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Psychiatry > Bipolar Disorder - Pharmacology > Flashcards

Bipolar Disorder - Pharmacology Flashcards

1
Q

What are the 3 main groups of mood stabilisers?

A

Lithium, anti-convulsants and anti-psychotics

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2
Q

Which types of mood stabilisers are useful for both mood states?

A

Lithium and anti-psychotics

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3
Q

Which type of mood stabiliser is especially good for bipolar depression?

A

Lamotrigine

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4
Q

Which type of mood stabiliser is especially good for mania/hypomania?

A

Valproate

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5
Q

Should anti-depressants be given in bipolar disorder?

A

They should generally be avoided since they can trigger mania, but may be used short-term for a severe depressive episode

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6
Q

When giving an anti-depressant what other medication should the person always be on?

A

An anti-manic drug

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7
Q

When can depot IM anti-psychotic be given and why?

A

Given every 2-4 weeks if compliance is poor or if the patient is unwilling to take oral medication

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8
Q

What are the two main agents used for prophylaxis of bipolar?

A

Lithium and sodium valproate

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9
Q

What impact does lithium have on bipolar disorder?

A

Lowers the frequency and severity of relapses by half and significantly reduces the likelihood of suicide

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10
Q

When should lithium plasma levels be monitored before the therapeutic dose is reached?

A

Weekly, 12 hours after the last dose

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11
Q

What is the therapeutic plasma range of lithium?

A

Between 0.5 and 1.0mmol/l

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12
Q

When should screening take place for lithium use?

A

Prior to starting and at 6 month intervals thereafter

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13
Q

What are the 3 screening tests for lithium use?

A

TFTs, parathyroid function and renal function

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14
Q

Why are TFTs screened when using lithium?

A

Lithium can produce hypothyroidism

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15
Q

Why are parathyroid levels screened when using lithium?

A

Serum calcium and parathyroid hormone levels are increased in 10% of patients

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16
Q

Why is renal function screened for when using lithium?

A

Long term lithium treatment can cause nephrogenic diabetes insipidus and reduced glomerular function

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17
Q

Because of lithium toxicity, what should patients be warned when starting it?

A

Always carry a lithium card, be advised to avoid dehydration and drug interactions such as NSAIDs and diuretics

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18
Q

What are some causes of lithium toxicity?

A

Increased dose, dehydration drug interactions, reduced salt intake

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19
Q

What are the warning signs of lithium toxicity?

A

GI upset, blurred vision, coarse tremor, ataxia and drowsiness

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20
Q

What are some signs of severe lithium toxicity?

A

Confusion, loss of consciousness, seizures, coma, death

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21
Q

How is lithium toxicity treated?

A

Stopping lithium, IV fluids, monitoring of renal function, maybe dialysis

22
Q

Should lithium be used in pregnancy?

A

It is not advised, particularly in the first trimester because of an increased risk of foetal malformation

23
Q

It is likely that women with bipolar disorder will relapse after giving birth. How can this risk be reduced?

A

Restarting lithium within 24 hours of delivery (if prepared to forgo breastfeeding)

24
Q

What is the mode of action of lithium?

A

The mode of action is unclear, but it is thought to act intracellularly as a secondary messenger system

25
Q

When should lithium be used?

A

Gold standard for the prophylaxis of bipolar disorder and can also be given as an adjunct to anti-depressants in treatment resistant depression

26
Q

What are some side effects of lithium?

A

GI upset, fine tremor, nephrotoxicity, hypothyroidism, weight gain

27
Q

Why should lithium plasma levels be measured so often?

A

Because of a narrow therapeutic index

28
Q

What blood test should be done every 5 days until on the therapeutic dose of lithium?

A

Us and Es

29
Q

Once at a therapeutic level, how often should plasma lithium levels and Us and Es be measured in a patient on lithium?

A

Every 3 months

30
Q

Once at a therapeutic level, how often should TFTs be measured in a patient on lithium?

A

Every 6 months

31
Q

If a patient on lithium is dehydrated from physical illness, generally unwell or if there are signs of toxicity, what tests should be done?

A

Lithium plasma levels and Us and Es

32
Q

When should lithium be taken and why?

A

At night due to sedation

33
Q

What are the main drugs that lithium interacts with?

A

ACE inhibitors, NSAIDs, ARBs and diuretics

34
Q

How should hypothyroidism as a result of lithium treatment be treated?

A

Levothyroxine

35
Q

What type of drugs are sodium valproate, carbamazepine or lamotrigine?

A

Anti-convulsants

36
Q

How do the anti-convulsant drugs work?

A

Block voltage sensitive sodium channels

37
Q

Which anti-convulsant drug is the only one to be first line along with lithium in the longterm treatment of bipolar?

A

Sodium valproate

38
Q

Anti-convulsants are mainly used for what type of treatment of bipolar disorder?

A

Long term prophylaxis (valproate can also be used for acute mania)

39
Q

Do people with rapid cycling respond better to anti-convulsants or lithium?

A

Anti-convulsants

40
Q

What are the side effects of sodium valproate?

A

GI upset, weight gain, sedation, tremor, dizziness

41
Q

How often is sodium valproate taken a day?

A

Twice

42
Q

What tests should be done prior to starting sodium valproate?

A

Platelet count and LFTs

43
Q

What are the rules with sodium valproate and pregnancy?

A

Must not be used in pregnancy and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place

44
Q

What is the risk of sodium valproate in pregnancy?

A

Neural tube defects

45
Q

What are the side effects of carbamazepine?

A

Drowsiness, ataxia, cardiovascular events

46
Q

Can carbamazepine be used in pregnancy?

A

No

47
Q

What are some side effects of lamotrigine?

A

Rash, GI upset, dizziness, ataxia

48
Q

Which anti-convulsant has a risk of Stevens Johnsons syndrome?

A

Lamotrigine

49
Q

How is the risk of Stevens Johnsons syndrome with lamotrigine reduced?

A

Titrate up very slowly

50
Q

Which aspect of bipolar is lamotrigine better for?

A

Bipolar depression

Psychiatry (20 decks)

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