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Behavioral Health > Bipolar Pharm > Flashcards

Bipolar Pharm Flashcards

1
Q

What medications can trigger mania?

A

SSRIs

SNRIs

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2
Q

What are the 2 factors that shape treatment of bipolar disorder?

A

How the patient has been affected by disorder

How the patient will be helped by treatment

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3
Q

What should patients be assessed for when presenting with mania?

A 
Suicide risk
Aggressiveness
Risk of violence to others
Ability to adhere to treatment program
Substance abuse evaluation & treatment
Alcohol, caffeine, & nicotine intake
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4
Q

What should be discontinued when a patient presents with mania?

A

Antidepressants

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5
Q

Classes of Medications

A

Mood Stabilizers: lithium, anticonvulsants
First generation antipsychotics
Second generation antipsychotics

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6
Q

Mood Stabilizing Agents

A

Lithium
Valproate (Depakote)
Carbamazepine (Tegretol)

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7
Q

What is important in determining which mood stabilizer to use?

A

Previous history
SE profile
Co-existing medical illness

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8
Q

Mood Stabilizing Agent SE

A 
Drowsiness
Dizziness
Headache
Diarrhea
Constipation
Heartburn
Mood swings
Stuffed/runny nose
Other cold-like symptoms
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9
Q

Lithium

A

Decreases frequency & severity of manic & depressive episodes
Decrease norepi and dopamine turnover
Blocks dopamine receptor supersensitivity
Augment synthesis of acetylcholine
May work better in maintenance phase

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10
Q

Why Lithium?

A 
Low therapeutic index
Constant blood level monitoring
Renal clearance reduced by diuretics
Tremor common SE
Decreased thyroid function
Polydipsia, polyuria
Edema, weight gain
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11
Q

Labs to Monitor Lithium

A

BUN
Creatinine
Thyroid function tests
Lithium levels

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12
Q

Why Valproate (Depakote)

A

SE profile less than lithium
Quick onset
Increase dose more rapidly
Larger therapeutic window

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13
Q

What drug class is valproate (Depakote) in?

A

Anti-convulsant

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14
Q

SE of Valproate (Depakote)

A

Weight gain
N/V
Hair loss
Tremor

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15
Q

Labs for Monitoring Valproate (Depakote)

A

Liver functions
Platelets
Valproate levels

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16
Q

What drug class is carbamazepine (Tegretol) in?

A

Anti-convulsant

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17
Q

SE of Carbamazepine (Tegretol)

A 
N/V
Hyponatremia
Rash (SJS & TENS)
Drowsiness
Blurred vision
Blood dyscrasia's
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18
Q

Labs to Monitor with Carbamazepine (Tegretol)

A

Liver function tests
CBC
Serum sodium
Carbamazepine levels

19
Q

What drug class is lamotrigine (Lamictal)

A

Anti-convulsant

20
Q

What does lamotrigine (Lamictal) treat?

A

Bipolar depression without triggering mania, hypomania, mixed states, or rapid cycling

21
Q

What medication is not recommended for treatment of acute mania

A

Lamotrigine

22
Q

Medications to use in acute severe manic or mixed episodes

A

Anti-psychotic +

Lithium or Valproate

23
Q

Medications to use in acute moderate manic or mixed episode

A

Lithium OR
Valproate OR
Antipsychotic agent

24
Q

Examples of First Generation Antipsychotics

A

Haloperidol (Haldol)

Chlorpromazine (Thorazine)

25
Q

Shortcomings of FGAs

A

Small percentage of patients helped to recover

Annoying & serious AE

26
Q

AE of FGAs

A

Akathisia
Parkinsonian-like rigidity & tremor
Tardive dyskinesia
Neuroleptic malignant syndrome

27
Q

Define Akathisia

A

Subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing

28
Q

SE of FGA Dopamine Antagonists

A

Extrapyramidal symptoms: dyskinesia, tardive dyskinesia
Akathisia
Dystonia

29
Q

Define Dyskinesia

A

Movement disorders including any of a number of repetitive, involuntary, & purposeless body or facial movements

30
Q

Examples of Dyskinesia

A 
Tongue movements
Lip smacking
Finger movements
Eye blinking
Movements of the arms or legs
31
Q

When does tradeoff dyskinesia occur?

A

After long-term treatment with an antipsychotic medication

32
Q

Define Akathisia

A

Extreme form of internal or external restlessness

33
Q

Define Dystonia

A

Muscle tension disorder involving very strong muscle contractions

34
Q

MOA of Cogentin

A

Blocks the effects of the neurotransmitter acetylcholine

35
Q

What drug class is effective in treating the negative symptoms of Bipolar Disorder?

A

SGAs

36
Q

SE of SGAs

A 
Weight gain
Glucose intolerance
DM
Hyperlipidemia
Drowsiness
Dizziness with changing positions
Blurred vision
Rapid HR
Sensitivity to the sun
Skin rashes
Menstrual problems
37
Q

Labs & Other Items to Watch with SGAs

A

Serum glucose
Lipids
Weight
Waist circumference

38
Q

Examples of SGAs

A 
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Clozapine (Clozaril)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
39
Q

Most Severe SE in Quetiapine (Seroquel)

A

Drowsiness

40
Q

Most Severe SE in Olanzapine (Zyprexa)

A

Weight gain

41
Q

2 Most Severe SE in Clozapine (Clozaril)

A

Weight gain

Agranulocytosis

42
Q

1st line therapy for acute depression in patients with bipolar disorder

A

Lithium OR

Lamotrigin (Lamictal)

43
Q

When is hospitalization indicated in bipolar patients?

A

Diagnostic purposes
Stabilization of medications
Patient’s safety
Grossly disorganized or inappropriate behavior

Behavioral Health (25 decks)

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