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Behavioral Health > Bipolar Pharmacy > Flashcards

Bipolar Pharmacy Flashcards

1
Q

Mood swings causes are unknown, although catecholamine-related activity may be present.

  1. Drugs that increase this activity tend to _______ mania?
  2. Drugs that reduce activity of dopamine or norepinephrine ________ mania?
A
  1. exacerbate

2. relieve

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2
Q

Some important observations to make before discussing treatment of psychotic disorders:
1. Two factors must shape treatment…

A
    • How the patient has been affected by the disorder
    • How the patient will be helped by the treatment
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3
Q

Acute Mania and Hypomania.
Patients presenting with acute mania should be assessed for the following:
7

A
  1. Suicide risk
  2. Aggressiveness
  3. Risk of violence to others
  4. Ability to adhere to a treatment program
  5. Substance abuse evaluation and treatment
  6. Alcohol, caffeine and nicotine intake
  7. Antidepressants should be discontinued
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4
Q

Biological Therapies

  1. ***Antipsychotic drugs treat what?
    - They do not treat what?
  2. Classes of Meds? 4
A
  1. the symptoms (They DO NOT cure the disorder)
  2. Classes of Medications:
    - Lithium (Mood Stabilizer)
    - Anticonvulsants (Mood Stabilizer)
    - First Generation Antipsychotics
    - Second Generation Antipsychotics (Atypical Antipsychotics)
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5
Q

Mood stabilizing agents
3

The choice of mood stabilizer is often based on what? 3

A
  1. Lithium
  2. Valproate (Depakote)
  3. Carbamazepine (Tegretol)

The choice of a mood stabilizer is often based upon:

  1. Previous history
  2. Side-effect profiles
  3. Co-existing medical illness
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6
Q

Common side effects of mood stabilizing medications include:

8

A
  1. Drowsiness
  2. Dizziness
  3. Headache
  4. Diarrhea
  5. Constipation
  6. Heartburn
  7. Mood swings
  8. Stuffed or runny nose, or other cold-like symptoms
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7
Q

LITHIUM
1. Significantly decreases the frequency and severity of what? 2

  1. May decrease what turnover? 2
  2. Blocks the development of what?
  3. May augment the synthesis of of what? By doing what?
  4. Use less first line with new what?.
  5. May work better in the ___________ phase of therapy.
A
  1. both manic and depressive episodes in about 70% of patients.
  2. norepinephrine and dopamine
  3. dopamine receptor supersensitivity
  4. acetylcholine, by increasing cholamine uptake into nerve terminals
  5. atypical antipsychotics
  6. maintenance
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8
Q

Lithium
Disadvantages?
7

A
  1. Has a low therapeutic index (dont need much to have an effect)
  2. Required constant blood level monitoring
  3. Renal clearance of lithium is reduced about 25% by diuretics
  4. Tremor is a common side effect (how could we counter this?)
  5. Decreased thyroid function
  6. Polydipsia, polyuria
  7. Edema, weight gain
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9
Q

Labs to monitor for Lithium? 3

A

Labs

  1. Bun, Creatinine
  2. Thyroid functions
  3. Lithium levels
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10
Q
  1. Valproate (Depakote): Drug class?
  2. Advanatges? 4
  3. SE? 4
  4. Labs to monitor? 3
A
  1. Antiepileptic
    • Side effect profile less than that of Lithium
    • Quick onset
    • May increase dose more rapidly (over a few days) to increase therapeutic range
    • Larger therapeutic window – 50-125
  3. Side effects:
    - Weight gain
    - N & V
    - Hair loss
    - Tremor (not as significant as Lithium)
  4. Labs
    - Liver functions
    - Platelets
    - Valproate levels
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11
Q

Carbamazepine (Tegretol)

