Bipolar/Psychosis Flashcards by Hayden Smith

Q

Which drug is the most effective long term therapy for bipolar, protection against depression + mania, and decreases risk of suicide/short term mortality?

A

Lithium

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

When dosing lithium, what should you do?

A

Start low and titrate up, then monitor the patient’s levels

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are some things we must monitor when a patient is on lithium?

A

Pregnancy test Renal fxn Thyroid fxn Weight

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Your patient is going to begin lithium for their bipolar diagnosis. What ADRs must you tell them about?

A

GI issues, nausea, fatigue

Tremor

Weight gain

Polyuria/polydipsia

Hypothyroidism

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Why is it important to do a pregnancy test for a patient on lithium?

A

Teratogenic Associated with Ebstein’s anomaly

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Chlorpromazine and Thioridazine are what type of drugs?

A

1st gen anti-psychotics (low potency)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Which 1st gen anti-psychotic is good for treating intractable hiccups?

A

Chlorpromazine

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Haloperidol is what type of drug?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Which 1st gen anti-psychotic would help for emergency sedation of a severely agitated or delirious patient?

A

Haloperidol

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is perphenazine in?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is fluphenazine in?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is loxapine in?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is molindone in?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is thiothixene in?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is trifluoperazine in?

A

1st gen anti-psychotic

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are the major ADRs associated with 1st gen anti-psychotics?

A

EPS - tardive dyskinesia

NMS

Postural hypotension

Sedation

QTc prolongation

Increased prolactin

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What is beneficial for 2nd gen anti-psychotics in comparison to 1st gen anti-psychotics?

A

Less risk of EPS

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Which 2nd gen anti-psychotic is the most effective and used for refractory schizophrenia?

A

Clozapine

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What class is risperidone in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is olanzapine in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is quetiapine in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is ziprasidone in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is paliperidone in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is asenapine in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is Iloperidone in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is lurasidone in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is cariprazine in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is brexpiprazole in?

A

Atypical Anti-psychotics (2nd gen)

Q

What class is aripiprazole in?

A

Atypical Anti-psychotics (2nd gen)

Q

Black box warning for Atypical Anti-psychotics (2nd gen)

A

Increased mortality risk in dementia-related psychosis and suicidality for depression

Q

If you are a primary care PA who thinks your patient would benefit from a 2nd gen anti-psychotic, what should you do?

A

Refer to psych

Q

Who should you avoid 2nd gen anti-psychotics in?

A

Dementia patients Children

Q

If you want to take your patient off Clozapine, how would you do that?

A

Taper by 50% q2weeks

Q

Your patient who is taking a 2nd gen anti-psychotic for their schizophrenia is here for a routine visit. What PE/labs must you do

A

Weight check (ass with weight gain) Fasting lipid panel (ass with dyslipidemia) Fasting blood glucose/HgA1c (ass with DM)

Q

Which 2nd gen anti-psychotic is associated with DM and worse weight gain?

A

Olanzapine

Q

Which 2 second gen anti-psychotics are associated with worse QTc prolongation?

A

Iloperidone and ziprasidone

Q

Which 2nd gen anti-psychotic is associated with anaphylaxis and angioedema?

A

Asenapine

Q

Which 2nd gen anti-psychotic is associated with compulsive urges?

A

Aripiprazole

Q

Which two 2nd gen anti-psychotics are associated with DRESS?

A

Olanzapine and ziprasidone

Q

What are the ADRs for Clozapine?

A

DM Wt gain QTc prolongation Seizure risk GI hypomotility (toxic megacolon) Myocarditis Agranulocytosis

Q

What is the typical regimen for acute mania when severe?

A

Atypical anti-psychotic + Li or Valproate Hospitalize the patient

Q

What is the typical regimen for acute bipolar psychosis?

A

Li or atypical antipsychotics (cariprazine, lurasidone, olanzapine with fluoxetine)

Q

What is the typical regimen for less severe acute mania?

A

Monotherapy: Lithium, valporate, or atypical anti-psychotic

Q

What is the typical maintenance therapy for mania?

A

Lithium

Q

What is the typical maintenance therapy for depression?

A

Lamotrigine

Q

What is the maintenance therapy for mania and depression?

A

Lithium alone, or with valproate, CBZ, lamotrigine, or atypical anti-psychotic

Q

What is the irreversible EPS common with anti-psychotics?

A

Tardive dyskinesia