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Psych Pharm > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

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1
Q

What is the first line treatment for bipolar disorder?

A

Lithium

-treats mania and depression of bipolar and maintenance

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2
Q

What drug reduces the risk of suicide in patients?

A

Lithium

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3
Q

How long does it for lithium to take full therapeutic effect?

A

2-3 weeks

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4
Q

How does lithium effect neurotransmitters?

A
  1. increases effects of 5-HT
  2. decreases turnover of NE and DA
  3. Increases synthesis of acetylcholine
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5
Q

Does lithium have an effect on electrolytes and ion transport? why?

A

yes due to similarity to Na

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6
Q

Does lithium have a narrow or wide therapeutic window?

A

narrow

.6-1.2 >1.2 is toxic effects

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7
Q

How is lithium excreted?

A

renally

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8
Q

What kidney drugs lead a decrease in lithium level?

A

drugs that affect the proximal tubule

  1. acetazolamide
  2. mannitol

-also aminophylline, theophylline, caffeine, and pregnancy

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9
Q

What kidney drugs do not change the level of Li?

A

Loop diuretics

  1. furosemide
    - also amiloride, acetaminophen, aspirin, sulindac
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10
Q

What kidney drugs increase the level of Li?

A

proximal tubule and collecting duct

  1. thiazides
  2. K+ sparing diuretics
  3. ACE inhibitors
  4. Angiotensin 2

also: NSIADS, COX2 inhibitors, dehydration, Na depletion, renal impairment and advanced age

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11
Q

What are lithium side effects?

A

Derm: acne, psoriasis, rashes, alopecia
Endocrine: Hypothyroid**, hyperparathyroid
GI: Nausea, Diarrhea
Heme: increase WBC
Neuro: fine tremor, decreased concentration, sedation
Other: weight gain, edema

More serious: NDI, mild renal insufficiency, end stage renal disease

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12
Q

Lithium Toxicity Mild toxicity ?

A

nausea, vomiting, diarrhea
lethargy, drowsiness
muscle weakness, coarse hand tremor

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13
Q

Lithium Toxicity Moderate toxicity?

A

confusion, myoclonic twitches, dysarthria, ataxia, nystagmus
ECG changes

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14
Q

Lithium toxicity severe toxicity?

A

Grossly Impaired consciousness; coma
Increase DTR’s Seizures
Syncope

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15
Q

What do you test before starting someone on lithium?

A
  1. TSH
  2. Renal function
  3. ECG-if pt > 50
  4. BMI
  5. Pregnancy test (ebstein anomaly)
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16
Q

After starting lithium what level do you need to check?

A

Lithium level

17
Q

After being stable on the drug what do you need to check every 6-12 months?

A
  1. TSH
  2. Renal function
  3. BMI
  4. Lithium level
18
Q

What is the difference between depakene and depakote?

What is depakote used for?

A

depakote-enteric kote that decreases nausea and diarrhea

Type 1 mania/non-severe mania & Type2
Type 1&2 depression

19
Q

How highly is depakote protein bound?

A

90% protein bound 100% absorbed

  • can displace other protein bound drugs like: phenytoin-increases potential toxicity
  • can be displaced itself by caffeine aspirin
20
Q

How is depakote metabolized? How does depakote affect drugs that have hepatic metabolism?

A

Metabolized by hepatic glucuronide conjugation
inhibits hepatic metabolism
-inhibits metabolism of other anticonvulsants-increases risk of toxicity

21
Q

What are side effects of depakote?

A

Derm: alopecia
GI: nausea, vomiting, diarrhea, mild increase LFTs
Heme: decrease platelets
Neuro:ataxia, headache, dizziness, tremor, sedation
Other:increase in ammonia level, weight gain, polycystic ovarian syndrome, increase in suicide risk

Toxicity: mild increase in LFTS, hepatotoxicity, hyperammonemia

22
Q

What do you test the patient for before starting them on depakote?

A
  1. LFT’s
  2. Platelet count
  3. BMI
  4. Pregnancy test
23
Q

What do you check after starting depakote?

A

depakote levels

24
Q

What do you check once the patient is stable on depakote every 6-12 months?

A
  1. LFT’s
  2. platelet count
  3. BMI
  4. Depakote levels
25
Q

How does carbamazepine (tegretol) affect the metabolism of other drugs? WHat is tegretol used for?

A

via CYP 450

  1. induces multiple CYP450 enzymes
  2. Induces UDP glucuronosyltransferase
  3. auto-induces its own metabolism

Type 1 Non severe & Type 2

26
Q

What are the side effects of carbamazepine(tegretol)?

A

Derm: Stevens Johnson Syndrome
GI: Nausea, vomiting, mild increase LFTs, hepatotoxicity
Heme: decrease in WBC, aplastic anemia, agranulocytosis
Neuro: ataxia, diplopia, dizziness, tremor, sedation
Other: decrease Na, weight gain, increased suicide risk

teratogenic
-increased risk of neural tube defects

27
Q

How is lamotrigine (lamictal) metabolized? WHat is lamictal used for?

A

low protein binding 55%
-metabolized by glucuronidation

DDI

  1. Depakote+lam
    - lam doubles
  2. oral contraceptives+ lam
    - lam halves
  3. carbamazepine+ lam
    - lam halves

Type 1&2 depression

28
Q

What are side effects of lamotrigine(lamictal) ?

A 
derm: rash(benign and Steven Johnson)**
GI: nausea, vomiting
Heme: decreased WBC, blood dyscrasias
Neuro: ataxia, headache, dizziness, double vision, blurred vision, fatigue
Other: insomnia
29
Q

Are anti-psychotics used for treating biopolar disorder?

A

yes
-many approved for mania, and maintenance
-just 3 approved for bipolar depression
For severe bipolar mania-psychosis, suicidal/dangerous behavior start:
1. Li + SGA
2. Depakote +SGA

Used for Type 1 Manic/Non severe& type 2
Sometimes for Type 1&Type 2 depression
(FGA-not used in type1&type 2 depression)

30
Q

What has the greatest risk of serious birth defects of all psychotropic meds?

A

depakote

-12-16X gen population rate of neural tube defects

31
Q

Do you treat Type 1 manic/non severe& type 2 with antidepressants?

A

no

32
Q

WHat are benzos used as in bipolar manic/non severe& type 2 and for type1&2 depression?

A

adjunct

Psych Pharm (6 decks)

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