  1. Drug class?
  2. Therapeutic window?
  3. SE? 5
  4. Labs? 3
A
  1. Anti-seizure
  2. Comparable efficacy to Lithium
    —therapeutic window is 3-14
  3. Side effects
    - N & V
    - Hyponatremia
    - Rash (Sevens Johnsons and TENS)**
    - Drowsiness, blurred vision
    - Blood dyscrasia’s
  4. Labs
    - Liver functions
    - CBC, Serum NA
    - Carbamazepine levels
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12
Q
  1. Lamotrigine (Lamictal) drug class?
  2. Treats bipolar depression without triggering what? 4
  3. It has not demonstrated efficacy in the treatment of what?
  4. Lamotrigine can be used as a first-line treatment what? 2
A
  1. Anti-epileptic
  2. Treats bipolar depression without triggering
    - mania,
    - hypomania,
    - mixed states, or
    - rapid cycling.
  3. It has not demonstrated efficacy in the treatment of acute mania.
  4. Lamotrigine can be used as a first-line treatment for
    - acute depression in bipolar disorder as
    - well as a maintenance therapy.
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13
Q

Mood stabilizing agents
1. According to the APA recommendations:
1st line pharm therapy for patients with ACUTE severe manic or mixed episodes is what? 2

  1. For less severe, what? 3
  2. __________ as a first-line treatment for acute depression in bipolar disorder as well as a maintenance therapy, but not recommended for treatment of ACUTE mania.
A
    • an antipsychotic agent
    • combined with either Lithium or Valproate.
  2. monotherapy with either Lithium, Valproate or an antipsychotic agent.
  3. Lamotrigine
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14
Q

First Generation Antipsychotics
DOPAMINE ANTAGONISTS
2

Effective in treatment of what?

A
  1. Haloperidol (Haldol)
  2. Chlorpromazine (Thorazine)

Effective in the treatment of schizophrenia, especially the positive symptoms (e.g. hallucinations, delusions)

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15
Q

First Generation Antipsychotics

DOPAMINE ANTAGONISTS two major shortcomings?

A

Two major shortcomings:

  1. Only a small percentage of patients (around 25%) are helped enough to recover a reasonable amount of normal mental functioning
  2. Associated with both annoying and serious adverse effects
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16
Q

First Generation Antipsychotics
DOPAMINE ANTAGONISTS
Adverse effects
Some of the more common annoying effects are what? 2

Potenital serious effects? 2

A
  1. akathisia (subjective feeling of muscular tension which can cause restlessness, pacing, repeated sitting or standing) and
  2. parkinsonian-like rigidity and tremor

Potential serious effects include 1. tardive dyskinesia and
2. neuroleptic malignant syndrome

17
Q

First Generation Antipsychotics DOPAMINE ANTAGONISTS: SE.

Extrapyramidal symptoms 2

A
  1. Dyskinesia
  2. Tardive dyskinesia
  3. Akathisia
  4. Dystonia
18
Q
  1. What is dyskinesia?

2. These movements can include? 5

A

Dyskinesia - movement disorders including any of a number of repetitive, involuntary, and purposeless body or facial movements.

2.

  • Tongue movements, such as “tongue thrusts” or “fly-catching” movements
  • Lip smacking
  • Finger movements
  • Eye blinking
  • Movements of the arms or legs.
19
Q

Tardive dyskinesia can occur when?

A

occurs after long-term treatment with an antipsychotic medication.
Sometimes, this condition may become permanent.

20
Q
  1. What is akathisia? 3symtpoms

2. Can be at risk for?

A
    • an extreme form of internal or external restlessness.
    • A complete inability to sit still, with an undeniable urge to be moving constantly.
    • An entirely inner feeling of jitteriness or shakiness.
  2. Can be exhausting and lead to suicide ideations
21
Q
  1. Dystonia is what?
A

a muscle tension disorder involving very strong muscle contractions.
These uncontrollable muscle contractions can cause unusual twisting of parts of the body, especially the neck

22
Q
  1. Extrapyramidal tracts are chiefly found in the reticular formation of the what and what,
  2. and target neurons in the spinal cord involved in what? 4
  3. These tracts are in turn modulated by various parts of the central nervous system, including the what? 5
A
  1. pons and medulla
    • reflexes,
    • locomotion,
    • complex movements, and
    • postural control
    • nigrostriatal pathway,
    • the basal ganglila,
    • the cerebellum,
    • the vestibular nuclei, and
    • different sensory areas of the cerebral cortex.
23
Q

First Generation Antipsychotics DOPAMINE ANTAGONISTS
1. These extrapyrmidal side effects can happen with atypical antipsychotics, but the likelihood is much less than with drugs like what? 2

  1. Is there anything to help?
A
  1. Haldol and Thorazine.

2. Cogentin

24
Q
  1. What is Cogentin?

2. MOA?

A
  1. an anticholinergic medication

2. blocks the effects of the neurotransmitter acetylcholine.

