bipolar drugs Flashcards
quetiapine (trade name) is….
class of drug?
seroquel
SGA
lurasidone (trade name) is….
class of drug?
Latuda
SGA
ziprasidone (trade name) is….
class of drug?
Geodon
SGA
lamotrigine (trade name) is….
class of drug?
Lamictal
2nd gen anti-epileptic drug // phenyltriazine
the rate of suicide with people with bipolar disorder is ____x the general poulaiton
10 times
% prevalence worldwide of bipolar disorder
1%
diagnostic difficulties with bipolar disorder
who was the first person to use lithium for mania? what observation led to this use?
John Cade; seeing the lethagry it produced in rats
what was lithium originally used for?
gout , headaches, as a salt subsitute
TI for lithium
TI: 1.25-2.5 (very narrow)
basically will kill you by causing kidney failure
lithium side effects?
Neurological – tremor, lethargy, impaired concentration, dizziness, muscle weakness, nystagmus (repetitive, uncontrolled movement of eyes)
GI – nausea, vomiting, diarrhea, pain. Weight gain can be substantial.
Skin – rash, acne, psoriasis, hair loss, mucosal lesions, brittle nails
Thyroid – enlargement, goiter
Kidneys – increased thirst, increased urine output, renal failure
Cardiovascular – arrythmia
nystagmus is…..
this is associated with what drug?
(repetitive, uncontrolled movement of eyes)
SE of lithium
examples of anticonvulsants
Valproic Acid (valproate, Depakote)
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptol)
Lamotrigine (Lamictal)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Topiramate (Topamax)
Zonisamide (Zonegran)
Tiagabine/retigabine
issues with anticonvulsants
teratogenic
inc suicidality
valproate (drug class and trade name)
depakote
anticonvulsant
**Valproate is better for _____ than lithium
mixed episodes
carbamazepine (trade name)
class of drug?
Tegretol
anticonvulsant
carbamazepine SE
most serious SE?
Side effects: cognitive impairments, GI upset, sedation, motor ataxia, leucopenia/agranulocytosis, skin reactions
most serious: leucopenia/agranulocytosis
carbamazepine may be better than lithium for ______
rapid cyclers / mixed mania
oxcarbazepine (trade name)
trileptal
benefits of oxcarbezpine
Better safety index; no GI issues, no alterations in liver enzymes (fewer drug interactions), no leucopenia (no monitoring required)
gabapentin / pregabalin (trade)
Neurontin, Lyrica
benefits of gabapentin / pregabalin
Excellent safety profile; not metabolized by liver, excreted intact
what was topiramate originally developed for?
anti-diabetes
topiramate trade name
topamax
benefits / considerations for topiramate?
Not super useful as a txt for BD, per se, however induces weight loss, which can counteract weight gain seen with other BD drugs
May increase lithium concentration in blood, so must monitor closely
common atypical antipsychotics
risperidone (Risperdal)
olanzapine (Zyprexa)
olanzapine + fluoxetine = Symbyax
quetiapine (Seroquel)
aripiprazole (Abilify)
ziprasidone (Geodon)
lurasidone (Latuda)
what is the first line of tmt for bipolar d/o?
atypical antipsychotics
ability to reduce mania is correlated to________
affinity for D2 receptors
STEP-BD study
~50% pxts achieved recovery, and ~50% of those pxts relapsed within 2 years
Residual symptoms at recovery, concurrent psychiatric diagnoses
Addition of an antidepressant did not give significantly better recovery rates
Valproate not recommended for female pxts (PCOS, teratogenic)
Lamotrigine is good for txt-resistant pxts
Psychosocial txt is very important for optimal recovery
The uncontrollable movements of muscles commonly in the limbs, face, and tongue produced by ACUTE treatment with antipsychotics are called
dystonia
risperidone trade name
drug class
(Risperdal)
SGA
olanzapine trade name
drug class
(Zyprexa)
SGA
Valproic Acid trade name
class?
(valproate, Depakote)
anticonvulsant
Carbamazepine trade name? drug class?
(Tegretol)
anticonvulsant
Topiramate trade name? drug class?
(Topamax)
anticonvulsant
dystonia is….
The uncontrollable movements of muscles commonly in the limbs, face, and tongue produced by ACUTE treatment with antipsychotics
