Bipolar Disorder Flashcards
why are bipolar meds considered “neuroprotective”?
during mania glutamate is released which increases intracellular calcium and cortisol which can damage nerve cells
name the list of drugs that can increase risk of mania in bipolar
-alcohol
-bronchodilators
-caffeine
-cocaine
-stimulants
-steroids
-antidepressants
-hallucinogens
-dopamine agonists
-pseudophedrine
-interferon
how to diagnose bipolar I?
previous manic or mixed features lasting at least 7 days or requiring hospitalization
what are the alternating symptoms of bipolar I?
full manic episodes alternate with full major depressive episodes
what are the alternative symptoms of bipolar II?
full major depressive episodes alternate with hypomanic episodes
T/F both BP I and II spend majority of life in a depressive state
True
what is leaden paralysis?
when you don’t want to get up or do anything
people with ADHD have a ____ chance of bipolar disorder
10-20%
people with anxiety have a ____ chance of bipolar disorder
35-50%
people with OCD have a ____ chance of bipolar disorder
12-20%
people with alcoholism have a ____ chance of bipolar disorder
60%
people with an eating disorder have a ____ chance of bipolar disorder
8-14%
which drug to treat bipolar has the most evidence for protecting against suicidality?
lithium
T/F people with atypical bipolar and bipolar with mixed features are more responsive to lithium than in classic bipolar
false, it’s the opposite
With bipolar, there is reduced grey matter volume in the _________ which impacts decision making and judgement
prefrontal cortical regions
elevated cortisol reduces ______ size and promotes stress hormones and glutamate neurotoxicity
hippocampal
why is misdiagnosis of depression a major concern in bipolar patients?
antidepressants trigger manic disorder
which two drugs are best for treating manic episodes?
divalproex and lithium
which drugs are used for bipolar depression?
lamotrigine
lithium
quetiapine
cariprazine
olanzapine/fluoxetine
lurasidone
lumateperone
which drugs are used for mania and mixed bipolar treatment
divalproex
carbamazepine
aripiprazole
ziprasidone
risperidone
asenapine
cariprazine
olanzapine
which drug is used for mania, mixed, and depression bipolar?
cariprazine
what are the SEs of lumateperone?
drowsiness, dizziness, dry mouth, and nausea
SEs of cariprazine?
drowsiness and sedation
what are the benefits of cariprazine? (lower risk of what SEs?)
low risk for EPS, weight gain, and metabolic SEs
what is the downside of cariprazine? (time for full efficacy)
takes 2-3 months for full efficacy
what are the top drugs of choice as monotherapy for bipolar I?
lithium, valproic acid, aripiprazole, risperidone, ziprasidone, olanzapine, and quetiapine
adjunctive therapy (most common) for bipolar I is combinations of?
Lithium + valproic acid OR Lithium/valproic acid with quetiapine or risperidone or aripiprazole or ziprasidone
drugs for monotherapy for bipolar II?
lithium, lamotrigine, olanzapine/fluoxetine, lurasidone
adjunctive therapy for bipolar II?
lithium or valproic acid with lamotrigine or quetiapine or lurasidone or olanzapine or olanzapine/fluoxetine
T/F lithium is not effective in bipolar with mixed or atypical features as monotherapy
True
what’s the best antipsych for children?
risperidone
T/F ADHD is the strongest predictor of poor lithium response in children
true
why is depakote ER and sprinkles a good choice for elderly with bipolar?
provides steadier serum levels with reduced peak level side effects
what is the best drug for pregnancy?
lurasidone
what is another good drug for pregnancy?
clozapine
which drugs should be avoided in 1st trimester and at delivery in pregnancy?
lithium
lamotrigine
valproic acid
carbamazepine
which drug class should be avoided in pregnancy?
benzos
why do we not typically prescribe lamotrigine to individuals using oral contraceptives?
lowers lamotrigine levels by ~50%
why do we not prescribe carbamazepine to people using oral contraceptives?
it may decrease the oral contraceptives efficacy
what signs should a mother look for for infant toxicity of drugs passing through breast milk?
poor feeding
jaundice
rash
sedation
what are the lithium adverse effects? (LITHIUM acronym)
Leukocytosis (incr WBC)
Diabetes Insipidus/ polyuria
Tremor
Hypothyroidism
Increased weight, edema
Unwanted acne, alopecia (hair thinning/loss), dermatitis
Memory impairment
what interaction is there b/w NSAIDs and lithium?
NSAIDs cause lithium toxicity, presenting as N/V, restlessness, and racing heart
what interaction is there b/w ACE-i/ARBs and lithium?
cause lithium toxicity
which “anti-inflammatory” agent is okay to take while on lithium?
aspirin
what interaction is there b/w diuretics and lithium?
cause lithium toxicity
what interaction is there b/w methylxanthines (like caffeine) and lithium?
can decrease lithium levels
what is the recommendation to patients taking lithium who consume a lot of caffeine?
don’t abruptly decrease or increase caffeine intake
what is the maintenance range of plasma concentration of lithium?
0.6-1
what is the acute mania range of plasma concentration of lithium?
0.8-1.2
what is the elderly range of plasma concentration of lithium?
0.4-1
is a maintenance level of 1.1 plasma concentration of lithium concerning?
no, only if patient is showing signs of an adverse reaction
what are the warning signs of initial lithium toxicity (0.9-1.4)
fine hand tremor
polyuria
mild thirst
counseling points for lithium:
take with food to avoid nausea and stomach upset
take at bedtime
what can pt do if they develop a mild tremor on lithium?
use beta blockers like atenolol and propranolol or a BZD
what can pt do if they have increased urination on lithium?
can add amiloride to treat it
T/F valproic acid is a safe alternative in pregnancy
false, do not use in pregnancy
what are the SEs of valproic acid?
weight gain, reduced platelets and WBCs, increased ammonia levels, and alopecia (hair loss)
why should aspirin not be used with valproic acid?
it increase valproic acid levels in body and can lead to higher ammonia levels
what is the treatment for hyperammonemic encephalopathy?
lactulose 30-45 ml every hour until a bowel movement, then q8-12 hrs for 5 days
list the drugs with interactions with valproic acid
lamotrigine, salicylates, carbapenem antibiotics, and warfarin
whats an adverse reaction to counsel on for lamotrigine?
stop use if a rash occurs and let prescriber know
what is the interaction b/w lamotrigine and estrogen products?
what to do about interaction?
they reduce lamotrigine levels
may need higher lamotrigine doses
what is the interaction b/w lamotrigine and valproic acid?
what to do about interaction?
lamotrigine levels may increase and valproic acid levels may decrease
lower dose of lamotrigine and possible higher dose of valproic acid
what is the interaction b/w lamotrigine and folic acid?
lamotrigine blocks folate metabolism
what’s a helpful counseling point for a patient starting lamotrigine?
avoid using new soaps or skin products during lamotrigine titration
what 2 drugs would be most sedating if one wanted to quickly slow down a manic person threatening to cause harm?
quetiapine and valproate/depakote
which drug has the best overall evidence for reducing suicide risk and treating acute euphoric mania?
lithium
if someone had past history of cardiac myopathy or QT prolongation, which drugs should they not use?
ziprasidone
risperidone
quetiapine
which drug is the safest in pregnancy?
lurasidone
which 4 drugs are not monotherapy for mania symptoms?
lamotrigine
olanzapine/fluoxetine
lurasidone
lumateperone
which 4 drugs are not monotherapy for mixed symptoms?
lithium
queitapine
lurasidone
lumateperone
