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Pharm main > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

Bipolar one disorder

A

Mania with Major depressive episodes

includes anything where mania results in hospitalization

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2
Q

Bipolar two disorder

A

hypomania with major depressive episodes

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3
Q

Mixed episode in bipolar disorder

A

mania and depression all at the same time

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4
Q

rapid cycling in bipolar disorder

A

4 major depressive or manic episodes in a 12 month period

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5
Q

What is Bipolar disorder often misdiagnosed as?
Why?
What happens when it is misdiagnosed this way

A

Unipolar depression because patients often present with depression and manic episodes are not brought to the attention of the physician
Physician describes antidepressants which can swing patient into a manic episode

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6
Q

Diagnosis of a manic episode

A

At least one week with at least 3/7 symptoms
DIG FAST
Distractibility
Increased activity or psychomotor activity
Grandiosity- inflated self esteem
Flight of ideas
Activities that are dangerous, hypersexual, or goal directed
Sleep- decreased need (1-2 hours/ night)
Talkative or pressured speech

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7
Q

Diagnosis of Hypomania

A

same set of DIG FAST symptoms but alsting at least 4 days

but not severe enough for a marked change in social or functional impairment

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8
Q

Epidemiology

A

average age of onset is 21

first presents in females as depressive episode, males as manic episode

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9
Q

Etiology

A

Most genetic of all psychological disorders
stressful or exciting events can trigger an episode
getting off of the rhythm can also trigger an episode

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10
Q

What is suicide rate in untreated bipolar disorder

other issues in untreated

A

10-20%
higher rate of job loss
divorce, violence, incarceration, and STDs

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11
Q

Concurrent social functioning issues

A

Substance abuse- inc risk of suicide

many patients lack insight into their disease making it hard to tx

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12
Q

What is compliance like

A

50-75% dont maintain their drug regimen

90% relapse

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13
Q

What happens if TCA’s or SNRI’s are given to these patients

A

Mania or rapid cycling

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14
Q

Triggers for Bipolar Episodes

A

avoid triggers such as sleep deprivation, antidepressants without a mood stabilizer, alcohol

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15
Q

Role of ECT in bipolar management

A

Bilateral ECT is used for acute mania and acute depression.
indicated in drug resistant mania
Pregnancy

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16
Q

Role of psycho education in bipolar management

A

Important for pt to learn to recognize the signs early so that they can take preventative measures

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17
Q

Li

A

Lithium

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18
Q

Li MOA

A

Not well understood

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19
Q

Gold standard to tx bipolar disorder is

A

Li

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20
Q

Why is Li the gold standard in bipolar tx

A

stabilizes acute mania, prevents relapse of mania and depression
does more to prevent mania than prevent depression
decreases suicide rate

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21
Q

how does Li compare to other drugs for dealing with depression

A

Better than many other drugs for dealing with depression in bipolar disorder

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22
Q

What is the metabolism/ Pharmacokinetics of Li?

how is it handled in the body

A

Rapidly absorbed, not metabolized, no protein binding
steady state is reached in 5 days but takes 1-2 weeks to see full effects
Renal excretion

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23
Q

Does Li have psychotropic effects in pts who dont have bipolar disorder?

A

no psychotropic effects

24
Q

What should patients use while waiting for Li take effect

A

takes 1-2 weeks

should use adjunctive therapy

25
Q

What are the AE of Li

A 
Dose dependent tremor
psoriasis/ rash
weight gain
acne
hypothyroid
GI discomfort (N/V/D, GI pain)
26
Q

What renal or urinary complications can be caused by LI

A

reduces the ability to concentrate the urine
causes interstitial fibrosis and gloerulosclerosis
dose dependent DI
polydipsia and polyuria

27
Q

How should dif GI AE be handled

A

N/V and pain are caused by irritation of GI, this is early onset so take it with food or use sustained release or divided dose
Diarrhea is caused by colon irritation from unabsorbed Li –> use liquid or immediate release dosage

28
Q

What are the signs of acute Li intoxication?

