Bipolar Disorder and Mania Flashcards by Alice Richards

severe cyclic episodes from mania to dpn

bipolar I

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milder episodes of hypomania that alternate w. periods of severe dpn

bipolar II

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psychotic sx - elevated, expressive, or irritable mood - can be present in

bipolar I

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dsm for mania

elevated, expansive, or irritable mood x 1 week most of the day

PLUS

3 or more euphoric sx

4 or more irritable sx

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what does DIGFAST stand for

sx of mania:

distractibility

insomnia

grandiosity

flight of ideas

activity

speech

thoughtlessness

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first line tx for bipolar

initial: lithium

AND

valporate

later: lamotrigine OR antidepressants

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tx of mania may require

atypical antidpn

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pharm for acute manic sx of bipolar

benzos → alprazolam, lorazepam

atypical antipsychotics

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lithium interferes w. __ recycling

PIP → Gg protein

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onset of action for lithium

10-21 days

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s.e of lithium

hypothyroidism

polyuria/polydipsia

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how does increased Na intake affect lithium

decreases lithium plasma levels

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how does Na restriction affect lithium

increases lithium plasma levels

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lithium has a narrow therapeutic index and minor toxicity can cause

tremor

GI upset

muscle weakness

hypothyroidism → wt gain

anti-ADH → polyuria/polydipsia

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what 4 drugs can decrease renal clearance of lithium

diuretics

ACEI

NSAIDs

analgesics

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effect of NSAIDs, diuretics, ACEI, analgesics on plasma lithium

increased

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pathway that increases dopamine → positive sx

mesolimbic

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pathway that decreases dopamine → negative sx

mesocortical

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positive sx of dopamine

delusions

hallucinations

disordered thoughts

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negative effects of dopamine

blunted affect → anhedonia

asociality → alogia

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dopamine hypothesis of schizophrenia

overactivity in brain mesolimbic system → overactive dopaminergic pathways

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virtually all antipsychotic drugs block __ receptors

dopamine D2

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drugs that block D2 receptors are immediate, but onset of psychoses improvement can take

3-6 weeks

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weak D2 blocker but extremely effective antipsychotic

clozapine

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5HT2a receptors __ dopamine release, activation of these receptors have __ effects

decrease hallucinatory

mc psychotic d.o

schizophrenia

hallmark of schizophrenia positive sx of schizophrenia

**acute episodes** of marked disturbance of thinking

t/f: schizophrenia affects males and females equally

T! *but age of onset differs*

positive sx of schizophrenia are caused by

overactivity of dopamine neurons → mesolimbic pathway

positive sx of schizophrenia

delusions hallucinations thought disorders

negative sx of schizophrenia are caused by

hypoactivity of dopamine

negative sx of schizophrenia

withdrawal from social contact flattening of emotional response decreased attention span poor memory

negative sx are associated w. what type of schizophrenia

chronic

what drug is used to treat apathy and blunted affect in schizophrenia

clozapine

atypical antipsychotics to know

quetiapine → seroquel aripiprazole → abilify rsiperidone → risperdal olanzapine → zyprexa

typical antipsychotics to know

haloperidol chlorpromazine

typical antipsychotics (1st gen) have __ D2/5HT blocking ratio, and therefore good efficacy for __ sx

high positive

s.e related to good block of D2

extrapyramidal toxicity

high potency antipsychotic \_\_ is associated w. high \_\_ but less \_\_

haloperidol D2 s.e → extrapyramidal ADR

low potency antipsychotic \_\_ is associated w. less \_\_, but higher \_\_

chlorpromazine D2 s.e → extrapyramidal ADRs → from M-H1-a1 block

typical antipsychotics have __ D2/5HT blocking ratio, and __ D2 block, and __ antipsychotic efficacy

high good good

atypical antipsychotics are effective for __ symptoms

negative

atypical antipsychotics have poor block of \_\_, \_\_ block of 5HT2a, and __ incidence of EPSE

D2 low low

typical antipsychotic: **chlorprozamine** D2/5HT ratio: clinical potency: EPS toxicity: sedative action: hypotensive action:

D2/5HT ratio: high clinical potency: low EPS toxicity: medium sedative action: high hypotensive action: high

typical antipsychotic: **haloperidol** D2/5HT ratio: clinical potency: EPS toxicity: sedative action: hypotensive action:

D2/5HT ratio: very high clinical potency: high EPS toxicity: very high sedative action: low hypotensive action: very low

atypical antipsychotics: D2/5HT ratio: clinical potency: EPS toxicity:

D2/5HT ratio: very low clinical potency: very low EPS toxicity: low

s.e of low potency typical antipsychotic (chlorpromazine)

muscarinic block → BBSLUDGE alpha 1 block → orthostatic hypotn H1 histamine block → sedation, wt gain, T2DM risk

s.e of high potency typical antipsychotic (haloperidol)

**EPS →** dystonia akathisia → can't sit still pseudoparkinsonism tardive dyskinesia

tx for dystonia

anticholinergics → diphenhydramine/benztropine

tx for akathisia

reduce dose change drug bb anticholinergic benzo

tx for pseudoparkinsonism

anticholinergics

tx for tardive dyskinesia

rarely effective but try: clozapine valbenazine → crazy expensive

really bad s.e of clozapine

agranulocytosis *CBC required prior to dosing*

common s.e of atypical antipsychotics (2)

wt gain T2DM

other adverse reactions of antipsychotics

altered thermoregulation galactorrhea photosensitivity lowered sz threshold neuroleptic malignant syndrome

most potent antipsychotic

haloperidol

2 considerations w. antipsychotic absorption

most are incompletely absorbed significant first pass effect

how can dose variation of antipsychotics be reduced

liquid formulations

3 routes of admin for antipsychotics

oral IM solution IM depot suspension

3 distribution properties of antipsychotics

extensively protein bound high lipid solubility cross placenta

3 metabolism/excretion properties of antipsychotics

almost completely metabolized oxidized by CYP450 excreted in breast milk

when are atypical agents preferred

negative sx cognition deficits decreased risk for EPSE

antipsychotic for refractory sx

clozapine

wt gain and metabolic effects are highest w.

olanzapine clozapine quetiapine

wt gain and metabolic effects are lowest w.

aripiprazole lurasidone

EPS effects are highest w.

risperidone

EPS effects are lowest w.

quetiapine iloperidone

sedation is minimum w.

aripiprazole risperidone

sedation is highest w.

quetiapine olanzapine *best for insomnia/agitation*

QT prolongation: highest risk: lowest risk:

highest: ziprasidone lowest: aripiprazole