Bipolar Drugs Flashcards
What drugs should not be used as sole treatment in bipolar disorder?
Antidepressants - can lead to manic episode
What is a unique benefit of lithium?
It reduces the risk of suicide in patients
What happens to Li+ levels with diuretics that act at the proximal tubule?
Li+ will decrease
What happens to Li+ levels with diuretics that act at the distal tubule?
Li+ will increase
For what kind of diuretics will the Li+ level remain normal?
Loop Diuretics
What does Na+ depletion do the Li+ level?
Increases it
Lithium SE
- Decreased thyroid function
- Increased parathyroid function
- Tremor
- Decreased concentration
- Sedation
- Weight gain - VERY slow
What is the therapeutic range of Li+ like?
Very narrow
What is the first line treatment for bipolar disorder?
Lithium
What are some of the difficulties with taking valproic acid?
High amount of GI side effects of diarrhea and nausea.
What is the difference between Depakote and valproic acid?
Depakote is a mix of valproic acid and sodium valproate that has less GI SE than valproic acid.
Depakote is highly _________ in the plasma.
Protein-bound
What hepatic enzymes does Depakote inhibit?
Phase II Glucoronidation - NOT CYP450
Depakote SE
- GI problems
- Tremor
- Sedation
- Weight gain
- Thrombocytopenia @ high doses
- Increased NH3
How does carbamazepine have DDIs?
Via the CYP450 system
Carbamazepine SE
- Nausea
- Dizziness
- Sedation
- Weight gain
- Ataxia
- Stevens Johnson Syndrome
Lamotrigine SE
- Benign rash
- Stevens Johnson Syndrome
- Nausea
When are 2nd Gen anti-psychotics typically used/
- Sever bipolar with psychosis
- Patient is a danger
What bipolar disorder drug has the greatest risk of serious birth defects?
Depakote
What bipolar drug increases the risk of neural tube defects?
Carbamazepine
Lithium MOA
Unknown…
o Inositol recycling: Li+ inhibits a number of enzymes involved in inositol recycling
o Protein kinase C: Li+ may affect specific isozymes of protein kinase C
What is the excretion of Li+?
Almost exclusively renal
What is the effect of spironolactone/amiloride on Li+ levels?
Increases Li+ levels
Valproic Acid/Depakote MOA
Unknown
GABA reuptake inhibitor; may increase GABA in synapse or mimic its affects at postsynaptic
receptors.
Carbamazepine MOA
- reduces Na+ influx and depresses synaptic transmission
- reduces release of norepinephrine and excitatory amino acids such as glutamate
What drug is not useful for treating a manic episode?
Lamotrigine
Lamotrigine MOA
Unknown
Inhibits release of glutamate
What drug can double lamotrigine’s plasma levels?
Valproic Acid
What bipolar drug is associated with Epstein’s anomaly as a birth defect?
Li+