How is it avoided?

A

Seizures, Arrhythmia
GI, coordination issues, cognition issues, permanent neurologic impairments, kidney damage
Maintain adequate Na and fluid intake

29
Q

What drugs increase the level of Li

A

NSAIDs- interfere with PGE synthesis –> dec elimination
ACE and ARB- RAAS
Thiazide diuretics- inc Li reab in distal tubule b/c inc Na reab

30
Q

What effect does GFR have on serum Li

A

as GFR dec serum Li increases

31
Q

What is the role fluid and Na balance in Li serum concentration

A

Dehydration inc Na reab as does low Na –> both inc Li reab so inc Li levels
Hyponatremia and dehydration lead to Li toxicity

32
Q

CI for Li

A

Renal dysfunction
Pregnancy- Cat D- Ebstein’s anomaly
cardiac dysfunction

33
Q

Anticonvulsants used in the tx of Bipolar disorder

A

Valproate
Carbamazepine/ Oxcarbazepine
Lamotrigine

34
Q

Valproate MOA

A

enhances GABA to break acute mania and manage mixed mania

Also affects Na channels

35
Q

Indications for Valproate

A

Superior to Li in mixed mania and rapid cyclers

alternative to Li

36
Q

AE for Valproate

A 
weight gain
PCOD
hepatotoxicity
neutropenia
thrombocytopenia
37
Q

CI for Valproate

A

pregnancy- causes neural tube defects and lowers IQ

38
Q

What baseline tests should be done before giving someone Li

A 
CBC- b/c may cause thrombocytopenia
SCr and BUN to monitor renal function
Thyroid function test- may cause hypothyroid
Urinalysis- may cause polyuria
Electrolytes
39
Q

What blood tests should be monitored while taking Li

A

Li levels
CBC
SCr/ BUN
urine TSH

40
Q

what stage of bipolar disorder are higher therapeutic levels of Li required

A

during acute mania

remember Li has a narrow therapeutic index

41
Q

Carbamazepine/Oxcarbazepine- indications

A

when Li and Valproate fail

42
Q

Lamotrigine MO

A

blocks voltage gated Na channels to block excitatory glutamate and aspartate

43
Q

How long does it take to achieve a therapeutic dose

A

2 months of titrating up

44
Q

Why does it take so long to titrate to a therapeutic dose

A

AE include Steven’s johnson syndrome (toxic necrotizing epidermolysis) and HA. Titrate up to avoid the rash

45
Q

What is the black box warning on Lamotrigine

A

Steven’s Johnson syndrome

46
Q

what effect does valproate have on Lamotrigine levels

A

Valproate inc Lamotrigine levels

47
Q

Lamotrigine indications

A

used with Li b/c better at managing the depression but is not effective for stabilizing or preventing mania

48
Q

What drugs are used to treat acute agitations

A

atypical antipsychotics
BZD- clonazepam, lorazepam
Antidepressants- SSRIs, venlafaxine, buproprion

49
Q

What is the role of atypical antipsychotics in bipolar disorder

A

fast acting monotx to be used with Li or valproate
the pt may have to be on these long term for mood stabilization
indicated over BZDs in psychosis and acute mania

50
Q

what is the role of BZDs in tx bipolar disorder

A

used to dec agitation and insomnia- they do not tx the dz

51
Q

What is role of antidepressants in tx of bipolar disorder

A

use cautiosly and make sure use with a mood stabilizer otherwise it can throw them into mania.
careful with pts with a history of going into acute mania or rapid cyclers when given an antidepressant

52
Q

what is the theory explains why anticonvulsants work

A

Kindling theory

53
Q

DOC for depression phase of bipolar disorder

A

Li and Lamotrigine

54
Q

DOC for mixed and rapid cyclers

A

Valproate and Carbamazepine

55
Q

DOC for pregnancy in bipolar disorder

A

Antipsychotics

ECT

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