BIPOLAR DISORDERS AND ANTIMANIC AGENTS Flashcards
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar I Diagnostic Criteria
At least ? Manic Episode
1
Major depressive episodes are common in
bipolar I disorder but are ? for the diagnosis of bipolar I disorder.
not required
Bipolar I Diagnostic Criteria
Elevated, expansive, or irritable mood and
increased activity/energy for at least ? week
1
Diagnostic Criteria for Mania
Marked ? in functioning
impairment
Marked impairment in functioning
Diagnostic Criteria for Mania
Mania Symptoms mnemonic
DIGFAST
DIGFAST
Mania Symptoms mnemonic
Mania Symptoms mnemonic
DIGFAST
D
Distractibility up
Mania Symptoms mnemonic
DIGFAST
I
Irresponsibility
Mania Symptoms mnemonic
DIGFAST
G
Grandiosity
an exaggerated sense of one’s importance, power, knowledge, or identity
I am going to be the next big thing to every exist.
Grandiosity
Mania Symptoms mnemonic
DIGFAST
F
Flight of Ideas
Mania Symptoms mnemonic
DIGFAST
A
Activity increases up
Mania Symptoms mnemonic
DIGFAST
S
Sleep decreases
Mania Symptoms mnemonic
DIGFAST
T
Talkativeness up
Which only requires only one mania eposide
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar I
At least one hypomanic episode + a major depressive episode (required)
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar II
Bipolar II
At least ? hypomanic episode +
a ? episode (required)
one
major depressive
Hypomania: Elevated, expansive,
or irritable mood and increased
activity/energy for at least 4 days
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar II
Bipolar II
Hypomania: Elevated, expansive,
or irritable mood and increased
activity/energy for at least ? days
4
What is a lesser version of Mania
Hypomania
What a more heighted version of hypomania
Mania
Maniac for 7 days without major depression
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar I
Hypomaia for 4 days with major depression
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar II
Diagnostic Criteria for Mania
Is ? or more symptooms of mania
three
Chronic fluctuating mood
* For at least 2 years, for at least 50% of the time, here have been multiple
Bipolar I
Bipolar II
Cyclothymic Disorder
Cyclothymic Disorder
Hypomanic and Depressive episodes without meeting full criteria
Bipolar I
Bipolar II
Cyclothymic Disorder
Cyclothymic Disorder
Cyclothymic Disorder
Chronic fluctuating mood
* For at least ? , for at least 50% of the time, there have been multiple:
2 years
What is the main(First) drug to treat Bipolar Disorders
Lithium
What Is Lithium
Mood Stablizer
First drug by the FDA to be used for Bipolar Disorder?
Lithium
Avoid alcohol and other CNS depressant drugs
Lithium
Lithium Drug interactions
ACE Inhibitors(pril)
Diuretics(depltes water and sodium from body)
TCA - antihistimine/anticholergic drugs
Nsaids
Lithium
? [Na] –> ? [Li]
Decreased
Increased
Lithium
Dehydration can ? serum concentration
increase
Lithium
serum level of ? to ? mEq/L
0.6 to 1.2 mEq/L
Lithium
Monitor at least ? days after dose changes
5
Lithium
Every ? months while in maintenance
1-3
Lithium
What are the labs you check
Lithium Levels, BUN, Creatine (Kidneys)
Lithium
Thyroid must be assessed ? !
annually
Goiter
Thyroid related-
Lithium
Less than 1.5
Common Adverse Reactions
Lithium
1.5 to 2.0
Early Indication
Lithium
2.0 to 2.5
Advance Indication
Lithium
> 2.5
Severe Toxicity
Diarrhea, Nausea, Vomiting, Thirst, Polyuria, Muscle Weakness, Fine Hand Tremors, Slurred Speech and Lethargy
Lithium Common Adverse Effects
Fine hand Tremors
Lithium Common Adverse Effects
Confusion, Sedation, Poor Coordination, Coarse Tremors, Cont GI Distress N/V/D
Lithium Early Indications
Coarse Tremors
Lithium Early Indications
Extreme Polyuria, Tinnitus, Giddiness, Jerking Movement , Blurred Vision, Ataxia, Seizure, Sev Hypotension, Coma , Death from RR
Lithium Advanced Indications
Jerking Movement
Lithium Advanced Indications
Rapid condition to death or coma
Lithium Severe Toxicity
Hemodialysis
Lithium Severe Toxicity
Lithium Mnemonic
Lithium
Lithium Mnemonic
L
Levels (0.6-1.2 mEq/L)
Lithium Mnemonic
I
Increased urination (polyuria)/ Insipidus
a rare condition where you pee a lot and often feel thirsty
Insipidus
Lithium Mnemonic
T
Tremors/Thirst
Lithium Mnemonic
H
Hypothyroidism
Lithium Mnemonic
I2
INTERACTIONS
ACE Inhibitors(pril)
Diuretics(depltes water and sodium from body)
TCA - antihistimine/anticholergic drugs
Nsaids
Lithium Mnemonic
U
Upset stomach
Lithium Mnemonic
M
Muscle weakness/ Miscellaneous- EKG
changes)
What has Blurred vision, nystagmus and diplopia N/V Hedaches. as side effect
Valproic acid
Lithium
Carbamazepine
LAMOTRIGINE
What does Valproic acid, Lithium, Carbamazepine, LAMOTRIGINE have in common
Vision Distrubance
Burred vision, nystagmus and diplopia N/V Headaches
Black Box: Hepatotoxicty + Pancreatitis + Teratogenic
Valproic acid
Valproic acid
Monitor ? + ? periodically
Monitor LFTs + amylase periodically
Jaundice
Valproic acid
Rarely Thrombocytopenia
Valproic acid
Which put more at risk of bruising
Valproic acid
Used after Lithuim fails
CARBAMAZEPINe
?
Stevens-Johnson syndrome, bone marrow
suppression leading to anemia and agranulocytosis
CARBAMAZEPINe
Black box: Stevens-Johnson syndrome
LAMOTRIGINE
Carbamazepine
Black box: Stevens-Johnson syndrome symptoms 3
Fever, Rash, Mouth sores
All The mediation on this test will have CNS isConcerns to avoud driving and Operating Heavy Machinery right
Yes
CNS Effects
Visual Distrubance, and Dizzieness, drowiness, Headaches,
Catiuon while driving
Carbamazepine
Check ?
BMP (Na, BUN)
Carbamazepine
What disease state should we be cautious with? 3
Kidney, Heart Failure, autoimmune disease.
Carbamazepine
Administration
Give ? food (can cause GI symptoms)
Can give at ?, if possible, to sleep through symptoms
With
bedtime
Carbamazepine
Due to ?
* Periodic checks of ?
* Report ?
bone marrow suppression
CBC
fever/sore throught
Due to bone marrow suppression
Carbamazepine
When Stevens-Johnson Syndrome (SJS) Appears what should you do
Stop Medication.
Slow titration regimen
LAMOTRIGINE