Bipolar Pharm Flashcards
What medications can trigger mania?
SSRIs
SNRIs
What are the 2 factors that shape treatment of bipolar disorder?
How the patient has been affected by disorder
How the patient will be helped by treatment
What should patients be assessed for when presenting with mania?
Suicide risk Aggressiveness Risk of violence to others Ability to adhere to treatment program Substance abuse evaluation & treatment Alcohol, caffeine, & nicotine intake
What should be discontinued when a patient presents with mania?
Antidepressants
Classes of Medications
Mood Stabilizers: lithium, anticonvulsants
First generation antipsychotics
Second generation antipsychotics
Mood Stabilizing Agents
Lithium
Valproate (Depakote)
Carbamazepine (Tegretol)
What is important in determining which mood stabilizer to use?
Previous history
SE profile
Co-existing medical illness
Mood Stabilizing Agent SE
Drowsiness Dizziness Headache Diarrhea Constipation Heartburn Mood swings Stuffed/runny nose Other cold-like symptoms
Lithium
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
Why Lithium?
Low therapeutic index Constant blood level monitoring Renal clearance reduced by diuretics Tremor common SE Decreased thyroid function Polydipsia, polyuria Edema, weight gain
Labs to Monitor Lithium
BUN
Creatinine
Thyroid function tests
Lithium levels
Why Valproate (Depakote)
SE profile less than lithium
Quick onset
Increase dose more rapidly
Larger therapeutic window
What drug class is valproate (Depakote) in?
Anti-convulsant
SE of Valproate (Depakote)
Weight gain
N/V
Hair loss
Tremor
Labs for Monitoring Valproate (Depakote)
Liver functions
Platelets
Valproate levels
What drug class is carbamazepine (Tegretol) in?
Anti-convulsant
SE of Carbamazepine (Tegretol)
N/V Hyponatremia Rash (SJS & TENS) Drowsiness Blurred vision Blood dyscrasia's
Labs to Monitor with Carbamazepine (Tegretol)
Liver function tests
CBC
Serum sodium
Carbamazepine levels
What drug class is lamotrigine (Lamictal)
Anti-convulsant
What does lamotrigine (Lamictal) treat?
Bipolar depression without triggering mania, hypomania, mixed states, or rapid cycling
What medication is not recommended for treatment of acute mania
Lamotrigine
Medications to use in acute severe manic or mixed episodes
Anti-psychotic +
Lithium or Valproate
Medications to use in acute moderate manic or mixed episode
Lithium OR
Valproate OR
Antipsychotic agent
Examples of First Generation Antipsychotics
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Shortcomings of FGAs
Small percentage of patients helped to recover
Annoying & serious AE
AE of FGAs
Akathisia
Parkinsonian-like rigidity & tremor
Tardive dyskinesia
Neuroleptic malignant syndrome
Define Akathisia
Subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing
SE of FGA Dopamine Antagonists
Extrapyramidal symptoms: dyskinesia, tardive dyskinesia
Akathisia
Dystonia
Define Dyskinesia
Movement disorders including any of a number of repetitive, involuntary, & purposeless body or facial movements
Examples of Dyskinesia
Tongue movements Lip smacking Finger movements Eye blinking Movements of the arms or legs
When does tradeoff dyskinesia occur?
After long-term treatment with an antipsychotic medication
Define Akathisia
Extreme form of internal or external restlessness
Define Dystonia
Muscle tension disorder involving very strong muscle contractions
MOA of Cogentin
Blocks the effects of the neurotransmitter acetylcholine
What drug class is effective in treating the negative symptoms of Bipolar Disorder?
SGAs
SE of SGAs
Weight gain Glucose intolerance DM Hyperlipidemia Drowsiness Dizziness with changing positions Blurred vision Rapid HR Sensitivity to the sun Skin rashes Menstrual problems
Labs & Other Items to Watch with SGAs
Serum glucose
Lipids
Weight
Waist circumference
Examples of SGAs
Quetiapine (Seroquel) Olanzapine (Zyprexa) Risperidone (Risperdal) Clozapine (Clozaril) Ziprasidone (Geodon) Aripiprazole (Abilify)
Most Severe SE in Quetiapine (Seroquel)
Drowsiness
Most Severe SE in Olanzapine (Zyprexa)
Weight gain
2 Most Severe SE in Clozapine (Clozaril)
Weight gain
Agranulocytosis
1st line therapy for acute depression in patients with bipolar disorder
Lithium OR
Lamotrigin (Lamictal)
When is hospitalization indicated in bipolar patients?
Diagnostic purposes
Stabilization of medications
Patient’s safety
Grossly disorganized or inappropriate behavior
