Bipolar pharmacotherapy

Question 1

what are the two poles of bipolar

Answer 1

depression and mania

Question 2

what are common comorbidities with bipolar

Answer 2

alcohol abuse
substance abuse
anxiety

Question 3

bipolar i classification

Answer 3

more than 1 manic episode

Question 4

bipolar ii classification

Answer 4

hypomanic episodes

Question 5

main mood symptoms

Answer 5

euphoria, depression, irritability

Question 6

main cognitive symptoms

Answer 6

racing thoughts, delusions, hallucinations

Question 7

main behavior symptoms

Answer 7

impulsivity, insomnia, increased sexual behavior, aggression

Question 8

how to use mood stabilizers in bipolar

Answer 8

acute and maintenance therapy

Question 9

what is first line therapy in bipolar

Answer 9

lithium or valproate

Question 10

what can be used in combo with first line therapy in bipolar

Answer 10

atypicals

Question 11

Lithium pros and cons

Answer 11

very effective
decrease in suicidality
narrow TPI
teratogenic in 1st trimester

Question 12

toxicity levels of lithium

Answer 12

1.5-3 mEq/L

Question 13

lithium toxicity syptoms

Answer 13

GI, ataxia, hand tremor, seizure, lethargy, altered mental status

Question 14

lithium side effects

Answer 14

hypothyroidism, polyuria, polydipsia, acne, dry mouth, weight gain

Question 15

when is lithium teratogenic

Answer 15

1st trimester

Question 16

lithium monitoring

Answer 16

SCr, BUN (renally excreted)
Electrolytes (tied to sodium)
Thyroid
CBC
Weight
Pregnancy

Question 17

what should patients taking lithium be consistent with

Answer 17

water and salt intake

Question 18

drug interactions with lithium

Answer 18

decreased clearance: ACE, ARB, TZD, NSAID
increased clearance: caffeine

Question 19

valproic acid admin risk

Answer 19

several dosage forms so higher med error risk

Question 20

what valproic acid form as less bioavailability

Answer 20

ER

Question 21

what valproic acid forms can be sprinkled

Answer 21

IR and capsule
higher risk for GI ulcers

Question 22

what is goal serum for valproic acid

Answer 22

80-125mcg/ml

Question 23

what are the adverse effects of valproic acid

Answer 23

teratogenic (decreased IQ)
PCOS
GI, anorexia, ulcers
thrombocytopenia
weight gain
hyperammonemia

Question 24

valproate baseline labs

Answer 24

pregnancy test
LFT
CBC w/ differential

Question 25

valproate routine labs

Answer 25

LFT CBC serum concentration *serum ammonia if issue suspected*

Question 26

what drug combo with valproate needs to be monitored

Answer 26

lamotrigine

Question 27

lamotrigine dose adjustment w/ valproate

Answer 27

half the lamotrigine dose

Question 28

what are the other mood stabilizers in bipolar

Answer 28

carbamazepine oxcarbazepine lamotrigine topiramate

Question 29

what is carbamazepine associated with

Answer 29

thrombocytopenia and hematologic issues

Question 30

what is oxcarbazepine risk

Answer 30

hyponatremia CYP3A4 inducer

Question 31

when is lamotrigine preferred in bipolar

Answer 31

depressive symptoms *not for acute manic episodes*

Question 32

what are the AE of topiramate

Answer 32

weight loss metabolic acidosis and kidney stones DRESS warning

Question 33

what antipsychotics can be used in bipolar

Answer 33

quetiapine aripiprazole symbyax latuda

Question 34

when to use antidepressants in bipolar

Answer 34

in combo w/ mood stabilizer use sertonergic antidepressants to treat anxiety

Question 35

what drugs are typically used for bipolar in pregnancy

Answer 35

atypicals lithium after 1st trimester