Bipolar Drugs

Question 1

What drugs should not be used as sole treatment in bipolar disorder?

Answer 1

Antidepressants - can lead to manic episode

Question 2

What is a unique benefit of lithium?

Answer 2

It reduces the risk of suicide in patients

Question 3

What happens to Li+ levels with diuretics that act at the proximal tubule?

Answer 3

Li+ will decrease

Question 4

What happens to Li+ levels with diuretics that act at the distal tubule?

Answer 4

Li+ will increase

Question 5

For what kind of diuretics will the Li+ level remain normal?

Answer 5

Loop Diuretics

Question 6

What does Na+ depletion do the Li+ level?

Answer 6

Increases it

Question 7

Lithium SE

Answer 7

• Decreased thyroid function
• Increased parathyroid function
• Tremor
• Decreased concentration
• Sedation
• Weight gain - VERY slow

Question 8

What is the therapeutic range of Li+ like?

Answer 8

Very narrow

Question 9

What is the first line treatment for bipolar disorder?

Answer 9

Lithium

Question 10

What are some of the difficulties with taking valproic acid?

Answer 10

High amount of GI side effects of diarrhea and nausea.

Question 11

What is the difference between Depakote and valproic acid?

Answer 11

Depakote is a mix of valproic acid and sodium valproate that has less GI SE than valproic acid.

Question 12

Depakote is highly _________ in the plasma.

Answer 12

Protein-bound

Question 13

What hepatic enzymes does Depakote inhibit?

Answer 13

Phase II Glucoronidation - NOT CYP450

Question 14

Depakote SE

Answer 14

• GI problems
• Tremor
• Sedation
• Weight gain
• Thrombocytopenia @ high doses
• Increased NH3

Question 15

How does carbamazepine have DDIs?

Answer 15

Via the CYP450 system

Question 16

Carbamazepine SE

Answer 16

• Nausea
• Dizziness
• Sedation
• Weight gain
• Ataxia
• Stevens Johnson Syndrome

Question 17

Lamotrigine SE

Answer 17

• Benign rash
• Stevens Johnson Syndrome
• Nausea

Question 18

When are 2nd Gen anti-psychotics typically used/

Answer 18

• Sever bipolar with psychosis

- Patient is a danger

Question 19

What bipolar disorder drug has the greatest risk of serious birth defects?

Answer 19

Depakote

Question 20

What bipolar drug increases the risk of neural tube defects?

Answer 20

Carbamazepine

Question 21

Lithium MOA

Answer 21

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

Question 22

What is the excretion of Li+?

Answer 22

Almost exclusively renal

Question 23

What is the effect of spironolactone/amiloride on Li+ levels?

Answer 23

Increases Li+ levels

Question 24

Valproic Acid/Depakote MOA

Answer 24

Unknown

GABA reuptake inhibitor; may increase GABA in synapse or mimic its affects at postsynaptic
receptors.

Question 25

Carbamazepine MOA

Answer 25

• reduces Na+ influx and depresses synaptic transmission

- reduces release of norepinephrine and excitatory amino acids such as glutamate

Question 26

What drug is not useful for treating a manic episode?

Answer 26

Lamotrigine

Question 27

Lamotrigine MOA

Answer 27

Unknown

Inhibits release of glutamate

Question 28

What drug can double lamotrigine’s plasma levels?

Answer 28

Valproic Acid

Question 29

What bipolar drug is associated with Epstein’s anomaly as a birth defect?

Answer 29

Li+