need higher lamotrigine doses

63
Q

what is the interaction b/w lamotrigine and valproic acid?
what to do about interaction?

A

lamotrigine levels may increase and valproic acid levels may decrease
lower dose of lamotrigine and possible higher dose of valproic acid

64
Q

what is the interaction b/w lamotrigine and folic acid?

A

lamotrigine blocks folate metabolism

65
Q

what’s a helpful counseling point for a patient starting lamotrigine?

A

avoid using new soaps or skin products during lamotrigine titration

66
Q

what 2 drugs would be most sedating if one wanted to quickly slow down a manic person threatening to cause harm?

A

quetiapine and valproate/depakote

67
Q

which drug has the best overall evidence for reducing suicide risk and treating acute euphoric mania?

A

lithium

68
Q

if someone had past history of cardiac myopathy or QT prolongation, which drugs should they not use?

A

ziprasidone
risperidone
quetiapine

69
Q

which drug is the safest in pregnancy?

A

lurasidone

70
Q

which 4 drugs are not monotherapy for mania symptoms?

A

lamotrigine
olanzapine/fluoxetine
lurasidone
lumateperone

71
Q

which 4 drugs are not monotherapy for mixed symptoms?

A

lithium
queitapine
lurasidone
lumateperone

IDT Fall (29 decks)

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