Bipolar pharmacotherapy Flashcards
what are the two poles of bipolar
depression and mania
what are common comorbidities with bipolar
alcohol abuse
substance abuse
anxiety
bipolar i classification
more than 1 manic episode
bipolar ii classification
hypomanic episodes
main mood symptoms
euphoria, depression, irritability
main cognitive symptoms
racing thoughts, delusions, hallucinations
main behavior symptoms
impulsivity, insomnia, increased sexual behavior, aggression
how to use mood stabilizers in bipolar
acute and maintenance therapy
what is first line therapy in bipolar
lithium or valproate
what can be used in combo with first line therapy in bipolar
atypicals
Lithium pros and cons
very effective
decrease in suicidality
narrow TPI
teratogenic in 1st trimester
toxicity levels of lithium
1.5-3 mEq/L
lithium toxicity syptoms
GI, ataxia, hand tremor, seizure, lethargy, altered mental status
lithium side effects
hypothyroidism, polyuria, polydipsia, acne, dry mouth, weight gain
when is lithium teratogenic
1st trimester
lithium monitoring
SCr, BUN (renally excreted)
Electrolytes (tied to sodium)
Thyroid
CBC
Weight
Pregnancy
what should patients taking lithium be consistent with
water and salt intake
drug interactions with lithium
decreased clearance: ACE, ARB, TZD, NSAID
increased clearance: caffeine
valproic acid admin risk
several dosage forms so higher med error risk
what valproic acid form as less bioavailability
ER
what valproic acid forms can be sprinkled
IR and capsule
higher risk for GI ulcers
what is goal serum for valproic acid
80-125mcg/ml
what are the adverse effects of valproic acid
teratogenic (decreased IQ)
PCOS
GI, anorexia, ulcers
thrombocytopenia
weight gain
hyperammonemia
valproate baseline labs
pregnancy test
LFT
CBC w/ differential
valproate routine labs
LFT
CBC
serum concentration
serum ammonia if issue suspected
what drug combo with valproate needs to be monitored
lamotrigine
lamotrigine dose adjustment w/ valproate
half the lamotrigine dose
what are the other mood stabilizers in bipolar
carbamazepine
oxcarbazepine
lamotrigine
topiramate
what is carbamazepine associated with
thrombocytopenia and hematologic issues
what is oxcarbazepine risk
hyponatremia
CYP3A4 inducer
when is lamotrigine preferred in bipolar
depressive symptoms
not for acute manic episodes
what are the AE of topiramate
weight loss
metabolic acidosis and kidney stones
DRESS warning
what antipsychotics can be used in bipolar
quetiapine
aripiprazole
symbyax
latuda
when to use antidepressants in bipolar
in combo w/ mood stabilizer
use sertonergic antidepressants to treat anxiety
what drugs are typically used for bipolar in pregnancy
atypicals
lithium after 1st trimester
