Bipolar disorder Flashcards
What drug classes are used in the treatment of bipolar D/O?
- Lithium
- Anticonvulsants
- Antipsychotics
- Benzos
What role do benzos have in bipolar tx?
Acute treatment of agitation, insomnia, or anxiety
What use does lithium have in bipolar disorder?
Treats acute mania, hypomania, mixed states, and bipolar/ unipolar depression
What PK information is important for lithium use?
- Rapidly absorbed PO route
- 100% excreted in urine, must monitor renal function test
Intro dosing of lithium?
Start BID-TID w/ titrations every few days until therapeutic level reached
Dosage changes in lithium use post- therapeutic level?
Change dosing schedule to once daily if no ADRs
What are contraindications to the use of lithium?
-Significant renal impairment
-Sodium depletion
Dehydration
-Significant CV disease
What drugs have DDIs with lithium?
- Diuretics
- ACEIs
- CCBs
- TCN & Metronidazole
- NSAIDs
What are acute ADRs of lithium?
- Nausea
- Weight gain
- Cognitive impairment
- Polyuria/polydipsia
- Loose stools
What are chronic ADRs of lithium use?
- Renal function
- Thyroid function
- Parathyroid function
- Rarely cardiac dysrhythmias
What tests must be performed at baseline before starting llithium use?
- Urinanalysis
- Bun/Cr
- Thyroid
- Pregnancy (if child bearing potential)
What is important in regards to lithium toxicity?
Narrow therapeutic window, correlate serum levels w/ timing of last dose since serum level may not correlate /w peak concentration
What signs/ sx are associated with lithium toxicity?
- GI: N/V/D
- Neurologic: confusion/agitation, ataxia; SEVERE- seizures, encephalopathy
- Cardiax (rare): arrythmias, bradycardia
If a patient is suspected to be experiencing lithium toxicity what do you do?
- Treat symptomatic patient even if serum concentrations low
- Treat high labs even if patient is asymptomatic
What is recommended treatment of lithium toxicity?
- Stop lithium, ABCs
- Supportive care/ hydration
- GI decontamination w/ whole bowel irrigation with PEG
What medications are C/I for bipolar disorder?
Antidepressants
What factors would rank a bipolar patient as ‘severe’?
- Suicidal/ homicidal
- Aggressiveness
- Psychotic features
- Poor judgment that places self/others in harm
How is a severe bi polar patient be managed?
Inpatient
What drug regiment is preferred for a severe bipolar patient w/ mania?
Lithium/ valproate with an antipsychotic (Haloperidoal, Aripiprazole, Olanzapine, Quetiapine, Risperidone)
How is a severe bipolar patient (mania) managed if they show resistance/ no response over 2 weeks?
Switch between Lithium and Valproate by cross-taper over 2 weeks
If changing Valproate/Lithium doesn’t have an effect over cross-taper to control mania how proceed?
Change antipsychotic
How is mania managed in a mild-moderate bipolar patient managed?
Outpatient
What type of medication therapy is a patient w/ mild-moderate manic bipolar patient treated with?
Monotherapy; Risperidone or Olanzapine (efficacy and tolerability)
How to treat manic bipolar in pregnancy? List first line, resistant, and refractory
- Haloperidol (other FGAs)
- Risperidone or Olanzapine
- Lithium or ECT
How is Bipolar mania treated in geriatric patients? 1st line and 2nd line
- Olanzapine or Quetiapine
- Combo tx, add lithium/valproate to 1st line med
How is acute bipolar depression treated pharmalogically?
Monotherapy
- Lamotrigine/ Olanzapine
- Lithium
How is bipolar depression managed in pregnant patients? 1st line, resistant, refractory
- Lamotrigine
- Quetiapine
- Fluoxetine + Olanzapine
How is bipolar depression treated in geriatric patients? 1st line, resistant, refractory
- Quetiapine
- Lamotrigine or combo
- ECT
How is maintenance therapy managed in bipolar patients?
1st line: same regimen that successfully treated acute bipolar mood episode
If the drug that managed the acute mood episode in bipolar doesn’t work how is patient managed?
2nd line: lithium/valproate/Lamotrigine
