Bipolar disorder Flashcards
Which antipsychotics are recommended in the treatment of acute mania?
Risperidone, olanzapine, haloperidol, quetiapine
Describe Olanzapine’s licensing in bipolar disorder
Licensed for long-term prophylaxis of mania in patient’s whose mania has previously responded to it.
What class of drugs should ALWAYS be stopped in acute mania/hypomania?
anti-depressants as can worsen mania
When should antidepressants be avoided in bipolar disorder?
Anyone with a recent episode of hypomania, rapid-cycling bipolar, recent functionally impairing mood fluctuations.
Why is lithium not used in severe mania first-line?
Delayed response of 10-14 days
When should benzodiazepines be considered in bipolar disorder?
If agitated in the initial stages of mania
Which anti-epileptic drugs AREN’T recommended for acute mania?
Carbamazepine and lamotrigine due to their anti-depressant effects
First line treatment for a mild, acute depressive episode in Bipolar?
Monitor and reassess in 2 weeks
First-line treatment for a moderate to severe depressive episode in Bipolar?
Quetiapine or SSRI
First-line treatment for a moderate to severe depressive episode in a patient with rapid-cycling bipolar disorder?
Increasing/ adding antimanic drug (including lamotrigine) as antidepressants can’t be used.
How to does therapy change upon remission of a depressive episode in bipolar?
Gradually reduce antidepressant and continue anti-manic drug
Which SSRI is preferred in the treatment of depressive episodes in bipolar disorder?
Fluoxetine
When should long-term management be considered in bipolar disorder?
Patient has had:
- a manic episode with significant risk
- 2+ manic episodes in bipolar I
- frequent episodes, suicidal ideation, or severe functional impairment in bipolar II
Which drugs and routes should be considered for rapid tranquilisation in bipolar disorder?
IM lorazepam, haloperidol, and olanzapine
How is an acute mixed episode of bipolar disorder treated?
Treated the same as acute manic episode
Describe place of therapy of carbamazepine in bipolar disorder
Used as long-term prophylaxis if lithium not tolerated or contra-indicated.
What tests are required in the monitoring of lithium- and how often?
TFTs, calcium, U&Es + BMI every 6 months once stable
How often should lithium levels be taken once therapy is stable?
Every 3 months
What is the therapeutic serum levels for lithium?
0.6-1.0mmol/L
Describe the symptoms most likely to be transient when being started on lithium therapy?
vomiting, diarrhoea, vertigo, muscle weakness, and dazed feeling
What side effects of lithium are likely to persist?
polydipsia, polyuria, and fine hand tremors
Describe the signs of lithium toxicity
diarrhoea, vomiting, anorexia, choreoathetoid movements, lethargy, muscle weakness, tremor of extremities and lower jaw, blurred vision + tinnitus
Describe the longer term adverse effects associated with lithium
rhabdomyolysis, thyroid disorders, nephrotoxicity, renal tumours
Which endocrine disorder is lithium contra-indicated in?
Addison’s disease
Which cardiac disease is lithium contra-indicated in?
Brugada syndrome and cardiac disorders associated with rhythm disorders
Which patient group may require lower doses of lithium?
The elderly
Describe the effect of dapagliflozin on lithium levels
levels decrease due to increased clearance
Which class of diuretics are particularly problematic when combined with lithium therapy?
thiazide and thiazide-like diuretics as they reduce clearance of lithium
Why do NSAIDs interact with lithium?
As they effect fluid balance which effects lithium levels
Describe the effect of ACE inhibitors on lithium levels
levels decrease- can cause lithium toxicity
Which two drugs can cause neurotoxicity if used in combination with lithium?
Haloperidol and carbamazepine
