Bipolar Treatments Flashcards
Approach to BPD treatment
Must be individualized, specific to the episode the patient is currently experiencing, and should include both pharmacologic and nonpharm treatments
Nonpharm BPD treatments
sleep, diet, exercise, psychoeducation, psychotherapy
Drugs to consider for BPD treatment
Li, mood stabilizers (valproic acid and derivatives), AEDs, APS
Once diagnosed with BPD, how long should a patient be on a mood stabilizer?
FOR LIFE
Approach to treating acute episodes
Augmentation medication should be added onto the mood stabilizer, then withdrawn when clinically appropriate
Treatment for patient on non-APS mood stabilizer that experiences psychosis during a manic episode
Add an APD onto the mood stabilizer
Treatment for patient on an APS mood stabilizer that experiences psychosis during a manic episode
Optimize the APS if not already or change to another agent with additional consideration of adding something else if symptoms continue
Goals of BPD therapy
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)
FDA-approved treatments for BPD: acute mania and mixed episodes
Li, VPA, CBZ
Aripiprazole, asenapine, cariprazine, olanzapine, quetiapine, risperidone, ziprasidone
FDA-approved treatments for BPD: maintenance
Li, LTG, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone in adjunct with Li/VPA
FDA-approved treatments for BPD: acute depression monotherapy
Cariprazine, lurasidone/Latuda, olanzapine with fluoxetine, quetiapine
APS considerations as adjunctive therapy in BPD
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
APS should be used in combination with what for acute or mixed episodes?
Li, VPA
APS as adjunctive therapy: what is olanzapine and quetiapine used for, respectively?
Olanzapine is used for maintenance
Quetiapine is used for depression
AD considerations as adjunct therapy in BPD
NEVER USE THEM ALONE!
AD that’s approved for BPD depressive episodes
Fluoxetine
BZD considerations as adjunct therapy in BPD
Avoid in substance abuse patients when clinically possible
Use in combination with other medications for acute treatment of mania or mixed episodes
BZDs used in BPD
Clonazepam and lorazepam- they’re high potency agents and are used with other drugs or exclusively for anxiety, panic, and agitation during acute mania
How long should you use BZDs for in BPD?
Use short-term as an adjunct sedative/hypnotic!
Lybalvi is a combination therapy of what two medications?
Olanzapine and samidorphan
Lybalvi indication
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
What is the purpose of samidorphan in Lybalvi?
Decrease the metabolic side effects of olanzapine
Lybalvi CI
Current use of opiates or undergoing opiate withdrawal
Anticonvulsants used in BPD
VPA, LTG, CBZ (but the Equetro version only)
LAIs approved for BPD
Abilify Maintena (aripiprazole), Risperdal Consta (risperidone)
Indication for Abilify Maintena
Maintenance treatment of BP-I
(MAINtena, MAINtenance treatment!)
Indication for Risperdal Consta
Monotherapy or adjunctive therapy to Li or VPA for the maintenance treatment of BP-I
LTG levels in pregnancy
Decreased levels in pregnancy and during estrogen supplementation in OC cycle
Birth defect associated with LTG
Cleft palate
Li levels in pregnancy
Increased doses are needed
Birth defects associated with Li
Ebstein’s anomaly, floppy baby syndrome
Li is CI’ed in what?
Breastfeeding (also severe renal and cardiac disease, dehydration and sodium depletion)
Divalproex in pregnancy
CONTRAINDICATED!
Birth defects associated with divalproex
Neural tube defects and irreversible cognitive damage
Birth defects associated with CBZ
Spina bifida; avoid in pregnancy
