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Summer Pharm - Exam 2 > Bipolar Disorder and Mania > Flashcards

Bipolar Disorder and Mania Flashcards

1
Q

severe cyclic episodes from mania to dpn

A

bipolar I

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2
Q

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

A

bipolar II

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3
Q

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

A

bipolar I

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4
Q

dsm for mania

A

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

PLUS

3 or more euphoric sx

OR

4 or more irritable sx

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5
Q

what does DIGFAST stand for

A

sx of mania:

distractibility

insomnia

grandiosity

flight of ideas

activity

speech

thoughtlessness

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6
Q

first line tx for bipolar

A

initial: lithium

AND

valporate

later: lamotrigine OR antidepressants

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7
Q

tx of mania may require

A

atypical antidpn

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8
Q

pharm for acute manic sx of bipolar

A

benzos → alprazolam, lorazepam

atypical antipsychotics

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9
Q

lithium interferes w. __ recycling

A

PIP → Gg protein

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10
Q

onset of action for lithium

A

10-21 days

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11
Q

s.e of lithium

A

hypothyroidism

polyuria/polydipsia

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12
Q

how does increased Na intake affect lithium

A

decreases lithium plasma levels

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13
Q

how does Na restriction affect lithium

A

increases lithium plasma levels

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14
Q

lithium has a narrow therapeutic index and minor toxicity can cause

A

tremor

GI upset

muscle weakness

hypothyroidism → wt gain

anti-ADH → polyuria/polydipsia

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15
Q

what 4 drugs can decrease renal clearance of lithium

A

diuretics

ACEI

NSAIDs

analgesics

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16
Q

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

A

increased

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17
Q

pathway that increases dopamine → positive sx

A

mesolimbic

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18
Q

pathway that decreases dopamine → negative sx

A

mesocortical

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19
Q

positive sx of dopamine

A

delusions

hallucinations

disordered thoughts

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20
Q

negative effects of dopamine

A

blunted affect → anhedonia

asociality → alogia

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21
Q

dopamine hypothesis of schizophrenia

A

overactivity in brain mesolimbic system → overactive dopaminergic pathways

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22
Q

virtually all antipsychotic drugs block __ receptors

A

dopamine D2

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23
Q

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

A

3-6 weeks

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24
Q

weak D2 blocker but extremely effective antipsychotic

A

clozapine

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25
Q

5HT2a receptors __ dopamine release,

activation of these receptors have __ effects

A

decrease

hallucinatory

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26
Q

mc psychotic d.o

A

schizophrenia

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27
Q

hallmark of schizophrenia positive sx of schizophrenia

A

acute episodes of marked disturbance of thinking

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28
Q

t/f: schizophrenia affects males and females equally

A

T!

