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Pharmacotherapy 3 Exam 1 > Bipolar Disorder > Flashcards

Bipolar Disorder Flashcards

1
Q

Bipolar disorder is depression mixed with episodes of ___

A

Mania

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2
Q

Symptoms of a manic episode include

A

Increased irritability and increased energy for at least 1 week (or any time if hospitalized) as well as a decreased need for sleep

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3
Q

True or False: mental status exams are unable to differentiate between unipolar and bipolar depression

A

True. Family history and being < 25 years old is needed to be able to diagnose bipolar depression

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4
Q

True or False: suicide rate in bipolar depression is half of that in unipolar depression

A

False. It is double

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5
Q

True or False: the severity of a manic episode in Bipolar 1 disorder is greater than in a patient with Bipolar 2 disorder

A

True

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6
Q

True or False: patients with bipolar depression spend less time in a depressed state than in a manic state

A

False. More time is spent in a depressed state

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7
Q

5HT and DA have a(n) ___ relationship

A

Direct. Agonism of serotonin receptors inhibits dopamine release. The inhibition of serotonin receptors increases dopamine release

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8
Q

An excess of dopamine can lead to ___

A

Mania

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9
Q

A deficit of dopamine can lead to ___

A

Depression

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10
Q

There is a 30% prevalence of depression in ___ disease due to deficits of dopamine

A

Parkinson’s

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11
Q

Bipolar disorder is associated with ___ activity in the amygdala, ___ activity in the hippocampus, and ___ activity in the prefrontal cortex

A

Increased
Decreased
Decreased

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12
Q

These 3 medications are used to treat acute and chronic depression + acute and chronic mania

A

Lithium
Quetiapine
Olanzapine

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13
Q

These 5 medications are used to treat only acute and chronic mania

A 
Risperidone
Aripiprazole
Ziprasidone
Divalproex (valproic acid)
Carbamazepine
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14
Q

This medication only treats acute depression

A

Lurasidone

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15
Q

This medication only treats chronic depression

A

Lamotrigine

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16
Q

This medication is the “most typical atypical”

A

Risperidone

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17
Q

What is the dosing and target level of Lithium?

A

Dosing: 600-900mg/day

Target level: 0.6-1.2mEq/L (1.2-1.5mEq/L in severe mania)

18
Q

These medications increase lithium concentrations

A

Thiazides

19
Q

These medications decrease lithium concentrations

A

Caffeine

20
Q

Adverse effects of lithium

A

Polyuria, increased thirst, renal impairment, hypercalcemia, hypothyroidism, fine motor tremor

21
Q

This adverse effect of lithium may occur during the first 6 months or may even take years to develop

A

Hypothyroidism

22
Q

At steady state, a supplemental 300mg dose of lithium will increase lithium concentration by ___ mEq/L

A

0.2

23
Q

This antipsychotic is associated with teratogenic effects and an increase in GABA

A

Valproic acid

24
Q

What are common adverse effects of valproic acid

A

Homer Simpson - Alopecia, weight gain, hepatic impairment

25
Q

Valproic acid dosing

A

Initial: 500-1000mg in 1 to 2 divided doses

Max of 60mg/kg

26
Q

Most formulations of valproic acid are given BID except for:

A

Divalproex ER. It is dosed QD and is only 80% bioavailable. It requires a 20% dose increased when switching from other formulations

27
Q

Which medication, used for bipolar disorder, is an “auto-inducer” for CYP3A4

A

Carbamazepine. It will reduce its own drug concentration over time

28
Q

What is the dose and target drug level for carbamazepine?

A

200-600mg/day in divided doses

4-12mcg/mL

29
Q

What is a common side effect for carbamazepine?

A

Rash

30
Q

What two medications are used off-label for the treatment of bipolar disorder?

A

Oxcarbazepine and topiramate

31
Q

What medication is used for “maintenance” treatment of bipolar disorder

A

Lamotrigine

32
Q

What is the initial dose of lamotrigine? Changes are made to that dose in the presence of what other medications?

A

25mg QD
If taking VPA - 25mg QoD
If taking carbamazepine or phenytoin - 25mg BID

33
Q

A rare but serious side effect of lamotrigine is ___

A

Stevens-Johnson Syndrome

34
Q

___ is the active metabolite of risperidone

A

Paliperidone

35
Q

What are common side effects of quetiapine?

A

Sedation and weight gain

36
Q

This medication, used for acute mania or mixed episodes, should be taken with a meal > 500 calories

A

Ziprasidone. This is done to increase absorption

37
Q

What medication, used for bipolar depression, should be administered with a meal > 350 calories and needs to be dose adjusted in hepatic impairment

A

Lurasidone

38
Q

Capiprazine takes ___ to see an effect (whether good or bad) from a dose change

A

Several weeks

39
Q

___ decrease the concentration of lamotrigine

A

Hormones (oral contraceptives)

40
Q

A common side effect of lurasidone is ___

A

Akathisia (restlessness)

Pharmacotherapy 3 Exam 1 (6 decks)

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