Bipolar Disorder Flashcards
What is bipolar I?
At least 1 episode of mania and usually bouts of intense depression (but not required); includes at least 1 of the following (psychosis/delusions, hospitalization, interferes with social/work functioning)
What is bipolar II?
At least 1 episode of hypomania (>/=4 consecutive days) and at least 1 depressive episode (>/= 2 weeks); does NOT affect social work/functioning, cause psychosis/delusions, or require hospitalization
What is mania?
abnormally elevated or irritated mood for at least a week (or any duration if hospitalization required)
What are symptoms of mania and when is it diagnosed?
- inflated self-esteem
- needs less sleep
- more talkative
- jumping from topic to topic
- easily distracted
- increased goal-directed activity
- high-risk pleasure activities
Diagnosis: >/=3 symptoms (>/=4 if irritated mood)
What is psychosis?
loss of contact with reality, abnormal thinking and perception
What are treatments for bipolar disorder?
mood stabilizers and antiepileptics are used to stabilize the mood without inducing depression or mania
What medications are used to stabilize mania with psychosis?
antipsychotics
What medications can exacerbate manic episodes?
Antidepressant monotherapy (OK if used with mood stabilizer)
What is preferred treatment for acute mania episodes?
- lithium
- valproate
- antipsychotic (olanzapine, risperidone)
What is preferred treatment for acute depressive episode?
- lithium
- valproate
- antipsychotic (quetiapine, lurasidone)
- lamotrigine
What are maintenance therapies for bipolar?
Usually combination with:
1. Lithium
2. Antiepileptics
3. second generation antipsychotics
What are antiepileptic therapies used for bipolar?
- Lamotrigine* (*slow titration required due to risk of severe rash)
- Valproate
- Carbamazepine
Lamotrigine
Lamictal, Lamictal ODT, Lamictal XR, Lamictal Starter Kit
Valproate/Valproic Acid
Depakote
Carbamazepine
Equetro
What second generation antipsychotics are used to treat bipolar?
- aripiprazole
- olanzapine
- quetiapine
- risperidone
- ziprasidone
- lurasidone (depressive ep)
- olanzapine/fluoxetine
Aripiprazole
Abilify, Abilify Maintena
Olanzapine
Zyprexa, Zyprexa Relprevv, Zyprexa Zydis
Quetiapine
Seroquel, Seroquel XR
Risperidone
Risperdal, Risperidal Consta, Perseris
Ziprasidone
Geodon
Lurasidone
Latuda
Olanzapine/Fluoxetine
Symbyax
Lithium
Lithobid
What is a boxed warning with lithium?
serum lithium levels should be monitored to avoid toxicity
What are warnings with lithium?
- Serotonin Syndrome
- renal impairment, hyponatremia, dehydration (all increase toxicity)
- Avoid in Pregnancy and breastfeeding (cardiac malfunctions in 1st trimester)
What are SEs with lithium (therapeutic range)?
- GI upset (nausea/diarrhea)
- Cognitive effects
- Cogwheel rigidity
- fine hand Tremor
- Thirst
- Polyuria/polydipsia
- Weight gain
- Hypothyroidism
- hypercalcemia
- cardiac abnormalities
- edema
- anorexia
- worsen psoriasis
- blue/grey skin pigmentation
- impotence
What are SEs with lithium toxicity?
> 1.5 mEq/L: Ataxia, Coarse hand tremor, Vomiting, persistent diarrhea, confusion, sedation
2.5 mEq/L: CNS Depression, Arrhythmia, Seizure, Coma
What is the therapeutic range for lithium?
Trough level: 0.6-1.2 mEq/L;
may need up to 1.5mEq/L for acute mania
What should be monitored while on lithium?
- Lithium levels
- Renal function
- Thyroid function (TSH, T4)
- electrolytes (Ca, K, Na)
What drugs increase the concentration of lithium?
- ACE/ARBs/ Thiazides via decreased salt
- NSAIDs (aspirin and sulindac preferred)
What drugs decrease the concentration of lithium?
- Increased salt intake
- caffeine
- theophylline
What drugs increase risk of serotonin syndrome when used with lithium?
- SSRIs
- SNRIs
- Triptans
- Linezolid
- Other serotonergic drugs
What drugs increase the risk of neurotoxicity when used with lithium?
- Verapamil
2.Diltiazem - Phenytoin
- Carbamazepine
What are counseling points for lithium therapy?
- take with food or after a meal to lessen GI sx
- maintain consistent salt intake
- maintain adequate hydration with non-caffeinated beverages
- avoid dehydration
- can impair alertness, use caution
What are dosing conversions from lithium citrate syrup to tablets?
5mL lithium citrate =8 mEq Li+
8 mEq Li+ = 300mg lithium carbonate tabs/caps
What are the preferred treatments for bipolar in pregnancy?
- Lamotrigine
- Lurasidone (bipolar depression only but safest option)
What bipolar treatments should not be used in pregnancy? WHY?
- valproate- neural tube defects and cognitive effects especially 1st trimester
- carbamazepine-fetal carbamazepine syndrome (facial abnormalities, etc. especially in 1st trimester
- lithium- cardiac abnormalities
