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701 > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

T/F Monotherapy is standard for BPD

A

FALSE, monotherapy is not appropriate

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2
Q

Which LAIs are approved for BPD?

A

Aripiprazole
- Maintena
- Asimtufii

Risperidone
- Consta
- Rykindo

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3
Q

What is aripiprazole approved for?

A

Mania BPD, Maintenance BPD, MDD augmentation

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4
Q

What is asenapine approved for?

A

Mania BPD, Maintenance BPD

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5
Q

What is cariprazine approved for?

A

Mixed BPD, Depression BPD, Mania BPD

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6
Q

What is lumateperone approved for?

A

Mixed BPD, Depression BPD

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7
Q

What is lurasidone approved for?

A

Mixed BPD, Depression BPD

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8
Q

What is olanzapine approved for?

A

Mixed BPD, Depression BPD (w/ fluoxetine), Mania BPD, Maintenance BPD, MDD augmentation (w/ fluoxetine)

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9
Q

What is Lybalvi approved for?

A

Mania BPD, Maintenance BPD

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10
Q

What is quetiapine approved for?

A

Mixed BPD, Depression BPD, Mania BPD, Maintenance BPD, MDD augmentation

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11
Q

What is risperidone used for?

A

Mania BPD, Maintenance BPD

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12
Q

What is ziprasidone used for?

A

Mixed BPD, Mania BPD, Maintenance BPD

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13
Q

Which SGA can be used for maintenance BPD?

A
  • Aripiprazole
  • Asenapine
  • Olanzapine
  • Lybalvi
  • Quetiapine
  • Risperidone
  • Ziprasidone

AAOLQRZ

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14
Q

Which SGA can be used for mania in BPD?

A
  • Aripiprazole
  • Asenapine
  • Cariprazine
  • Olanzapine
  • Lybalvi
  • Quetiapine
  • Risperidone
  • Ziprasidone

AACOLQRZ

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15
Q

Which SGA can be used for depression in BPD?

A
  • Cariprazine
  • Lumateperone
  • Lurasidone
  • Olanzapine
  • Quetiapine

CLLOQ

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16
Q

Which SGA can be used for mixed BPD?

A
  • Asenapine
  • Cariprazine
  • Lumateperone
  • Lurasidone
  • Olanzapine
  • Quetiapine
  • Ziprasidone

ACLLOQZ

17
Q

Which AEDs/mood stabilizers can be used in BPD mania?

A
  • Carbamazepine
  • Lithium
  • Valproate
18
Q

Which AEDs/mood stabilizers can be used in BPD maintenance?

A
  • Lamotrigine
  • Lithium
19
Q

T/F Lithium should not be used in suicide risk

A

FALSE: Lithium has anti-suicidal properties

20
Q

T/F It’s not a good sign if a patient feels great after 2 weeks of therapy

A

TRUE: It is a sign of a manic switch

21
Q

What is IGALMI?

A

Dexmedetomidine
- SL film for acute agitation in BPD or schizo
- Alpha 2 agonist
- SL is a limitation (difficult to administer)

22
Q

What is Lybalvi?

A

Olanzapine + samidorphan
- Samidorphan reduces metabolic effects of olanzapine
- DO NOT use with opioids -> withdrawal

23
Q

Lithium

A
  • Not good for rapid cyclers and mixed states
  • No hepatic anything
  • CI in severe renal or cardiac disease
  • Nephrogenic diabetes up to 50% of patients, AKI common, CKD reported
  • Thyroid must also be monitored
  • GI/CNS ADE dose related
  • Muscle weakness/lethargy/tremor common
  • Best for euphoric mania
  • Significant dermatologic effects
24
Q

Lithium in pregnancy/lactation

A

Not recommended in pregnancy - floppy baby syndrome

Contraindicated in nursing

25
Q

How long does lithium take to work?

A

6-10 days for mania, full effect in 3 weeks

6-8 weeks for antidepression

Best for less complicated patients (fewer episodes, not mixed)

26
Q

Which drugs can increase lithium levels?

A
  • ACE/ARBs
  • NSAIDs
  • Diuretics
27
Q

Which drugs can decrease lithium levels

A

Methylxanythines (caffeine, theophylline)

28
Q

Valproic acid

A
  • Early dose forms GI irritating
  • ER form has lower bioavailability
  • Tremor, sedation
  • Prolonged bleeding
  • Weight gain!!
  • Alopecia
29
Q

What are the BBW for valproic acid?

A

Hepatotoxicity
Fetal risk
Pancreatitis

30
Q

What can be used to treat tremor in most cases?

A

Beta blockers

31
Q

Carbamazepine

A
  • Bone marrow suppression, leukopenia -> probably not a good idea
  • Asian HLA-B 1502 increases SJS/TEN risk 10x
  • Hyponatremia, confusion
32
Q

Does lamotrigine require serum concentration monitoring?

A

No

33
Q

T/F: Antidepressants should not be used unopposed in BPD

A

TRUE: Can cause manic switch, especially TCAs

34
Q

Benzodiazepine place in BPD

A

High potency (clonazepam, lorazepam) can be used short-term as adjunct for anxiety/panic/agitation during acute mania
- Lorazepam IM for hepatic dysfunction
- Avoid in substance abuse

35
Q

T/F augmentation agents should be continued in BPD once proven efficacious

A

FALSE: taper and discontinue if possible when the acute mood episode is in remission

36
Q

Which BZDs have no hepatic burden?

A

OTL - over the liver
Oxazepam
Temazepam
Lorazepam***

701 (11 decks)

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