Bipolar Disorder Meds Lecture PDF

Question 1

Bipolar individuals have __x the rate of suicide of the general population

Answer 1

20x

Question 2

Pathophysiology of bipolar disorder

Answer 2

Etiology unknown, but evident symptoms are caused by altered brain physiology with abnormalities in neuroendocrine, neurotransmitter, etc

Question 3

Clinical manifestation patterns of mood episodes in bipolar disorder

Answer 3

-Mood episodes can occur in variety of patterns, not all patients alternate repeatedly between mania and depression, episodes can last typically a few months

Question 4

3 major types of bipolar disorder

Answer 4

I - Manic or mixed episode usually with major depressive episodes
II - hypomanic episodes with greater major depressive episode, no manic episodes
Mixed - manic and depressive symptoms occur simultaneously

Question 5

Drug therapy alone is not optimal for treatment of bipolar disorder, typically needs a combo of psychotherapy and drugs. Drug therapy generally consists of….
Non drug therapy consists of….

Answer 5

….Mood stabilizing drugs, antidepressants, antipsychotics (during manic phase), and adjuncts such as fish oil
….Education and family counseling, ECT

Question 6

Lithium function, mech of action, pharmacokinetics

Answer 6

• Mainstay in treatment for all episodes and subtypes of bipolar disorder highly effective for stabilizing acute mania by reducing euphoria and hyperactivity without causing sedation
• Unknown mech of action
• Short half life and low therapeutic index, sodium depletion decreases renal excretion of lithium therefore requires sodium levels remain normal

Question 7

Alternative therapeutic uses of lithium (4) and ADR’s (4)

Answer 7

• Alcoholism
• schizophrenia
• migraine
• SIADH

-Extremely toxic when out of therapeutic range, polyuria, tremor, teratogen in 1st trimester or breast feeding

Question 8

Lithium drug interactions (2)

Answer 8

• Diuretics (promote sodium loss increasing risk of lithium toxicity)
• anticholinergic drugs (urinary retention but polyurea)

Question 9

Valproic acid function (bipolar meds)

Answer 9

Alternative drug normally used as an antiepileptic effective for first line treatment of acute mania with efficacy similar to lithium

Question 10

Carbamazepine function (bipolar meds)

Answer 10

Alternative drug approved for treatment and prevention of manic episodes in patients with bipolar disorder, like valporate but appears to be less effective in treatment and prevention of depression

Question 11

Second gen antipsychotics function

Answer 11

Used to acutely control symptoms during manic episodes and long term to hep stabilize mood used often in combo with a mood stabilizer such as valproate or lithium

Question 12

Second gen antipsychotics ADR’s

Answer 12

• Somnolence
• Metabolic disorders
• lowered risk of movement disorder compared to older antipsychotics, but more susceptible to extrapyramidal effects

Question 13

Extrapyramidal effects

Answer 13

Physical symptoms, including tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia, that are primarily associated with improper dosing of or unusual reactions to neuroleptic (antipsychotic) medications.

Question 14

In patients with bipolar disorder, antidepressants are always combined with…

Answer 14

….a mood stabilizer because of long held belief that when used alone antidepressants may elevate mood so much that a hypomanic or manic episode may result

Question 15

Mood stabilizers of choice for management of acute manic episodes (2)

Answer 15

• lithium

- valproate