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PHM 701- Bipolar, Anxiety, Parkinson's, Dementia > Bipolar Treatments > Flashcards

Bipolar Treatments Flashcards

1
Q

Approach to BPD treatment

A

Must be individualized, specific to the episode the patient is currently experiencing, and should include both pharmacologic and nonpharm treatments

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2
Q

Nonpharm BPD treatments

A

sleep, diet, exercise, psychoeducation, psychotherapy

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3
Q

Drugs to consider for BPD treatment

A

Li, mood stabilizers (valproic acid and derivatives), AEDs, APS

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4
Q

Once diagnosed with BPD, how long should a patient be on a mood stabilizer?

A

FOR LIFE

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5
Q

Approach to treating acute episodes

A

Augmentation medication should be added onto the mood stabilizer, then withdrawn when clinically appropriate

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6
Q

Treatment for patient on non-APS mood stabilizer that experiences psychosis during a manic episode

A

Add an APD onto the mood stabilizer

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7
Q

Treatment for patient on an APS mood stabilizer that experiences psychosis during a manic episode

A

Optimize the APS if not already or change to another agent with additional consideration of adding something else if symptoms continue

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8
Q

Goals of BPD therapy

A

Rapid control over behavioral symptoms, sleep restoration, and mood stabilization

Enhance and maintain levels of function

Complete remission and prevent future episodes

Optimize the chance for successful drug therapy (increase adherence, reduce side effects and DIs, individualize therapy and include patient in decision making)

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9
Q

FDA-approved treatments for BPD: acute mania and mixed episodes

A

Li, VPA, CBZ

Aripiprazole, asenapine, cariprazine, olanzapine, quetiapine, risperidone, ziprasidone

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10
Q

FDA-approved treatments for BPD: maintenance

A

Li, LTG, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone in adjunct with Li/VPA

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11
Q

FDA-approved treatments for BPD: acute depression monotherapy

A

Cariprazine, lurasidone/Latuda, olanzapine with fluoxetine, quetiapine

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12
Q

APS considerations as adjunctive therapy in BPD

A

SGAs may be good for some episodes but not all

FGAs are okay for acute mania but lack efficacy data for maintenance and prevention of recurrence

Injectables may be good for non adherent patients

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13
Q

APS should be used in combination with what for acute or mixed episodes?

A

Li, VPA

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14
Q

APS as adjunctive therapy: what is olanzapine and quetiapine used for, respectively?

A

Olanzapine is used for maintenance

Quetiapine is used for depression

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15
Q

AD considerations as adjunct therapy in BPD

A

NEVER USE THEM ALONE!

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16
Q

AD that’s approved for BPD depressive episodes

A

Fluoxetine

17
Q

BZD considerations as adjunct therapy in BPD

A

Avoid in substance abuse patients when clinically possible

Use in combination with other medications for acute treatment of mania or mixed episodes

18
Q

BZDs used in BPD

A

Clonazepam and lorazepam- they’re high potency agents and are used with other drugs or exclusively for anxiety, panic, and agitation during acute mania

19
Q

How long should you use BZDs for in BPD?

A

Use short-term as an adjunct sedative/hypnotic!

20
Q

Lybalvi is a combination therapy of what two medications?

A

Olanzapine and samidorphan

21
Q

Lybalvi indication

A

Approved for BP-I in maintenance monotherapy and acute treatment of manic or mixed episodes as either monotherapy or as an adjunct to Li or VPA

22
Q

What is the purpose of samidorphan in Lybalvi?

A

Decrease the metabolic side effects of olanzapine

23
Q

Lybalvi CI

A

Current use of opiates or undergoing opiate withdrawal

24
Q

Anticonvulsants used in BPD

A

VPA, LTG, CBZ (but the Equetro version only)

25
Q

LAIs approved for BPD

A

Abilify Maintena (aripiprazole), Risperdal Consta (risperidone)

26
Q

Indication for Abilify Maintena

A

Maintenance treatment of BP-I

(MAINtena, MAINtenance treatment!)

27
Q

Indication for Risperdal Consta

A

Monotherapy or adjunctive therapy to Li or VPA for the maintenance treatment of BP-I

28
Q

LTG levels in pregnancy

A

Decreased levels in pregnancy and during estrogen supplementation in OC cycle

29
Q

Birth defect associated with LTG

A

Cleft palate

30
Q

Li levels in pregnancy

A

Increased doses are needed

31
Q

Birth defects associated with Li

A

Ebstein’s anomaly, floppy baby syndrome

32
Q

Li is CI’ed in what?

A

Breastfeeding (also severe renal and cardiac disease, dehydration and sodium depletion)

33
Q

Divalproex in pregnancy

A

CONTRAINDICATED!

34
Q

Birth defects associated with divalproex

A

Neural tube defects and irreversible cognitive damage

35
Q

Birth defects associated with CBZ

A

Spina bifida; avoid in pregnancy

PHM 701- Bipolar, Anxiety, Parkinson's, Dementia (27 decks)

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