25
Q

By blocking the effects of acetylcholine, Cogentin helps to re-establish a normal balance between what?

A

dopamine and acetylcholine.

26
Q 
SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS
Second Generation Antipsychotics
1. Referred to as what?
2. Interact with different subtypes of what compared to standard antipsychotics?
3. Fewer what? 3
4. Effective for what symtpoms?
5. Effective for who?
6. It is suggested that antipsychotics may be slightly more effective than \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ as monotherapy for acute mania, and may also be used as adjunctive therapy with mood stabilizers?
A
  1. Referred to as “atypical antipsychotics”
  2. dopamine receptors than standard antipsychotics
    • Produce fewer neurological and
    • endocrine side effects
    • Cause very few, if any, extrapyramidal side effects
  4. Effective in treating negative symptoms (such as withdrawal) in addition to the positive symptoms.
  5. Effective for a broader range of patients
  6. mood stabilizers
27
Q 
SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS
Second Generation Antipsychotics
1. SE? 4
2. Labs and other tests? 4
A
  1. Side effects:
    - Weight gain
    - Glucose intolerance
    - Diabetes mellitus
    - Hyperlipidema
  2. Labs and other
    - Serum glucose
    - Lipids
    - Weight
    - Waist circumference
28
Q

SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS Second Generation Antipsychotics
Other Side Effects?
7

A
  1. Drowsiness
  2. Dizziness when changing positions
  3. Blurred vision
  4. Rapid heartbeat
  5. Sensitivity to the sun
  6. Skin rashes
  7. Menstrual problems for women
29
Q

SEROTONIN-DOPAMINE ANTAGONISTS (SDAS)
ATYPICAL ANTIPSYCHOTICS
6

A
  1. Quetiapine (Seroquel)
  2. Olanzapine (Zyprexa)
  3. Risperidone (Risperdal)
  4. Clozapine (Clozaril)
  5. Ziprasidone (Geodon)
  6. Aripiprazole (Abilify)
30
Q

Quetiapine (Seroquel)
1. Main SE?

  1. Olanzapine (Zyprexa)
    Main SE??
A
  1. Drowsiness

2. Weight gain most pronounced

31
Q

Clozapine (Clozaril)

2 big SE??

A
  1. Weight gain most pronounced

2. Steady monitoring of white count (agranulocytosis)*****

32
Q

Ziprasidone (Geodon) advantage?

Disadvantage of Aripiprazole (Abilify)?

A

less weight gain

Expensive

33
Q

2002 APA practice guidelines
1. 1st line therapy for acute depression in patients with bipolar disorder is what? 2

  1. Lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of what?
  2. Antipsychotic medications may have some efficacy in the treatment of what?
  3. _____________ have little impact on improving bipolar depression, in fact, they may worsen it, or cause increase in manic symptoms.
A
  1. Lithium or Lamotrigin (Lamictal)
  2. bipolar depression.
  3. bipolar depression, in addition to their effects in mania.
  4. Antidepressants
34
Q

Hospitalization for psychosis is indicated in the following circumstances:
4

A
  1. For diagnostic purposes
  2. For stabilization of medications
  3. For patients’ safety (e.g. because of suicidal or homicidal ideation)
  4. For grossly disorganized or inappropriate behavior
35
Q
  1. Patients presenting with acute mania, mixed, or hypomania should be assessed for what? 4
  2. __________ should be discontinued, and substance abuse treated.
  3. The mainstays of treatment are what? 3
A
    • suicide and homicide,
    • aggressiveness,
    • psychotic features, and
    • poor judgement.
  2. Antidepressants
    • lithium,
    • anticonvulsants and
    • antipsychotics

Behavioral Health (20 decks)

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