Bipolar Disorder - Gen. Principles of Pharmacotx Flashcards
When would a mood stabilizer be used in BD pts?
During manic episodes and to prevent manic and MDD episodes
When would an antidepressant be used in BD pts?
During episodes of bipolar depression
When would Li be preferred over divalproex?
When pt displays classical, euphoric mania (elated mood without depressive sx’s)
When would divalproex be preferred over Li?
When pt has irritable/dysphoric mania
What are our first line options for tx’ing acute mania?
Li OR Divalproex OR atypical antipsychotic OR 2-drug combo (Li or DVP + AAP)
What do we do if no response is observed in BD pts within 2 weeks of starting a 1st line agent?
Add-on or switch should be considered
What add-on tx strats are possible (i.e. 2nd line add-on)?
Olanzapine + Li OR divalproex
What switch strats are possible (i.e. 2nd line switch tx)
Olanzapine, carbamazepine, ziprasidone, haloperidol
In what specific pop should we be careful using divalproex?
Women of childbearing age
Agents not recommended for acute mania?
eslicarbazepine, gabapentin, LAMOTRIGINE, omega 3 fatty acids, topiramate
Best agent for mania prevention (i.e. maintenance tx)?
Lithium
T or F: Whatever was effective in tx’ing acute mania will probably be effective in the maintenance phase too.
T
BDI depression 1st line tx’s
- quetiapine
- lurasidone + Li/divalproex
- Li
- lamotrigine
- lurasidone
- quetiapine + Li (esp. if sleeping probs)
BDI - how long before improvement of depressive episode?
usually 2 weeks, but can be up to 2 mths for full improvement
BDI - add-on/switch tx’s for BDI depression?
- quetiapine
- lurasidone + Li/divalproex
- Li
- lamotrigine
- lurasidone
- quetiapine + Li (esp. if sleeping probs)
(EXACT SAME AS first-line agents - just pick a diff one)