Bipolar Disorder - Gen. Principles of Pharmacotx Flashcards

1
Q

When would a mood stabilizer be used in BD pts?

A

During manic episodes and to prevent manic and MDD episodes

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2
Q

When would an antidepressant be used in BD pts?

A

During episodes of bipolar depression

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3
Q

When would Li be preferred over divalproex?

A

When pt displays classical, euphoric mania (elated mood without depressive sx’s)

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4
Q

When would divalproex be preferred over Li?

A

When pt has irritable/dysphoric mania

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5
Q

What are our first line options for tx’ing acute mania?

A

Li OR Divalproex OR atypical antipsychotic OR 2-drug combo (Li or DVP + AAP)

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6
Q

What do we do if no response is observed in BD pts within 2 weeks of starting a 1st line agent?

A

Add-on or switch should be considered

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7
Q

What add-on tx strats are possible (i.e. 2nd line add-on)?

A

Olanzapine + Li OR divalproex

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8
Q

What switch strats are possible (i.e. 2nd line switch tx)

A

Olanzapine, carbamazepine, ziprasidone, haloperidol

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9
Q

In what specific pop should we be careful using divalproex?

A

Women of childbearing age

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10
Q

Agents not recommended for acute mania?

A

eslicarbazepine, gabapentin, LAMOTRIGINE, omega 3 fatty acids, topiramate

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11
Q

Best agent for mania prevention (i.e. maintenance tx)?

A

Lithium

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12
Q

T or F: Whatever was effective in tx’ing acute mania will probably be effective in the maintenance phase too.

A

T

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13
Q

BDI depression 1st line tx’s

A
  1. quetiapine
  2. lurasidone + Li/divalproex
  3. Li
  4. lamotrigine
  5. lurasidone
  6. quetiapine + Li (esp. if sleeping probs)
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14
Q

BDI - how long before improvement of depressive episode?

A

usually 2 weeks, but can be up to 2 mths for full improvement

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15
Q

BDI - add-on/switch tx’s for BDI depression?

A
  1. quetiapine
  2. lurasidone + Li/divalproex
  3. Li
  4. lamotrigine
  5. lurasidone
  6. quetiapine + Li (esp. if sleeping probs)

(EXACT SAME AS first-line agents - just pick a diff one)

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16
Q

What’s definitely NOT recommended in tx’ing acute bipolar depression?

A

Antidepressant monotx (mood switching conern)

17
Q

T or F: Maintenance tx for BDI is not necessary after the very first mood episode.

A

F

Even after the FIRST mood episode, indefinite tx must be started

18
Q

First line maintenance tx’s for BDI

A
  1. Li
  2. Quetiapine
  3. Divalproex
  4. lamotrigine
  5. asenapine OR aripiprazole (PO/IM)
  6. quetiapine or aripiprazole + Lithium/divalproex
19
Q

First line add-on/switch tx for BDI maintenance?

A
  1. Li
  2. Quetiapine
  3. Divalproex
  4. lamotrigine
  5. asenapine OR aripiprazole (PO/IM)
  6. quetiapine or aripiprazole + Lithium/divalproex

(EXACT same as first line maintenance tx’s for BDI - just pick a diff 1st line tx)

20
Q

Mixed episodes pharm tx

A

d/c antideps

monotx: atypical antipsychotic OR combo tx (Li or divalproex + atypical antipsychotic)
- -> This is the same tx for acute manic phase

21
Q

Preferred bipolar agent for pregnant women?

A

Lamotrigine

22
Q

CI’ed bipolar drugs in preggos?

A

Carbamazepine and valproic acid

23
Q

What can happen if a pregnant woman takes Li?

A

Epstein’s anomaly in the baby’s heart (small risk)

24
Q

What drug has the most evidence for preventing suicide?

A

Li