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Psychology- Pharm > Bipolar Disorder Medications > Flashcards

Bipolar Disorder Medications Flashcards

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1
Q

What is the one treatment regimen for bipolar disorder everyone agrees on?

A

Do NOT treat bipolar depression with antidepressants ONLY- the anti-depressant may flip them into a manic episode

Always treat with both an antidepressant and a mood stabilizer

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2
Q

Which is the first line medication for bipolar disorder?

A

Lithium

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3
Q

Is lithium used for bipolar mania or depression?

A

both

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4
Q

How does lithium affect suicide tendencies?

A

Lithium is one of the few drugs that reduces the risks of suicide in patients with bipolar I disorder (and bipolar II as well as major depression)

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5
Q

What is the onset of lithium?

A

Delayed- takes 2-3 weeks for full therapeutic effect

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6
Q

How does lithium affect 5HT?

A

Increases the effect of 5HT

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7
Q

How does lithium affect turnover of NE and DA?

A

Decreases turnover

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8
Q

How does lithium affect acetylcholine levels?

A

Increases ACh synthesis

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9
Q

How can we guess the ion transport of Li?

A

Similar to Na+

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10
Q

Describe the blood protein binding of lithium?

A

THere is none – unique

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11
Q

Describe the therapeutic window of lithium

A

Super narrow

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12
Q

How is lithium excreted?

A

Entirely renally

All DDI involve the kidney

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13
Q

What types of drugs decrease serum lithium levels?

A

Drugs that act at the proximal tubules- acetazolamide, mannitol

Also: aminophylline, theophylline, caffeine, pregnancy..

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14
Q

What type of drugs do not affect lithium serum levels?

A

Loop diuretics: furosemide

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15
Q

What type of drugs increase lithium serum levels?

A

Thiazides, potassium sparing diuretics, ACE inhibitors, angiotensin II

Also: dehydration, renal impairment, advanced age, sodium depletion (body increases reabsorption of Na+)

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16
Q

What’s a common endocrine side effect of lithium?

A

Hypothyroidism- important because patients can appear depressed.

TSH levels should be checked once/twice per year

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17
Q

Name three neurologic side effects of lithium

A

Fine tremor, decreased concentration and sedation

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18
Q

List symptoms of mild Li+ toxicity

A

GI symptoms: nausea, vomiting, diarrhea
State of Consciousness: drowsy/lethargic
Neuro: weakness, coarse hand tremor

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19
Q

List symptoms of moderate Li+ toxicity

A

Confusion
Myoclonic twitches, dysarthria, ataxia, nystagmus
ECG changes

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20
Q

List symptoms of severe Li+ toxicity

A

Grossly impaired consciousness/coma
Increased deep tendon reflex and seizure
Syncope

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21
Q

What is the treatment for Li+ toxicity?

A

Mild: stop treatment and wait for levels to come down
Moderate: hold off on treatment, maybe provide some supportive care
Severe: dialysis

22
Q

What are a few labs that need to be monitored/checked while administering lithium?

A

TSH levels
Renal function
BMI
Lithium levels

Pregnancy, while starting

23
Q

Name three mood stabilizers used in the treatment of bipolar disorder

A

Valproic acid/Depakote
Carbamezepine (Tegretol)
Lamotragine

24
Q

What is the MOA of valproic acid?

A

Unclear

25
Q

What is the absorption of depakote? How does it travel through blood?

A

100% absorbed

90% protein bound

26
Q

What is the half-life of depakote?

A

12 hours (relatively short)

27
Q

Name 3 major DDI of depakote

A

1) Displaces other drugs from protein
2) Inhibits hepatic metabolism
3) Inhibits metabolism of other convulsants –> risk of toxicity

28
Q

Name major side effects of depakote (valproic acid)

A

GI, tremor, sedation, weight gain

also..ataxia, increased ammonia, headaches

29
Q

Patient blood levels of what must be routinely checked for at higher levels of valproic acid treatment?

A

Platelets- check for thrombocytopenia

30
Q

What labs need to be routinely checked when on valproic acid/depakote?

A

LFTs
Platelet count
Weight (BMI)
Valproic acid level

Pregnancy test before starting

31
Q

Do we have to be concerned about carpamezapine drug-drug interactions?

A

YES- CYP450 inducer ( slows down metabolism of other drugs)

alos AUTOINDUCES its own metabolism

32
Q

List unique side effects of carpamezapine (other than dizziness, sedation and nausea)

A

Neuro: ataxia, diplopia, tremor…

SJS, aplastic anemia, agranulocytosis

33
Q

Which is the only mood stabilizer drug that we have to worry about knocking other drugs off of protein in the blood (due to high protein binding?)

A

Valproic acid/depakote

34
Q

WHat is the metabolism of lamotrigine?

A

Glucuronidation

35
Q

How does valproic acid/depokote affect lamotrigine levels?

A

Increases! Lamotrigine levels may double

B/C depakote inhibits UDP-glucuronidation, which is responsible for the metabolism of lamotrigine

36
Q

How do oral contraceptives affect lamotrigene levels?

A

Cut them in half

37
Q

How does carpamezepine affect lamotrigene levels?

A

cuts in in half

38
Q

Why is the rash symptom of lamotrigene so annoying?

A

Because there is no way of differentiating between rash and early SJS

39
Q

When does SJS occur when taking lamotrigene?

A

Within the first 8 weeks- unless another medication is added that may change the pharmacology of the drug

40
Q

When are second generation anti-psychotics used in the treatment of bipolar disorder?

A

Used in combo with mood stabilizers for acute mania

SGA + Lithium or SGA + depakote

41
Q

Exposure to lithium in the first trimester is associate with what teratogenic defect?

A

Ebstein’s anomaly

–general risk is actually pretty low…

42
Q

What type of birth defects are associated with the mood stabilizers?

A

neural tube defects

Lamotrigine carries the lowest risk- maybe risk of cleft palate

43
Q

Should you use lamotrigine to treat a manic bipolar episode?

A

NO

Only used for maintenance therapy

44
Q

How are antidepressants used in the treatment of a manic episode of bipolar disorder?

A

They are not used

45
Q

How are benzodiazepines used in the treatment in a manic bipolar episode?

A

Adjunct therapy

46
Q

How is the maintenance of bipolar disorder treated?

A

Use whatever worked for the acute episode

47
Q

Is carpamezepine used for the treatment of bipolar depression?

A

No- only treats mild acute manic episode or hypomania

48
Q

Are FGAs used in the treatment of bipolar depression?

A

No- antipsychotics are really only used in the treatment of the manic phases

49
Q

Which drug may be used to treat acute manic episodes, maintenance and depressive episodes of bipolar disorder?

A

Lithium

Valproic acid is also good, although not shown to be as efficacious in treating the depressive symptoms

50
Q

How can lamotrogene be used for treating bipolar disorder?

A

It can be used to treat the depressive phase

Psychology- Pharm (7 decks)

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