Bipolar Disorder Flashcards
fitzpatrick
Rapid Plasma Reagin (RPR) tests for what to rule out other causes of disorganized behavior
syphilis
if a first degree relative has bipolar there is what
increase risk of also having BPD
bipolar has shown to have these abnormalities in the brain
changes in the amygdala and prefrontal cortex
what is the difference between mania vs hypomania
all of the same sx but hypomania is NOT causing a marked impaired function and/or doesnt need hospitlization
is a depression episode required for bipolar diagnosis
nope but it’s common
symptoms of facial grimace and rapid eye blinking are most likely signs of this EPS symptom
tardive dyskinesia
for short term agitation the guidelines are recommend what
starting oral maintenance anti-manic if px agrees
can do IM meds (lorazepam 2 mg, OLZ 2.5 mg , droperidol 5 mg)
you should never administer these to parenteral drugs together due to risk of hypotension and resp depression
lorazepam and olanzapine
CANMAT recommendations for acute mania 1st line
Lithium
quetiapine
divalproex
asenapine
aripiprazole
paliperidone
risperidone
cariprazine
what is more effect mono or combo and what class works faster
Combo
second gen antipsychotic
CANMAT recommendations for bipolar depression 1st line
quetiapine
lurasidone
Lithium
lamotrigine
lurasidone+ Li/DVP
Lithium has an interesting interaction with this element
sodium Na
they move together so important to maintain a consistent sodium intake
Lithium has DDI with
diuretics: may lower lithium levels
ACE/ARB, NSAID: may increase lithium levels
when should you get a Lithium level and what are the goals
12 hr level
acute: 0.8-1.2 mEq/L
maintain: 0.6-1 mEq/L
Lithium is a good drug because its known to decrease….
suicide risks
Lithium ADE
GI upset
tremor
Diabetes insipidus
renal dysfunction
hypothyroidism
leukocytosis
acne/psoriasis
weight gain
impaired memory/concentration
ebstein anomaly (teratogenic)
when does Lithium toxicity occur
Lithium levels >1.5 (mild) >2 (severe)
mild and severe symptoms of Lithium toxicity
M: GI intolerance, worsened tremor, drowsiness, ataxia
S: seizure, coma, arrhythmia, death
divalproex is an antiepileptic that is used as a mood stabilizer because it has this MOA
increases GABA at postsynapic receptors
what level of divalproex is the goal and when do we take these levels
85 -125 mcg/mL
12 hr if DR/IR
24 hr if ER **
Divalproex ADE
BW: HEPATIC FAIL/PANCREATITIS
Fetal valproate syndrome (teratogenic)
Gi upset
somnolence
dizziness
alopecia
PCOS
thrombocytopenia
rash
weight gain
hyperammonemia
second gen antipsychs have LA injectables that work more quickly than traditional mood stabilizers whats the difference
2 days vs 1 week
what do you need to monitor second gen antipsychs
monitor EPS
no drug levels and titrate to response and tolerability
second gen antipsych ADE
decrease seizure threshold
sedation
weight gain
QTc prolongation
hyperprolactinemia
anticholinergic
EPS: akathisia, dystonia, pseudoparkinsonism, tardive dyskinesia
lamotrigine is an anticonvulsant used as a mood stabilizer but it is only used for this type of bipolar
bipolar depression (not good in anti-manic)
Lamotrigine has a BBW of… and these other SE
rash!
dizzy, nausea, diplopia
lamotrigine has DDI with
Valproate (use 1/2 normal dose) and oral contraceptives
CBZ is an anticonvulsant that is used as a mood stabilizer but you need to monitor closely because of…
auto-induction of metabolism 3-4 wks after starting
CBZ is shown to be good for ___ compared to ____
acute mania compared to mixed episodes
CBZ has DDI with
VPA by displacing it from binding sites meaning increased CBZ levels
goal trough of CBZ
4-12 mcg/mL
CBZ ADE and BW
BW: agranulocytosis, aplastic anemia, rash!!
dizzy
Gi upset
sedation
hyponatremia/SIADH
ataxia
What should be tested in patients taking CBZ?
HLA-B 1502* testing required esp for Asian descent
if a px is started on Li but is on lisinopril what is likely to happen
Li toxicity causing tremor, drowsiness, and ataxia
a px received divalproex ER 2000 mg for bipolar and got a 12 hr trough drawn interpret these results.
you cant because it was drawn wrong! needs to be 24 hrs
what medication is not a good choice for a manic episode
-Lithium
-divalproex
-lamotrigine
-paliperidone
lamotrigine
a px being treated with 2nd gen antipsych for bipolar and the px complains of restlessness and feelings of needing to move. what is the most likely cause
-tardive dyskinesia: aripiprazole
-akathisia: aripiprazole
-hyperprolactinemia: paliperiodne
-akathisia: paliperidone
akathisia: aripiprazole