but age of onset differs

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29
Q

positive sx of schizophrenia are caused by

A

overactivity of dopamine neurons → mesolimbic pathway

30
Q

positive sx of schizophrenia

A

delusions

hallucinations

thought disorders

31
Q

negative sx of schizophrenia are caused by

A

hypoactivity of dopamine

32
Q

negative sx of schizophrenia

A

withdrawal from social contact

flattening of emotional response

decreased attention span

poor memory

33
Q

negative sx are associated w. what type of schizophrenia

A

chronic

34
Q

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

A

clozapine

35
Q

atypical antipsychotics to know

A

quetiapine → seroquel

aripiprazole → abilify

rsiperidone → risperdal

olanzapine → zyprexa

36
Q

typical antipsychotics to know

A

haloperidol

chlorpromazine

37
Q

typical antipsychotics (1st gen) have __ D2/5HT blocking ratio,

and therefore good efficacy for __ sx

A

high

positive

38
Q

s.e related to good block of D2

A

extrapyramidal toxicity

39
Q

high potency antipsychotic __

is associated w. high __

but less __

A

haloperidol

D2 s.e → extrapyramidal

ADR

40
Q

low potency antipsychotic __

is associated w. less __,

but higher __

A

chlorpromazine

D2 s.e → extrapyramidal

ADRs → from M-H1-a1 block

41
Q

typical antipsychotics have __ D2/5HT blocking ratio,

and __ D2 block,

and __ antipsychotic efficacy

A

high

good

good

42
Q

atypical antipsychotics are effective for __ symptoms

A

negative

43
Q

atypical antipsychotics have poor block of __,

__ block of 5HT2a,

and __ incidence of EPSE

A

D2

low

low

44
Q

typical antipsychotic: chlorprozamine

D2/5HT ratio:

clinical potency:

EPS toxicity:

sedative action:

hypotensive action:

A

D2/5HT ratio: high

clinical potency: low

EPS toxicity: medium

sedative action: high

hypotensive action: high

45
Q

typical antipsychotic: haloperidol

D2/5HT ratio:

clinical potency:

EPS toxicity:

sedative action:

hypotensive action:

A

D2/5HT ratio: very high

clinical potency: high

EPS toxicity: very high

sedative action: low

hypotensive action: very low

46
Q

atypical antipsychotics:

D2/5HT ratio:

clinical potency:

EPS toxicity:

A

D2/5HT ratio: very low

clinical potency: very low

EPS toxicity: low

47
Q

s.e of low potency typical antipsychotic (chlorpromazine)

A

muscarinic block → BBSLUDGE

alpha 1 block → orthostatic hypotn

H1 histamine block → sedation, wt gain, T2DM risk

48
Q

s.e of high potency typical antipsychotic (haloperidol)

A

EPS →

dystonia

akathisia → can’t sit still

pseudoparkinsonism

tardive dyskinesia

49
Q

tx for dystonia

A

anticholinergics → diphenhydramine/benztropine

50
Q

tx for akathisia

A

reduce dose

change drug

bb

anticholinergic

benzo

51
Q

tx for pseudoparkinsonism

A

anticholinergics

52
Q

tx for tardive dyskinesia

A

rarely effective but try:

clozapine

valbenazine → crazy expensive

53
Q

really bad s.e of clozapine

A

agranulocytosis

CBC required prior to dosing

54
Q

common s.e of atypical antipsychotics (2)

A

wt gain

T2DM

55
Q

other adverse reactions of antipsychotics

A

altered thermoregulation

galactorrhea

photosensitivity

lowered sz threshold

neuroleptic malignant syndrome

56
Q

most potent antipsychotic

A

haloperidol

57
Q

2 considerations w. antipsychotic absorption

A

most are incompletely absorbed

significant first pass effect

58
Q

how can dose variation of antipsychotics be reduced

A

liquid formulations

59
Q

3 routes of admin for antipsychotics

A

oral

IM solution

IM depot suspension

60
Q

3 distribution properties of antipsychotics

A

extensively protein bound

high lipid solubility

cross placenta

61
Q

3 metabolism/excretion properties of antipsychotics

A

almost completely metabolized

oxidized by CYP450

excreted in breast milk

62
Q

when are atypical agents preferred

A

negative sx

cognition deficits

decreased risk for EPSE

63
Q

antipsychotic for refractory sx

A

clozapine

64
Q

wt gain and metabolic effects are highest w.

A

olanzapine

clozapine

quetiapine

65
Q

wt gain and metabolic effects are lowest w.

A

aripiprazole

lurasidone

66
Q

EPS effects are highest w.

A

risperidone

67
Q

EPS effects are lowest w.

A

quetiapine

iloperidone

68
Q

sedation is minimum w.

A

aripiprazole

risperidone

69
Q

sedation is highest w.

A

quetiapine

olanzapine

best for insomnia/agitation

70
Q

QT prolongation:

highest risk:

lowest risk:

A

highest: ziprasidone
lowest: aripiprazole

Summer Pharm - Exam 2 (12 decks)

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