Bipolar Disorder Drugs

Question 1

What is valproate?

Answer 1

-Valproate is anticonvulsant that is a GABA agonist and glutamate antagonist
-It is better for mixed episodes than lithium*
-But it is also a teratogenic*

Question 2

What is carbamazepine?

Answer 2

-Carbamazepine is an anticonvulsant that blocks Na+ channels and decreases neuronal activity
-Side effects include cognitive impairments, GI upset, sedation, motor ataxia, leucopenia/angranulocytosis, skin reactions
-Lucopenia/agranulocytosis is the white blood cell count is low

Question 3

What are the anticonvulsant medications used to treat bipolar disorder

Answer 3

1. Valproic acid (valproate, Depakote)
2. Carbamazepine (Tegretol)
3. Oxcarbazepine (Trileptol)
4. Lamotrigine (Lamictal)
5. Gabapentin (Neurontin)
6. Pregabalin (Lyrica)
7. Topiramate (Topamax)
8. Zonisamide (Zonegran)
9. Tiagabine/retigabine

Question 4

What is oxcarbazepine?

Answer 4

-Oxcarbazepine (Trileptal) is an anticonvulsant that has an addition of O molecule to carbamazapine
-It has a better safety index; no GI issues, no alterations in liver enzymes (fewer drug interactions), no leucopenia (no monitoring required)*

Question 5

What is gabapentin?

Answer 5

-Gabapentin/pregabalin (Neurontin, Lyrica) is an anticonvulsant that is a GABA analogues and decrease Ca^2 entry into presynaptic terminals
-It has an excellent safety profile; not metabolized by liver, excreted intact*

Question 6

What is topiramate?

Answer 6

-Topiramate (Topamax) is an anticonvulsant that was originally developed as an anti-diabetic Rx and is used to treatment migrations
-It is not super useful as a treatment for BD, but it does induce weight loss which can counteract weight gain seen with other BD drugs*

Question 7

What are the atypical antipsychotics used to treat bipolar disorder?

Answer 7

1. Risperidone (Risperdal)
2. Olanzapine (Zyprexa)
   - olazapine + fluoxetine = Symbyaz
3. Quetiapine (Seroquel)
4. Aripriprazole (Abilify)
5. Ziprasidone (Geodon)
6. Lurasidone (Latuda)

Question 8

Valproate appears to be more effective for patients who have ________________, compared to lithium.

Answer 8

Mixed episodes

Question 9

One of the biggest problems with carbamazepine is that it can induce:

Answer 9

Agranulocytosis

Question 10

Topamax is used in the treatment of Bipolar Disorder to decrease

Answer 10

weight gain

Question 11

Electro-convulsive therapy (ECT) is sometimes used to treat Bipolar Disorder because

Answer 11

It has rapid effects

Question 12

Atypical antipsychotics are often used as a first-line treatment for Bipolar Disorder because:

Answer 12

They have a safer profile than lithium

Question 13

The rate of suicide for bipolar patients is approximately _____ times that of the general population.

Answer 13

10

Question 14

One of the most serious side effects associated with taking Lamictal is

Answer 14

Rash

Question 15

What is the original primary indication for lamotrigine?

Answer 15

Seizure disorder/epilepsy

Question 16

Bipolar patients spend most of their lives in a ____________ state.

Answer 16

Asymptomatic

Question 17

Which of the following is NOT a side-effect of lithium?

Answer 17

EPS

Question 18

The classic drug for treating bipolar disorder is

Answer 18

lithium

Question 19

The therapeutic index for lithium is _______; the antidote for overdose is __________

Answer 19

Low; unavailable

Question 20

Similarly to antidepressants lithium appears to

Answer 20

Increase neuroprotective factors

Question 21

Oxcarbazepine is an improvement of the carbamazepine molecule and has a better side effect profile. Which of the following is NOT one of the improvements?

Answer 21

Less weight gain

Question 22

Antiepileptics include all of the following drugs except:

Answer 22

lithium